河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 651-655,660.doi: 10.3969/j.issn.1007-3205.2021.06.007

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多种血清指标预测老年脑卒中后抑郁的临床价值

  

  1. 苏州大学附属太仓医院，太仓市第一人民医院神经内科，江苏 太仓 215400
  • 出版日期:2021-06-25 发布日期:2021-07-05
  • 作者简介:唐甲凡（1982-），男，江苏射阳人，苏州大学附属太仓医院副主任医师，医学学士，从事神经内科疾病诊治研究。
  • 基金资助:
    江苏省卫生厅项目（2016052）

Predictive effects of multiple serum indicators for post-stroke depression in elderly patients with ischemic stroke

  1. Department of Neurology, the First People′s Hospital of Taicang City, Taicang, Jiangsu 215400, China
  • Online:2021-06-25 Published:2021-07-05

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摘要： 目的  探讨血清学指标对老年脑卒中后抑郁(post-stroke depression,PSD)的预测价值。
方法  回顾性分析我院诊治的560例老年急性脑梗死患者的临床资料，依据脑卒中后6个月是否合并抑郁，分为PSD组221例、非PSD组339例。比较2组临床资料及血清学指标差异，多因素Logistic回归分析PSD发生的危险因素，ROC曲线分析各血清指标预测PSD发生的临床价值。
结果  单因素分析结果显示，PSD组血清总胆固醇、血肌酐、尿酸(uric acid,UA)、淀粉样蛋白A(serum amyloid A,SAA)、白细胞介素1(interleukin-1,IL-1)、IL-2、IL-6、IL-17、超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞的比值（platelet to lymphocyte ratio,PLR）均高于非PSD组（P＜0.05），TNF-α、SAA水平，通过血常规检测计算 NLR、PLR低于非PSD组（P＜0.05），2组丙氨酸转氨酶、天冬氨酸转氨酶比较差异无统计学意义（P＞0.05）；多因素Logistic回归分析结果显示，IL-6(OR=1.48,95%CI:1.06~1.97,P=0.026)、IL-17(OR=1.26,95%CI:1.03~1.56,P=0.038)、NLR(OR=2.45,95%CI:1.52~4.89,P＜0.001)、SAA(OR=1.87,95%CI:1.22~2.65,P＜0.001)、UA(OR=2.68,95%CI:1.72~5.68,P＜0.001)是老年急性脑梗死患者发生PSD的影响因素；UA、NLR、SAA、IL-6、IL-17预测老年急性脑梗死患者6个月发生PSD的AUC分别为0.838、0.826、0.759、0.732、0.569。
结论  血清IL-6、IL-17、SAA、NLR、UA水平增高是老年急性脑梗死患者发生PSD的危险因素，可预测PSD发生风险，且UA、NLR预测价值较高。


关键词: 脑梗死, 脑卒中后, 抑郁, 老年人

Abstract: Objective  To explore the predictive value of serological indicators for post-stroke depression(PSD) in elderly patients with ischemic stroke. 
Methods  The clinical data of 560 elderly patients with acute ischemic stroke(AIS) diagnosed and treated in our hospital were retrospectively analyzed. Based on presence or absence of depression at 6 months after stroke, they were divided into PSD group(n=221) and non-PSD group(n=339). The clinical data and serological indicators of the two groups were compared. The multivariate Logistic regression analysis was used to analyze the risk factors of PSD. The ROC curve was used to analyze the clinical value of each serum indicator in predicting the occurrence of PSD. 
Results  The results of univariate analysis showed that total serum cholesterol, serum creatinine, uric acid(UA), serum amyloid A(SAA), interleukin(IL)-1, IL-2, IL-6, IL-17, hypersensitive C-reactive protein(hs-CRP), tumor necrosis factor alpha(TNF-α), neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR) were higher than those in the non-PSD group(P＜0.05), while TNF-α, and SAA levels, as well as NLR and PLR calculated by routine blood tests, were lower than those in non-PSD group(P＜0.05). There was no significant difference in alanine aminotransferase and aspartate aminotransferase between two groups(P＞0.05). The results of multivariate Logistic regression analysis showed that IL-6(OR=1.48, 95%CI : 1.06-1.97, P=0.026), IL-17(OR=1.26, 95%CI: 1.03-1.56, P=0.038), NLR(OR=2.45, 95%CI: 1.52-4.89, P＜0.001), SAA(OR=1.87, 95%CI: 1.22-2.65, P＜0.001), UA(OR=2.68, 95%CI: 1.72-5.68, P＜0.001) were influencing factors of PSD in elderly patients with AIS. The AUC of UA, NLR, SAA, IL-6, and IL-17 for predicting the occurrence of PSD at 6 months in elderly patients with AIS was 0.838, 0.826, 0.759, 0.732, and 0.569, respectively. 
Conclusion  Increased serum levels of IL-6, IL-17, SAA, NLR, and UA are risk factors for PSD in elderly patients with AIS. They can predict the risk of PSD, and UA and NLR have the highest predictive value.


Key words: acute ischemic stroke, post-stroke depression, serum indicators, elderly

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