血浆神经递质与出血性卒中急性期抑郁相关性研究  

The association between plasma neurotransmitters levels and depression in acute hemorrhagic stroke

作　　者：袁怀武[1] 张宁[1] 王春雪[1] 石玉芝[1] 齐冬[2] 罗本燕[3] 王拥军[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,100050 [2]首都医科大学附属北京友谊医院神经内科 [3]浙江大学医学院附属第一医院神经内科

出　　处：《中华内科杂志》2013年第8期675-678,共4页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金（81071115）;北京市自然科学基金（7102050）

摘　　要：【摘要】目的探索血浆神经递质与出血性卒中急性期抑郁相关性。方法从连续住院急性卒中患者中筛选研究对象。在人院第2天取空腹血样，液相色谱一高分辨质谱测定血浆神经递质。在发病后2周根据第四版美国精神疾病诊断与统计手册诊断抑郁。在卒中发病后1年随访改良神经功能评分（mRS）。Pearson相关分析血清神经递质浓度与汉密尔顿抑郁量表（HAMD）-17项评分相关性。logistic回归分析神经递质浓度与抑郁和卒中后1年结局关系。结果181例患者纳入本研究。伴抑郁的出血性卒中患者1氨基丁酸（GABA）显著降低[6．1（5．0，8．2）Ixg／L比8．1（6．3，14．7）Ixg／L，P〈0．05]，谷氨酸（GAA）、5-羟色胺（5-HT）、去甲肾上腺素（NE）差异无统计学意义。GABA浓度与HAMD．17评分呈负相关（r=-0．131，P〈0．05）；GABA每增加1μg／L，出血性卒中急性期抑郁患病风险降低5．6％（OR0．944，95％C10．893～0．997）。GAA每增加1μg／L，卒中后1年不良结局风险增加0．1％，但显著水平处于边缘状态（OR1．001，95％CI1．000～1．002）。结论脑出血急性期血浆GABA降低者，发生抑郁的风险增加，该递质可能对出血性卒中后抑郁发生具有保护作用。GAA浓度升高可能会增加卒中后1年不良结局风险。Objective To explore the relation between plasm neurotransmitters （Glutamic acid, GAA ; γ-aminobutyric acid, GABA ; 5-hydroxytryptamine, 5-HT; and noradrenaline, NE） and depression in acute hemorrhagic stroke. Methods Objectives were screened from consecutive hospitalized patients with acute stroke. Fasting blood samples were taken on the day next to hospital admission, and neurotransmitters were examined by the liquid chromatography-high resolution mass spectrometry （LC-HRMS）. The fourth edition of Diagnostic and Statistical Manual of Mental Disorders （DSM-IV） was used to diagnose depression at two weeks after onset of stroke. The modified Ranking Scale （mRS） was followed up at 1 year. Pearson test was used to analyse the correlation between serum concentration of neurotransmitters and the Hamilton Depression scale-17items （HAMD-17） score. Logistic regression was used to analyse the relation of serum concentration of neurotransmitters and depression and outcome of stroke. Results One hundred and eighty- one patients were included in this study. GABA significantly decreased [ 6. 1 （5.0-8.2） μg/L vs 8. 1 （6. 3- 14. 7） p,g/L, P 〈 0. 05] in patients with depression in hemorrhagic stroke, and there was no significant difference in GAA, 5-HT, or NE. GABA concentration was negatively correlated with HAMD-17 score （r = - 0. 131, P 〈 0. 05 ） ; while concentration of serum GABA rose by 1μg/L, risk of depression in acute phase of hemorrhagic stroke was reduced by 5.6% （ OR 0. 944, 95% CI 0. 893-0. 997 ）. While concentration of serum GAA rose by 1 μg/L, risk of worse outcome at 1 year was raised by 0. 1%, although a statistic level was on marginal status （ OR 1. 001,95 % CI 1. 000-1. 002）. Conclusions In patients with depression in the acute phase of hemorrhagic stroke, there was a significant reduction in plasm GABA concentration. GABA may have a protective effect on depression in acute phase of hemorrhagic stroke. Increased concentrations of serum GAA may increase the risk o

关 键 词：卒中 抑郁 神经递质 

分 类 号：R749.1[医药卫生—神经病学与精神病学]