血清脑源性神经营养因子水平与缺血性卒中后抑郁的相关性  

Correlation between serum brain-derived neurotrophic factor level and depression after ischemic stroke

作　　者：李婛[1] 邹东华[3] 徐丙超[4] 陈莉[5] 季兴[2] 董万利[1] 

机构地区：[1]苏州大学附属第一医院神经内科,215006 [2]解放军第三○三医院神经内科,南宁530021 [3]解放军第三○三医院老拥病科,南宁530021 [4]连云港市第一人民医院神经内科,222000 [5]广西医科大学第一附属医院神经内科,南宁530022

出　　处：《国际脑血管病杂志》2016年第9期815-818,共4页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金（81560205）;广西卫计委医药卫生科研项目（Z2012470,Z2012473）;广西自然科学基金（2012GXNSFAA276028,2016GXNsFCA380012）

摘　　要：目的探讨血清脑源性神经营养因子（brain—derived neurotrophic factor，BDNF）与卒中后抑郁（post—stroke depression，PSD）的相关性。方法前瞻性纳入90例缺血性卒中患者，人院后检测血清BDNF含量，采用美国国立卫生研究院卒中量表（National Institutes of Health Strokescale，NIHSS）评定神经功能缺损，采用Barthel指数（Barthelindex,BI）评定日常生活活动能力。6个月随访时采用17项汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）进行抑郁评定，≥17分为抑郁，〉24分为重度抑郁。结果共40例患者（44．4％）发生PSD，轻度抑郁30例（33．3％），中度抑郁8例（8．9％），重度抑郁2例（2．2％）。单变量分析显示，PSD组多发性梗死的患者比例（65．0％对32．0％;Х^2=9．723，P=0．002）、基线NIHSS评分[（7．05±4．25）分对（4．35±3．14）分；t=3．465，P=O．001]和出院时NIHSS评分[（5．43±3．02）分对（3．11±2．56）分；扣3．944，P〈0．001]显著高于非PSD组，而受教育年限[（9．03±4．51）年对（13．45±5．02）年；扣4．340，P〈0．001]、血清PDNF浓度[（16．754±4．451）pg／ml对（29．551±3．213）pg／ml；扣15．827，P〈0．001]以及出院时BI[（55．00±28．10）分对（83．11±27．11）分；f=4．809，P〈0．001]显著低于非PSD组。多变量logistic回归分析显示，高血清BDNF水平是PSD的独立保护因素（优势比0．571，95％可信区间0．416～0．967；P=0．003）。结论高血清BDNF水平是PSD的独立保护因素。Objective To investigate the correlation between brain-derived neurotrophic factor （BDNF） and post-stroke depression （PSD）. Methods A total of 90 patients with ischemic stroke were enrolled prospectively. After admission, the serum BDNF levels were detected. National Institutes of Health Stroke Scale （NIHSS） was used to assess neurological deficit. Barthel index （BI） was used to assess the activities of daily living, The 17-term Hamilton depression scale （HAMD） was used to conduct the depression assessment at 6-month follow-up, ≥ 17 was depression and 〉 24 was severe depression. Results A total of 40 patients （44.4%） had PSD, 30 （33.3%） had mild depression, 8 （8.9%） had moderate depression, and 2 （2%） had severe depression. Univariate analysis showed that the proportion of patients with multiple infarcts in the PSD group （65.0% vs. 32.0% ;Х^2 =9. 723, P =0. 002）, baseline NIHSS score （7.05 ±4. 25 vs. 4. 35 ± 3.14; t = 3. 465, P = 0. 001） and NIHSS score at the time of discharge （5.43± 3.02 vs. 3.11 ± 2. 56; t = 3.944, P 〈 0. 001） were significantly higher than those in the non-PSD group, and years of education （9. 03 ±4. 51 years vs. 13.45±5.02 years; t =4. 340, P〈0： 001）, serum concentration of PDNF （16. 754±4. 451 pg/ml vs. 29. 551 ± 3.213 pg/ml; t = 15. 827, P 〈0. 001）, and BI at the time of discharge （55.00±28.10 vs. 83.11 ±27.11; t =4. 809, P〈0. 001） were significantly lower than those in the non-PSD group. Multivariate logistic regression analysis showed that high serum BDNF level was an independent protective factor for P SD （odds rat io 0. 571,95 % confidence interval 0.416 -0. 967; P = 0. 003）. Conclusiom High serum BDNF level is an independent protective factor for PSD.

关 键 词：卒中 脑缺血 抑郁症 脑源性神经营养因子 危险因素 生物标志物 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]