卒中后抑郁与血清炎性细胞因子水平及神经功能损害的相关性分析  

The relationship between acute inflammatory cytokines,nerve function defect,daily living ability and PSD

作　　者：李平[1] 张巧莲[1] 李双英[1] 

机构地区：[1]武警后勤学院附属医院神经内科,天津300162

出　　处：《中国应用生理学杂志》2017年第2期121-123,145,共4页Chinese Journal of Applied Physiology

摘　　要：目的:探讨急性脑梗死患者不同时间卒中后抑郁(PSD)发病与血清炎性细胞因子水平、神经功能缺损、日常生活能力的相关性。方法:用Hamilton抑郁量表(HDRS)筛查280例符合条件的急性脑梗死患者急性期与恢复期PSD的发病情况,并同时测定血清炎性细胞因子hs-CRP、TNF-α、IL-6的水平,NIHSS评分进行神经功能缺损评估,Barthel指数进行日常生活能力的评估,分析PSD的发生与各因素之间的相关性,采用多因素logistic回归分析进行危险因素分析。结果:脑梗死恢复期PSD的发病率高于急性期,但无明显差异。急性期PSD组血清炎性细胞因子水平高于非PSD组,有显著性差异,而急性期、恢复期神经功能缺损和日常生活能力与非PSD组比较均有显著性差异;急性期血清TNF-α、IL-6和Barthel指数,恢复期NIHSS评分、Barthel指数与PSD发生的OR值分别1.765、1.646、1.817、1.188、2.015。结论:PSD的发病机制在病程的不同时间可能存在着差异,急性期血清升高的炎性细胞因子水平和降低的日常生活能力,恢复期神经功能缺损的程度和降低的日常生活能力是不同时间PSD发病的危险因素。Objective： To investigate the correlation between poststroke depression （PSD） and serum levels of inflammatory cytokines, neurologic impairment, daily life ability in patients with acute cerebral infarction at different time. Methods： Two hundreds and eighty patients who admitted to our hospital with a diagnosis of acute infarction excluded the patients mismatch conditions were evaluated by Hamilton depression rating scale （HDRS） to diagnose PSD respectively at admission and 3 months after stroke. Serum inflammatory cytokines high-sensitivity C-reactive protein（hs-CRP）, tumor necrosis factor-α（TNF- α） and interleukin-6 （IL-6） were determined. NIH stroke scale（NIHSS） and Barthel index for daily life ability were used to evaluate nerve functions. Then we analyzed the correlation between PSD and serum inflammatory cytokines, correlation between PSD and functional impairment and daily life ability at different time. Logistic regression was performed to analyze the risk factors of PSD. Results： The PSD incidence was higher in recovery stage than that in acute stage, but there was no difference. Serum inflammatory eytokines were higher in PSD group at admission than that in non-PSD group. The NIHSS score and Barthel index in PSD group were different from those in non-group at acute and recovery stage. The OR score was 1.765, 1.646, 1.817, 1. 188 and 2.015 respectively to TNF-α, IL-6 and Bartbel index in the acute phase and to NIHSS and Barthel index in recovery stage. Conclusion： The pathogenesis of PSD at different courses of stroke is not same. TNF-α, IL-6 and Barthel index are the independent risk factors of PSD in acute phase, so do NIHSS score and Barthel index in recovery period.

关 键 词：脑梗死 卒中后抑郁 炎性细胞因子 神经功能缺损 日常生活能力 

分 类 号：R743[医药卫生—神经病学与精神病学]