血清学指标回归模型在老年性抑郁症和抑郁状态鉴别诊断中的应用价值  

The practical value of a Logistic regression model of serum indexes in differentiating between geriatric depression and depressive state

作　　者：徐宇浩[1] 于明[1] 李月峰[2] 姚舜[2] Xu Yuhao;Yu Ming;Li Yuefeng;Yao Shun(Departrnent of Neurology,the Affiliated Hospital of J iangsu University,Zhenjiang 212000,China（Xu YH,Yu M;Department of Radiology,the Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China（Li YF,Yao S）Corresponding author ：Li Yuefeng,Ernail ：jiangdalyf2009 @126.com)

机构地区：[1]江苏大学附属医院神经内科,镇江212000 [2]江苏大学附属医院影像科,镇江212000

出　　处：《中华老年医学杂志》2018年第9期984-987,共4页Chinese Journal of Geriatrics

基　　金：江苏省重点研发项目（BE2017698）

摘　　要：目的探讨血清学指标回归模型在老年抑郁症和抑郁状态鉴别诊断中的应用价值。方法2013年1月至2016年1月门诊共收集160例患者，根据中国精神障碍分类与诊断标准第3版（cCMD3）回顾性诊断将其分为老年抑郁症组80例和老年抑郁状态组80例，所有受试者均采集血清样本，采用酶联免疫吸附法（EI。IsA）测定脑源性神经营养因子（BDNF）、胶质细胞源性神经营养因子（GDNF）、成纤维细胞生长因子-2（FGF-2）、血管内皮生长因子（VEGF）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子α（TNF—α）、皮质醇、血小板衍生因子（PDGF）共10项血清学指标。采用二元Logistic回归法建立回归模型，绘制ROC曲线，分析其在老年抑郁症和抑郁状态鉴别诊断中应用价值。结果老年抑郁症患者血清BDNF、GDNF、VEGF水平低于抑郁状态患者[BDNF：（208．7±41．4）ng／L比（262．9±84．6）ng／L，GDNF：（92．3±18．6）ng／L，比（101．4±30．9）ng／L，VEGF：（223．1±98．2）ng／L比（257．8土77．2）ng／L]，而IL-1β皮质醇、CORT水平高于抑郁状态患者[1L-1β：（27．0±4．9）μg／L比（19．6±5．7）μg/L，皮质醇：（96．3±16．7）ng／L比（83．0±17.3）μg/L]，差异均有统计学意义。经Logistic回归分析筛选出BDNF（OR=0．987，P=0.001）、IL-1β（OR=1．295，P=0．000）、皮质醇（OR=1．065，P=0．000）3项血清学指标，构建回归方程P=1/[1＋e－（-8.546-01.13（BDFE）＋0258（IL-1β）＋0.063（CORT））]。据此建立的ROC曲线下面积为0．906，与两周后回顾性诊断结果相比，模型诊断率为90．47％。结论本文构建的血清学指标Logistic回归模型可对老年抑郁症和抑郁状态进-步鉴别，更有利于老年抑郁症的诊断、鉴别诊断和治疗的良好开展。Objective To investigate the practical value of a logistic regression model of serum indexes in distinguishing between geriatric depression and geriatric depressive state. Methods A total of 160 patients were recruited from the outpatient department from January 2013 to January 2016, and were divided into a depression group （ n = 80 ） and a depressive state group （ n = 80 ）, with retrospective diagnoses based on the Chinese Classification of Mental Disorders-Third Edition（CCMD- 3）. Serum samples were collected and enzyme linked immunosorbent assays（ELISA）were used to determine the concentrations of brain-derived neurotrophic factor （BDNF）, glial cell line-derived neurotrophic factor （GDNF）, fibroblast growth factor 2 （FGF-2）, vascular endothelial growth factor （VEGF）, interleukin-1β （II.-1β）, interleukin-6 （IL-6）, interleukin 10 （IL-10）, tumor necrosis factor-α （TNF-α）, cortisol （ CORT）, and platelet-derived growth factor （PDGF） . Binary logistic regression analysis was used to establish the regression model,and the ROC curve was drawn to explore its value of differentiating geriatric depression from depressive state. Results The levels of serum BDNF, GDNF and VEGF in the depression group were lower than those in the depressive state group（BDNF： 208.7±41.4 vs. 262.9±84.6 ng/L,GDNF：92.3±18.6 vs. 101.4±30.9 ng/L,VEGF：223.1±98.2 vs. 257.8±77.2ng/L） ,while the levels of IL-Iβ and CORT in the depression group were higher than in the depressive group（IL-1β： 27. 0± 4.9 vs. 19.6± 5.7 μg/L,CORT： 96.3 ±16.7 vs. 83.0±17.3 nng/L）. In multivariate logistic regression analysis,BDNF（OR = 0. 987, P = 0. 001）, II. Iβ（OR =1.29,P = 0. 000） and CORT （OR = 1. 065, P = 0. 000） were selected to build the regression model. The regression equation was P=1/[1＋e-（- 8.546 0.013（BDNF）＋ 0.258（IL-1β）＋ 0.063（OCRT）） ]and the area under the ROC curve was 0. 966. Compared with retrospective diagnoses made two weeks later,

关 键 词：血清学指标 LOGISTIC模型 抑郁症 抑郁状态 

分 类 号：R749.4[医药卫生—神经病学与精神病学]