血清同型半胱氨酸联合血小板与淋巴细胞比值预测卒中后抑郁的应用价值  

Correlation of Serum Homocysteine and Platelet-to-lymphocyte Ratio with Post-stroke Depression

作　　者：李亚强 张梅[1] 薛敏[1] 李静[1] 刘培培 陈光 LI Ya-Qiang;ZHANG Mei;XUE Min;LI Jing;LIU Pei-Pei;CHEN Guang(Department of Neurology,The First Affiliated Hospital of Anhui University of Science and Technology(The First People's Hospital of Huainan City),Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院(淮南市第一人民医院)神经内科,淮南232000

出　　处：《中国卒中杂志》2020年第4期406-410,共5页Chinese Journal of Stroke

基　　金：安徽省科技攻关项目(12010402124);蚌埠医学院自然科学重点项目(BYKY2019316ZD)。

摘　　要：目的探讨血清同型半胱氨酸(homocysteine,Hcy)联合血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对卒中后抑郁(post-stroke depression,PSD)的预测价值。方法连续纳入2018年10月-2019年10月安徽理工大学第一附属医院神经内科收治的急性缺血性卒中患者。记录患者的临床资料,入院后第2天晨起检测血清Hcy、血小板及淋巴细胞计数。以住院或门诊方式随访3个月,根据是否诊断为抑郁,分为PSD组和对照组。采用多因素Logistic回归模型分析与PSD相关的因素,应用ROC曲线评估Hcy联合PLR对PSD的预测价值。结果共纳入408例患者,平均年龄65.86±8.61岁,发生PSD共162例(39.70%)。多因素Logistic回归分析显示,入院时NIHSS评分(OR 1.422,95%CI 1.291~1.565,P=0.023)和空腹血糖水平升高(OR 1.120,95%CI 1.014~1.236,P=0.046),以及Hcy≥12.36μmol/L(OR 3.841,95%CI 2.270~6.500,P<0.001)、PLR≥127.92(OR 5.197,95%CI 3.040~8.886,P<0.001)是PSD的独立危险因素。ROC曲线分析显示,Hcy联合PLR的预测价值最大,曲线下面积为0.835(95%CI 0.796~0.874,P<0.001),敏感度64.5%,特异度88.27%。结论血清Hcy水平和PLR升高是急性缺血性卒中患者发病3个月内发生抑郁的独立预测因素,两者联合预测价值较好。Objective To investigate the relationship between serum homocysteine(Hcy)level and plateletto-lymphocyte ratio(PLR)and post-stroke depression(PSD)in patients with acute ischemic stroke(AIS).Methods This prospective study included consecutive AIS patients admitted to department of neurology of our hospital from October 2018 to October 2019.Clinical data were collected,blood platelet and lymphocyte counts and serum Hcy level were measured in the next morning after admission.All cases were divided into PSD group and non-PSD group based on the diagnosis results of depression at 3 months.Multivariate logistic regression analysis was used to identify the risk factors of PSD.The ROC curve analysis was performed to evaluate the predictive value of Hcy and PLR for PSD.Results A total of 408 patients were included,with an average age of 65.86±8.61 years.During the follow-up 3 months after onset,162(39.70%)patients were diagnosed with depression.Multivariate analysis showed that the admission NIHSS score(OR 1.422,95%CI 1.291-1.565,P=0.023)and high fasting blood glucose(OR 1.120,95%CI 1.014-1.236,P=0.046),Hcy≥12.36μmol/L(OR 3.841,95%CI 2.270-6.500,P<0.001),PLR≥127.92(OR 5.197,95%CI 3.040-8.886,P<0.001)were independent risk factors for PSD.ROC analysis showed that the combination of Hcy and PLR had a maximum predictive value,and the AUC was 0.835(95%CI 0.796-0.874,P<0.001),with a sensitivity and specificity of 64.5%and 88.27%,respectively.Conclusions Elevated PLR and serum Hcy level were independent risk factors for PSD,and the combination of these two factors had a high predictive value for PSD.

关 键 词：同型半胱氨酸 卒中 卒中后抑郁 抑郁 血小板与淋巴细胞比值 

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]