T淋巴细胞亚群水平对急性脑梗死后抑郁的预测价值  

The predictive value of T-lymphocyte subsets on depression after acute cerebral infarction

作　　者：史莉瑾[1] 张雪莹 郭双喜[1] 杜佳[1] 徐斌 伊婷婷 SHI Lijin;ZHANG Xueying;GUO Shuangxi;DU Jia;XU Bin;YI Tingting(The First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院,河南新乡453100

出　　处：《中国实用神经疾病杂志》2020年第18期1609-1614,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省高等学校重点科研项目(编号:19A320031)。

摘　　要：目的探讨T淋巴细胞亚群水平对急性脑梗死后抑郁(PSD)的预测价值。方法收集2018-10―2019-11新乡医学院第一附属医院收治的300例急性脑梗死患者临床资料,根据汉密尔顿抑郁量表(HAMD-17项)评分分为卒中后非抑郁组(HAMD评分<7分)153例和卒中后抑郁组(HAMD评分≥7分)147例,选择同期150例健康体检者为对照组,比较3组外周血T淋巴细胞亚群水平,并通过病例对照研究采用χ^2检验和多因素Logistic回归分析PSD的相关因素,同时应用受试者操作特征(ROC)曲线评价T淋巴细胞亚群水平预测PSD的准确性。结果与健康对照组相比较,卒中后非抑郁组和卒中后抑郁组外周血CD4^+和CD4^+/CD8^+水平均显著降低,CD8^+水平明显升高(P<0.05);与卒中后非抑郁组相比较,卒中后抑郁组CD4^+和CD4^+/CD8^+水平均显著降低,CD8^+水平明显升高(P<0.05);Pearson相关分析显示,外周血CD4^+/CD8^+与年龄(r=0.43,P=0.12)、性别(r=0.39,P=0.22)、高血压(r=0.28,P=0.38)、冠心病(r=0.30,P=0.26)、糖尿病(r=0.57,P=0.34)、梗死部位情况(r=0.53,P=0.31)无相关性,而与NIHSS评分(r=-0.25,P=0.00)、Barthel指数(r=-0.24,P=0.00)、MMSE评分(r=-0.19,P=0.01)呈负相关。以CD4^+/CD8^+为因变量,以NIHSS评分、Barthel指数和MMSE评分为自变量,进行多元逐步回归分析,结果显示NIHSS和MMSE评分与CD4^+/CD8^+比值独立相关,回归方程Y=0.42-0.02×NIHSS评分-0.01×MMSE评分(P<0.05),提示NIHSS和MMSE评分是CD4^+/CD8^+水平的独立影响因素;以PSD为因变量,以外周血CD4^+、CD8^+和CD4^+/CD8^+水平为自变量,进行Logistic回归分析,然后以预测概率做ROC曲线,得到T淋巴细胞亚群预测PSD发生发展的敏感度和特异度达到94%和75%。结论外周血T淋巴细胞亚群水平变化均参与了PSD患者的发生、发展,且CD4^+/CD8^+水平与脑卒中后神经精神功能状态呈负相关,可有效反映病变程度和神经功能负荷变化,临床可作为早期评估和预测患者神经精神功能�Objective To explore the predictive value of T-lymphocyte subsets on depression(PSD)after acute cerebral infarction.Methods The clinical data of 300 patients with acute cerebral infarction admitted to our hospital from October 2018 to November 2019 were collected.According to the different scores of Hamilton Depression Scale(HAMD-17 items),they were divided into two groupsnon depression group(HAMD score<7 points)and depression group(HAMD score≥7 points)147 patients were divided into three groups.150 healthy controls were selected at the same time.The levels of T-lymphocyte subsets in three groups were compared.The related factors of PSD were analyzed byχ^2 test and multivariate logistic regression,and the accuracy of T-lymphocyte subsets in predicting PSD was evaluated by ROC curve.Results Compared with the healthy control group,the levels of CD4^+and CD4^+/CD8^+in the peripheral blood of the post-stroke non depression group and the post-stroke depression group were all the same The level of CD4^+and CD4^+/CD8^+in the post-stroke depression group was significantly lower than that in the post-stroke non depression group(P<0.05);Pearson correlation analysis showed that the level of CD4^+/CD8^+in the peripheral blood was significantly higher than that in the age group(r=0.43,P=0.12),gender group(r=0.39,P=0.22),hypertension group(r=0.28,P=0.38),coronary heart disease(r=0.3)There was no correlation between NIHSS score(r=-0.25,P=0.00),Barthel Index(r=-0.24,P=0.00),MMSE score(r=-0.19,P=0.01),diabetes mellitus(r=0.57,P=0.34),infarction location(r=0.53,P=0.31).With CD4^+/CD8^+as the dependent variable,NIHSS score,Barthel Index and MMSE score as the independent variables,multiple stepwise regression analysis was carried out.The results showed that NIHSS and MMSE score were independently related to the ratio of CD4^+/CD8^+,regression equationY=0.42-0.02×NIHSS score-0.01×MMSE score(P<0.05),suggesting that NIHSS and MMSE score were independent influencing factors of CD4^+/CD8^+level;with PSD as the dependent variable,

关 键 词：T淋巴细胞亚群 急性脑梗死 抑郁症 神经功能 不良心脑血管事件 心理疾病 

分 类 号：R743.33[医药卫生—神经病学与精神病学]