血浆皮质醇、脑源性神经营养因子、亚硝酸根水平与急性缺血性脑卒中后抑郁状态相关性研究  

Correlation between plasma cortisol,brain-derived neurotrophic factor,NOand post-stroke depression in patients with acute ischemic stroke

作　　者：郑宗菊[1] 鄢宗仁 秦枫[2] ZHENG Zong-ju;YAN Zong-ren;QIN Feng(Department of neurology,People′s Hospital of Chongqing Ba′nan District,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院神经内科,重庆401320 [2]重庆医科大学附属第一医院检验科,重庆400010

出　　处：《创伤与急危重病医学》2021年第5期331-336,共6页Trauma and Critical Care Medicine

基　　金：重庆科技计划项目(2016BN003)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)患者血浆皮质醇、脑源性神经营养因子(BDNF)、亚硝酸根(NO^(-)_(2))水平与卒中后抑郁状态(PSD)的关系。方法选取自2018年3月至2020年7月收治的239例AIS患者为研究对象。随访6个月,汉密尔顿抑郁量表17项(HAMD)≥7分者诊断为PSD。采用化学发光微粒子免疫分析法、酶联免疫吸附试验、Griess脱氨基反应检测血浆皮质醇、BDNF和NO^(-)_(2)含量。采用国立卫生研究院卒中量表(NIHSS)评定神经系统状况。采用HAMD量表评定患者的情绪状态,采用改良版Rankin量表(mRS)评定患者的功能状态。结果本组239例AIS患者中,53例经6个月随访诊断为PSD(HAMD评分≥7分),纳入PSD组,其发生率为22.2%。与未出现PSD患者(非PSD组)相比较,PSD组患者的婚姻状况(单身/离异/丧偶)、脑卒中严重程度(入院时NIHSS评分和出院时mRS评分)、随访6个月HAMD评分以及血浆皮质醇水平均较高,血浆BDNF和NO^(-)_(2)水平较低,差异有统计学意义(P<0.05)。多因素Logistic回归模型分析结果显示,单身/离异/丧偶、出院时mRS评分≥2分、血浆皮质醇水平升高以及血浆BDNF和NO^(-)_(2)水平降低是PSD发生的独立危险因素(P<0.05)。经Spearman相关性分析,PSD患者血浆皮质醇水平与HMDA评分呈正相关(rs=0.507,P<0.001);而血浆BDNF、NO^(-)_(2)水平与HMDA评分呈负相关(rs=-0.294、-0.409,P<0.05)。入院时血浆皮质醇、BDNF、NO^(-)_(2)水平预测随访6个月PSD发生风险的曲线下面积(area under curve,AUC)分别为0.824、0.833、0.759,灵敏度分别为92.5%、66.1%、95.2%,特异度分别为55.9%、88.7%、47.2%,联合检测预测的AUC为0.893,灵敏度和特异度分别为86.8%和74.7%。结论AIS患者入院时,血浆皮质醇水平升高以及血浆BDNF和NO^(-)_(2)水平降低与PSD的发生风险有关,及时对其进行检测可预测随访6个月PSD的发生风险。Objective To investigate the correlation between plasma cortisol,brain-derived neurotrophic factor(BDNF),NO^(-)_(2)and post-stroke depression(PSD)in patients with acute ischemic stroke(AIS).Methods A retrospective study was performed on 239 cascs of patients with AIS who were admitted from March 2018 to July 2020.During a 6-month follow-up,PSD was diagnosed in patients with Hamilton Depression Rating Scale(HAMD)≥7 scores.Plasma levels of cortisol,BDNF and NO^(-)_(2) were determined by chemiluminescence microparticle immunoassay,enzymelinked immunosorbent assay and Griess deamination reaction.The National Institutes of Health stroke scale(NIHSS)was used to assess the neurological status.Mood state was assessed with HAMD scale and functional state was assessed with the modified Rankin scale(mRS).Results Among 239 AIS patients,53 were diagnosed with depression(HAMD≥7 scores)at 6-month follow-up and included into the PSD group,with an incidence of 22.2%.Compared with patients without PSD(non-PSD group),PSD patients had higher marital status(single/divorced/widowed),stroke severity(NIHSS score at admission and mRS score at discharge),HAMD score at 6-month follow-up,and plasma cortisol level,and lower plasma BDNF and NO^(-)_(2) levels(P<0.05).Multivariate Logistic regression analysis showed that single/divorced/widowed,mRS score≥2 scores at discharge,increased plasma cortisol level and decreased plasma BDNF and NO^(-)_(2) level were independent risk factors for PSD(P<0.05).Spearman correlation analysis showed that plasma cortisol level was positively correlated with HMDA score(rs=0.507,P<0.001),while plasma BDNF and NO^(-)_(2) levels were negatively correlated with HMDA score(rs=-0.294,-0.409,P<0.05).The area under curves(AUCs)of plasma cortisol,BDNF,NO^(-)_(2) for predicting the risk of PSD at 6-month follow-up were 0.824,0.833 and 0.759,and the sensitivities were 92.5%,66.1%and 95.2%,the specificities were 55.9%,88.7%and 47.2%,respectively.The AUC of combined detection was 0.893,the sensitivity and specificity

关 键 词：急性缺血性脑卒中 皮质醇 脑源性神经营养因子 亚硝酸根 卒中后抑郁状态 

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