南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (06): 665-.doi: 10.12122/j.issn.1673-4254.2019.06.06

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炎症指标对缺血性脑卒中卒中后抑郁的预测价值

胡佳，周伟，周志明，杨倩，韩剑，颜燕，董万利   

  • 出版日期:2019-06-20 发布日期:2019-06-20

Predictive value of inflammatory indicators for post-stroke depression in patients with ischemic stroke

  • Online:2019-06-20 Published:2019-06-20

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摘要： 目的探讨患者入院时静脉血白细胞与淋巴细胞比值（NLR）和血小板和淋巴细胞比值（PLR）值以及发病后2周外周血细 胞因子IL-17、IL-6水平与急性缺血性脑卒中卒中后抑郁发生的相关性。方法贯序性纳入2015年3月~2017年9月就诊于皖南 医学院弋矶山医院神经内科卒中病房首次诊断急性脑梗死的患者，记录患者入院时的人口学资料、临床基线资料、影像学资料， 并与入院14 d后抽取静脉血，随访3个月时根据患者临床症状按照美国精神病治疗协会发布的美国心理疾病诊断标准第五版 DSM-IV（SCID-I-R）诊断标准诊断抑郁，分为卒中后非抑郁障碍组和卒中后抑郁障碍组；并根据Hamilton抑郁量表（HAMD-17） 行抑郁程度的评价采用多元logistic回归分析法，探讨缺血性脑卒中患者PSD与入院时NLR和PLR值、以及病后2周外周血细 胞因子IL-17、IL-6的相关性。结果单因素分析显示：性别、受教育年限、BMI、独居、卒中功能缺损程度（NIHSS评分）、认知功 能障碍（MMSE评分）、神经功能恢复程度（mRS评分）、实验室指标（NLR、PLR、IL-17、IL-6）与卒中后抑郁PSD的发生具有显著 相关性（P均<0.05）。多因素Logistic 回归分析显示：对相关因素进行调整后，NLR第三四分位数（即NLR≥4.02）（P<0.001）、 PLR第三四分位数（即PLR≥203.74）（P=0.002）、IL-17（P=0.025）、IL-6（P=0.016）与缺血性卒中后抑郁症状的发生具有独立相关 性。对重度抑郁患者（HAMD≥24）的亚组分析中，调整相关因素后发现此4组实验室指标仍是其独立预测因素。结论入院时 静脉血NLR、PLR水平、发病2周后外周静脉血IL-17、IL-6是缺血性脑卒中后3个月PSD的独立预测因素。

Abstract: Objective To investigate the association of venous blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and levels of interleukin-17 (IL-17) and IL-6 at 2 weeks after admission with the occurrence of post-stroke depression (PSD) in patients with first-ever acute ischemic stroke. Methods The hospitalized patients with first-ever acute ischemic stroke were recruited consecutively from the Department of Neurology of Yijishan Hospital from March, 2015 to September, 2017. The demographic and baseline clinical data on admission and the imaging data were collected. The diagnosis of PSD was established in line with DSM-IV (SCID-I-R) at 3 months during the follow-up. The severity of PSD was assessed using the Hamilton Depression Scale ( HAMD-17). Multivariate logistic regression analysis was used to investigate the correlation of NLR, PLR, IL-17, and IL-6 with PSD in these patients. Results A total of 376 patients with acute ischemic stroke were enrolled, including 224 male patients (59.57%) and 152 female patients (40.43%), whose mean age was 61.37±10.34 years. Of these patients 104 (27.66%) were found to have PSD. Univariate analysis showed that gender, years of education, BMI, widowhood, NIHSS score, MMSE score, mRS score, and laboratory indexes (NLR, PLR, IL-17, and IL-6) were all significantly correlated with PSD (all P<0.05). Multivariate logistic regression analysis showed that, after adjusting for the compounding factors, the third quartile of NLR (P<0.001), the third quartile of PLR (P=0.002), IL-17 (P=0.025) and IL-6 (P= 0.016) were independent factors that predicted the occurrence of PSD. Conclusion Elevated NLR and PLR at admission and levels of IL-17 and IL-6 at 2 weeks after admission are all independent predictors of the occurrence of PSD at 3 months after stroke.