血清脑源性神经营养因子水平与缺血性卒中后抑郁的相关性

目的 探讨血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)与卒中后抑郁(post-stroke depression,PSD)的相关性.方法 前瞻性纳入90例缺血性卒中患者,入院后检测血清BDNF含量,采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评定神经功能缺损,采用Barthel指数(Barthel index,BI)评定日常生活活动能力.6个月随访时采用17项汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)进行抑郁评定,≥17分为抑郁,＞24分为重度抑郁.结果 共40例患者(44.4％)发生PSD,轻度抑郁30例(33.3％),中度抑郁8例(8.9％),重度抑郁2例(2.2％).单变量分析显示,PSD组多发性梗死的患者比例(65.0％对32.0％;x2=9.723,P=0.002)、基线NIHSS评分(7.05±4.25)分对(4.35±3.14)分;t=3.465,P =0.001]和出院时NIHSS评分(5.43±3.02)分对(3.11±2.56)分;=3.944,P＜0.001]显著高于非PSD组,而受教育年限(9.03±4.51)年对(13.45 ±5.02)年;=4.340,P＜0.001]、血清PDNF浓度(16.754 ±4.451) pg/ml对(29.551 ±3.213)pg/ml;t =15.827,P＜0.001]以及出院时BI(55.00±28.10)分对(83.11±27.11)分;=4.809,P＜0.001]显著低于非PSD组.多变量logistic回归分析显示,高血清BDNF水平是PSD的独立保护因素(优势比0.571,95％可信区间0.416 ～0.967;P=0.003).结论 高血清BDNF水平是PSD的独立保护因素.

Correlation between serum brain-derived neurotrophic factor level and depression after ischemic stroke

Objective To investigate the correlation between brain-derived neurotrophic factor (BDNF) and post-stroke depression (PSD).Methods A total of 90 patients with ischemic stroke were enrolled prospectively.After admission,the serum BDNF levels were detected.National Institutes of Health Stroke Scale (NIHSS) was used to assess neurological deficit.Barthel index (BI) was used to assess the activities of daily living The 17-term Hamilton depression scale (HAMD) was used to conduct the depression assessment at 6-month follow-up,≥ 17 was depression and ＞ 24 was severe depression.Results A total of 40 patients (44.4％) had PSD,30 (33.3％) had mild depression,8 (8.9％) had moderate depression,and 2 (2％) had severe depression.Univariate analysis showed that the proportion of patients with multiple infarcts in the PSD group (65.0％ vs.32.0％;x2 =9.723,P =0.002),baseline NIHSS score (7.05 ±4.25 vs.4.35 ±3.14;t =3.465,P=0.001) and NIHSS score at the time of discharge (5.43 ± 3.02 vs.3.11 ± 2.56;t =3.944,P ＜ 0.001) were significantly higher than those in the non-PSD group,and years of education (9.03 ±4.51 years vs.13.45 ± 5.02 years;t =4.340,P ＜0.001),serum concentration of PDNF (16.754 ± 4.451 p g/ml vs.29.551 ± 3.213 p g/ml;t =15.827,P ＜ 0.001),and BI at the time of discharge (55.00 ±28.10 vs.83.11 ±27.11;t =4.809,P＜0.001) were significantly lower than those in the non-PSD group.Multivariatelogistic regression analysis showed that high serum BDNF level was an independent protective factor for PSD (odds ratio 0.571,95％ confidence interval 0.416-0.967;P =0.003).Conclusions High serum BDNF level is an independent protective factor for PSD.