卒中亚急性期抑郁与急性期血浆同型半胱氨酸水平的相关性研究

Correlational Study on Post-stroke Depression in Subacute Phase and Serum Concentration of Homocysteine in Acute Stroke

目的研究卒中亚急性期发生的卒中后抑郁(post-stroke depression,PSD)与卒中急性期血浆同型半胱氨酸(homocysteine,Hcy)水平的相关性。方法连续收集2010年4月～2011年7月北京航天总医院神经内科住院的198例缺血性卒中惠者,根据《中国精神疾病分类方案与诊断标准》第3版(Chinese Classification and Diagnostic Criteria of MentalDisorders-3,CCMD-3)进行PSD的诊断,根据诊断结果分为PSD组1 02例和卒中后无抑郁组(对照组)96例。由固定的、经过培训的心理咨询师对PSD患者进行汉密尔顿抑郁量表17项(Hamilton RatingScale for Depression-17,HRSD-17)评定,根据评定结果分为轻度、中度、重度抑郁组。采用微量荧光偏振免疫分析法于入院次日对所有患者进行血浆Hcy水平测定,比较两组患者血浆Hcy水平,并与PSD进行相关分析。结果 PSD组102例患者有高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)68例(66.7%),对照组有12例(12.5%),PSD组HHcy阳性检出率较对照组差异具有显著性(x^2=17.29,P<0.001)。经非条件Logistic回归分析PSD的危险因素,显示血浆Hcy水平与PSD有相关性[优势比(odds ratio,OR)=1.946.P<0.001,95%可信区间(confidence interval,CI)1.10～1.22]。结论卒中急性期血浆Hcy水平与卒中亚急性期抑郁有相关性。

Objective To investigate the relationship between post-stroke depression（PSD） occurring in subacute phase of stroke and plasma level of homocysteine（Hcy） in acute stroke. Methods One hundred and ninety-eight ischemic stroke patients who were hospitalized at Department of Neurology of Beijing Aerospace General Hospital from April 2010 to July 2011 were consecutively recruited into our study. They were diagnosed PSD as defined in Chinese ClassiHcation and Diagnostic Criteria of Mental Disorders-3（ CCMD-3 ）. One hundred and two patients were diagnosed with PSD（PSD group） and 96 patients were not（control group）. Those PSD patients were evaluated by the same trained psychological consultant with Hamilton Rating Scale for Depression-17（HRSD-17）, and they were subdivided into three groups：mild, moderate and severe. All patients of interest were examined the level of plasma Hcy by fluorescence polarization immunoassay on the second day of hospitalization. Comparison of the levels of plasma Hcy between both groups was made and their relationship with PSD was analyzed. Results In the PSD group, 68 patients had hyperhomocysteinemia（HHcy）（66.7%）, and the control group had 12 cases（12.5%）. There was statistically significant difference in positive rate of HHcy between both groups. The unconditional Logistic regression analysis was adopted to evaluate the risk factors of PSD, and the results show that the plasma Hcy level is associated with PSD（odds ratio[OR]=l.946, P〈0.001, 95% confidence interval[CI] 1.10-1.22）. Conclusion The plasma level of Hcy in acute stroke is relevant to PSD in subacute phase of stroke.