脑卒中后不同时段抑郁障碍患者血清IL-1β、IL-6变化特点

Observation of serum IL-1β and IL-6 in patients with post stroke depression in different periods

目的比较分析脑卒中后不同时段抑郁障碍(PSD)患者的血清IL-1β、IL-6的水平变化特点。方法脑卒中住院连续病例223例,于脑卒中后72 h予HAMD(24项版)评分,评分≥8分者,随机分为对照组(第2组)、抗抑郁药物干预组(第1组);对未达标者于脑卒中后1月再次予HAMD评分,评分≥8分者同方法再随机分为对照组(第4组)、抗抑郁药物干预组(第3组);对1月时HAMD评分<8分者于脑卒中后2月再次予HAMD评分,评分≥8分者同方法再随机分为对照组(第6组)、抗抑郁药物干预组(第5组);2月时HAMD评分<8分者于脑卒中后3月再次予HAMD评分,得出评分≥8分组(第7组)、<8分组(第8组)。所有入选病例于发病72 h、1个月、3个月予血清IL-1β、IL-6水平检测。结果 (1)发病72 h发生PSD组(第1+2组)与未发生PSD组(第3+4+5+6+7+8组)血清IL-1β、IL-6水平比较无统计学差异(P>0.05);脑卒中后1个月发生PSD组(第3+4组)与未发生PSD组(第5+6+7+8组)血清IL-1β、IL-6水平比较有显著性差异(P<0.001);脑卒中后3个月发生PSD组(第7组)与未发生PSD组(第8组)血清IL-1β、IL-6水平比较均无统计学差异(P>0.05)。(2)不同时段发生PSD组(第2、4、6、7组)之间,在脑卒中后72 h,4组血清IL-1β、IL-6水平均无统计学差异(P>0.05);脑卒中后1月4组血清IL-1β、IL-6水平有显著性差异(P<0.001);脑卒中后3月4组血清IL-1β、IL-6水平有显著性差异(P<0.001,P<0.01)。结论脑卒中早期检测血清IL-1β、IL-6水平对预测PSD的发生意义较小;炎症细胞因子IL-1β、IL-6在脑卒中后1月PSD中起重要作用,且该时段检测血清IL-1β、IL-6水平可能在推测PSD发生的大致时间方面有一定的指导意义;脑卒中后中晚期发生PSD与炎症细胞因子的相关性有待于进一步深入探讨。

Objective To explore the changes of serum IL-1β and IL-6 in patients with post stroke de- pression （PSI）） in different periods. Methods 223 consecutive patients with acute stroke were admitted. 24-i- tem Hamilton Depression Rating Scale （HAMD） was utilized to rate at 72 hours, 1 month, 2 month and 3 month after stroke onset. Subjects who got HAMD score 28 at 72 hours, 1 month and 2 months after stroke onset were randomly classified into control groups （Group 2, Group 4 and Group 6） and intervention groups （Group 1, Group 3 and Group 5） correspondingly. At each observation point, subjects whose HAMD score 〈8 were reassessed with HAMD. At 3 months with symptoms onset, subjects whose HAMD score 28 or〈 8 were enrolled into Group 7 or Group 8 respectively. All cases underwent detection of serum IL-1β and IL-6 at 72 hours, 1 month and 3 months with symptoms onset. Results At 72 hours and 3 months after stroke onset, serum levels of IL-1β and IL-6 showed no significant difference between PSD group and non-PSD group. How- ever, at 1 month after stroke onset a statistically significant difference between the two groups was revealed. A- mong each control group, serum levels of IL-1β and IL-6 showed no significant difference at 72 hours after stroke onset but a great difference at 1 month and 3 months after stroke onset. Furthermore,at 72 hours after stroke onset, serum levels of IL-1β and IL-6 among four groups represented no difference, but showed a signifi- cant difference at 1 and 3 months after stroke onset. Conclusions Early detection of serum IL-1β and IL-6 in patients with stroke may not be useful/or the occurrence of PSI）. However, it is well established that inflam-matory cytokines IL-1β and IL-6 play important roles in PSD at 1 month after stroke and might be predictors of PSI）. Further studies are needed to value the correlation between PSI） at middle and late period of stroke and inflammatory cytokines.