血清瘦素、NSE及S-100B水平与卒中后抑郁关系的前瞻性巢式病例对照研究

Serum leptin, neuron specific enolase and S-100B in relation to post-stroke depression in a prospective nested case-control study

目的探讨脑卒中患者血清瘦素、神经元特异性烯醇化酶（NSE）及S-100B水平与卒中后发生抑郁的危险性的关系。方法 2010年6月-2012年12月入住郑州大学附属郑州中心医院的急性缺血性脑卒中患者121例,随访半年后42例患者确诊为卒中后抑郁（汉密尔顿抑郁量表评分≥8分）,按照入组时间、年龄、性别及脑损伤部位匹配原则,选择未患卒中后抑郁的脑卒中患者42例作为对照。收集出院时患者血清,采用酶联免疫吸附法检测患者血清瘦素、NSE及S-100B浓度,分析其与卒中后抑郁发生的相关性。采用受试者工作特征曲线（ROC）检验各组数据值对诊断卒中后抑郁的效率。结果卒中后抑郁组血清瘦素、NSE、S-100B浓度（分别为25.84±13.80、2.59±1.48、25.03±8.24μg/L）与对照组（分别为8.67±6.17、2.27±1.84、22.40±6.84μg/L）比较明显增高（P〈0.05）。卒中后抑郁患者血清瘦素水平与NSE及S-100B未见明显相关性;基于ROC曲线,卒中后患者血清瘦素曲线下面积为0.935（95%CI 0.885~0.984）,血清瘦素值16.17μg/L是诊断卒中后抑郁的最佳临界点,敏感性为81.0%,特异性为90.1%,是具有较高精准度的诊断指标。结论脑卒中患者血清瘦素水平升高与卒中后发生抑郁密切相关,可作为诊断卒中后抑郁的血清预测标志物。

Objective To investigate the relationship between the serum levels of leptin, neuron-specific enolase （NSE） and S-100B in patients of stroke and the incidence of post-stroke depression （PSD）. Methods The clinical data of 121 cases of acute ischemic stroke, admitted to Zhengzhou Central Hospital affiliated to Zhengzhou University from Jun. 2010 to Dec. 2012, were retrospectively analyzed. After six months of follow-up 42 patients were diagnosed as suffering from PSD （Hamilton Depression Scale score 38）. Another 42 participants with available matching data on onset time, age, gender and lesions of brain were selected. The serum samples were collected from all patients at time of discharge, and the concentrations of serum leptin, NSE and S-100B were analyzed by enzyme-linked immunosorbent assay （ELISA） kit. Correlation and efficiency of diagnosing PSD among them was validated by receptor operator curve （ROC）. Results The concentration of serum leptin, NSE, and S-100B in PSD group （25.84±13.80, 2.59 ±1.48 and 25.03 ± 8.24μg/L, respectively） was higher than that in the control group （8.67 ±6.17, 2.27 ± 1.84 and 2Z.40 ± 6.84μg/L, respectively）. No obvious correlation was found between serum leptin and the NSE and S-100B in PSD patients. Based on the ROC curve, the area under the curve of serum leptin in PSD patients was 0.935 （95%CI 0.885-0.984）, and the optimal cutoff value of serum leptin level was 16.17μg/L, which was an indicator for predicting of PSD with 81.0% sensitivity and 90.1% specificity. Conclusion Elevation of serum leptin level at admission was found to be associated with PSD, and it may act as a new marker for predicting the occurrence of PSD.