血清铁蛋白水平与缺血性卒中后3个月抑郁的相关性

Correlation between the serum ferritin levels and the post-stroke depression at 3 months after ischemic stroke

目的：探讨血清铁蛋白水平与卒中后抑郁（post-stroke depression, PSD）的相关性。方法连续收集2014年7月至2015年10月期间住院的首次急性缺血性卒中患者,在入院后24 h内采用化学发光微粒子免疫分析法检测血清铁蛋白水平。在发病后90 d时采用17项汉密尔顿抑郁量表筛查抑郁,评分≥7分的患者进一步采用《精神疾病诊断与统计手册（第4版）》确诊抑郁。结果共纳入200例首次急性缺血性卒中患者,其中55例（27．5%）诊断为 PSD。 PSD 组体质指数、受教育年限、腰围、高敏 C 反应蛋白、高半胱氨酸、NIHSS 评分（基线、出院和90 d 时）、mRS 评分（出院和90 d时）、BI（出院和90 d时）以及丧偶或独居患者的构成比与非 PSD 组均存在显著性统计学差异（P 均〈0．05）。 PSD 组血清铁蛋白水平[中位数和四分位数间距：261．90（142．10～364．90）μg/L 对164．40（132．50～195．10）μg/L；Z =-4．814,P 〈0．001]显著高于非 PSD 组。经多变量logistic回归分析校正混杂因素后,基线血清铁蛋白水平〉136．375μg/L是 PSD 的独立危险因素（每增高1个四分位数：优势比1．041,95%可信区间1．009～1．239；P =0．045）。结论血清铁蛋白水平增高与 PSD 显著相关。

Objective To investigate the correlation between the serum ferritin levels and the post-stroke depression （PSD）. Methods From July 2014 to October 2015, the inpatients with the first-ever acute ischemic stroke were colected consecutively. Chemiluminescence microparticle immune assay was used to measure the serum ferritin levels within 24 h after admission. Depressive symptoms were screened by using the 17-item Hamilton depression scale （HAMD-17） at 3 months after onset. In patients with a HAMD-17 score ≥7, the depression was further diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Results A total of 200 patients with the first-ever acute ischemic stroke were enroled, 55 （27. 5% ） of them were diagnosed as PSD. There were significant differences in the body mass index （BMI）, years of education, waist circumference, high sensitive-C-reactive protein, homocysteine, National Institutes of Health Stroke Scale score （at baseline, discharge, and day 90）, mRs score （at discharge and day 90）, BI （at discharge and day 90）, and the proportions of widowed or solitary patients between the PSD group and the non-PSD group （al P 〈 0. 05 ）. The serum ferritin level in the PSD group was significantly higher than that in the non-PSD group （ median [ interquartile range], 261. 90[142. 10-364. 90] μg/L vs. 164. 40[132. 50- 195. 10] μg/L; Z = - 4. 814, P 〈 0. 001 ）. Multivariate logistic regression analysis adjusted for confounding factors showed that the baseline serum ferritin level 〉136. 375 μg/L was an independent risk factor for PSD （odds ratio 1. 041 per 1-quartile increase, 95%confidence interval 1. 009-1. 239; P = 0. 045）. Conclusions The elevated baseline serum ferritin level is associated with PSD.