预防性应用抗抑郁药物对急性脑梗死预后及血清BDNF水平的影响

Effects of preventive antidepressant application on prognosis and serum BDNF level of acute cerebral infarction

目的探讨预防性应用抗抑郁药对急性脑梗死预后及血清脑源性神经营养因子(BDNF)水平的影响。方法前瞻性选择2013年1月至2016年4月该院141例急性脑梗死患者,干预组72例,给予急性脑梗死常规治疗同时加用盐酸舍曲林治疗12周,对照组69例,仅进行常规治疗。采用神经功能缺损评分(NIHSS)及日常生活能力评定量表barthel(BI)指数评价神经功能缺损程度及日常生活能力,汉密尔顿抑郁量表(HAMD)-17评价卒中后情绪,简明智力状态检查(MMSE)评定认知功能,用双抗体夹心酶联免疫吸附法检测血清BDNF水平。结果治疗3个月后,干预组NIHSS、HAMD评分分别为(1.77±0.58)分和(5.43±1.77)分,对照组分别为(4.06±0.79)分和(10.27±3.78)分,均较入组时明显降低(P<0.05);干预组和对照组BI分别为(96.24±4.58)和(77.64±6.96),均较入组时明显升高(P<0.05);干预组和对照组血清BDNF水平分别为(8.38±0.74)、(5.72±0.67)ng/mL,均较入组时明显升高(P<0.05),干预组高于对照组(P<0.05)。MMSE评分两组差异无统计学意义(P>0.05)。干预组PSD发生率(10.0%)较对照组(53.6%)明显降低(P<0.05)。结论急性脑梗死预防性应用抗抑郁药,可升高血清BDNF水平,改善预后,值得推广应用。

Objective To investigate the effect of preventive antidepressants application on the prognosis of and serum brain derived neurotrophic factor（BDNF） level in acute cerebral infarction（ACI）. Methods One hundred and forty-one patients with ACI were prospectively and randomly selected. Seventy-two cases in the intervention group was added with sertraline for 12 weeks on the basis of the routine therapy,while 69 cases in the control group only used the routine therapy. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the nervous function impairment degree and daily living ability. The Hamilton Depres sion Rating Scale-17 was used to evaluate the emotion after stroke. The cognition function was evaluated by the Mini-Mental State Examination （MMSE）. The BDNF level was detected by using the double antibody sandwich enzyme-linked immunosorbent assay. Results The NIHSS and HAMD scores after 3-month treatment were （1.77±0.58）points and （5.43±1. 77）points in the inter vention group,and （4.06±0.79）points and（10.27±3.78）points in the control group,which were significantly decreased compared with before treatment（P〈0.05）the BI value in the intervention group and control group were （96.24 ± 4.58） and （77.64 ± 6.96） ,which were significantly increased compared with before treatment （P〈0.05） ,and serum BDNF levels were （8.38±0.74） ng/mL and （5. 72 ±0. 67）ng/mL respectively, which were significantly increased compared with before treatment, moreover the change in the intervention group was more obvious than that in the control group （P〈0.05）. The MMSE score had no statistical difference between the two groups （P〈0.05）. The PSD occurrence rate was 10.0% in the intervention group, which was signifi- cantly decreased compared with 53.6% in the control group （P〈0.05）. Conclusion Preventive antidepressants application in the patients with ACI can increase the serum BDNF level,improves the prognosis and is worth promotion and application.