缺血性脑卒中后抑郁患者血清淀粉样蛋白A水平检测及其意义研究

Changes of serum amyloid A level and its significance in depression following ischemic stroke

目的探讨急性缺血性脑卒中后抑郁患者血清淀粉样蛋白A（SAA）水平及其临床意义。方法对新乡医学院第二附属医院神经内科自2016年1月至2017年6月收治的164例首发急性缺血性脑卒中患者采用汉密顿抑郁量表17项版本（HAMD-17）评估抑郁状况，依据评估结果分为脑卒中后抑郁（PSD）组（n=57）、非PSD组（n=107），并抽取同期体检健康的志愿者（n=50）设为健康对照组。采用酶联免疫吸附法（ELISA）检测3组对象的SAA水平，并收集PSD组、非PSD组的临床资料，采用单因素分析及多因素Logistic回归分析筛选出PSD的危险因素。结果PSD组SAA水平[（18.85±5.25） mg/L]明显高于非PSD组[（15.25±5.75） mg/L]及健康对照组[（7.65±4.50） mg/L]，非PSD组明显高于健康对照组，差异均有统计学意义（P〈0.05）。单因素分析显示，PSD组在中等或以上受教育程度、性格内向、经济状况差、独居、婚姻状态差、入院时美国国立卫生研究院卒中量表（NIHSS）评分≥9分、并发症、关键部位（额叶、基底节）梗死比例方面与非PSD组比较差异均有统计学意义（P〈0.05）。多因素Logistic回归分析显示，性格内向、经济状况差、独居、入院时NIHSS评分≥9分、关键部位（额叶、基底节）梗死及SAA水平升高（OR=1.545，P=0.035，95%CI：1.257~1.898）均是PSD的独立危险因素（P〈0.05）。结论SAA作为一种生物学标记物，其水平检测对PSD的早期诊断、临床干预具有重要意义。

ObjectiveTo explore the changes of serum amyloid A （SAA） level and its clinical significance in patients with post-stroke depression （PSD）.MethodsOne hundred and sixty-four patients with acute ischemic stroke, admitted to our hospital from January 2016 to June 2017 were assessed with Hamilton Depression Scale-17 （HAMD-17） to evaluate the depression degrees, and accordingly, they were divided into PSD group （n=57） and non-PSD group （n=107）. Healthy volunteers who were examined in the corresponding period were selected as healthy control group （n=50）. The SAA level was determined with ELISA in subjects of the 3 groups. Clinical data were collected; single factor analysis and multivariate Logistic regression analysis were performed to select the risk factors of PSD.ResultsThe SAA level in PSD group （[18.85±5.25] mg/L） was significantly higher than that in the non-PSD group （[15.25±5.75] mg/L） and healthy control group （[7.65±4.50] mg/L, P〈0.05）; that in the non-PSD group was significantly higher than that in the healthy control group （P〈0.05）. Single factor analysis showed that differences in education level, introversion, economic status, living alone, marital status, National Institutes of Health Stroke Scale （NIHSS） scores≥9 at admission, complications, and proportion of key area infarction （frontal lobe and basal ganglia） had statistical significance between PSD group and non-PSD group （P〈0.05）. Multivariate Logistic regression analysis showed that introversion, poor economic status, living alone, NIHSS scores≥9, infarction of key areas, and elevation of SAA level （OR=1.545, P=0.035, 95% CI： 1.257-1.898） were independent risk factors for PSD （P〈0.05）.ConclusionSAA used as one of the detection biomarkers has great significance in early diagnosis, intervention and clinical prevention for PSD.