血清白细胞介素-2和白细胞介素-4水平与卒中后抑郁的相关性

Correlation between the levels of serum interleukin-2 and interleukin-4 and post stroke depression

目的探讨急性脑梗死(ACI)患者早期血清白细胞介素-2(IL-2)和白细胞介素-4(IL-4)水平与卒中后抑郁(PSD)的关系。方法选择2018年2月10日至3月10日新乡医学院第一附属医院收治的80例ACI患者为研究对象,所有患者入院后随访3个月,根据汉密尔顿抑郁量表(HAMD)评分将患者分为PSD组(HAMD评分≥8分,n=43)和非PSD组(HAMD评分≤7分,n=37)。43例PSD患者中,轻度PSD 19例(轻度PSD组),中重度PSD 24例(中重度PSD组)。另选择同期进行健康体检者40例为对照组。ACI患者于入院第7天、对照组受试者于体检当日抽取空腹静脉血5 m L,采用酶联免疫吸附法(ELISA)检测血清IL-2和IL-4水平,对各组受试者血清IL-2及IL-4水平进行比较;采用受试者工作特征曲线(ROC)评价血清IL-2和IL-4水平预测PSD的敏感度和特异度,计算Youden指数,确定最佳截断值;采用线性相关分析血清IL-2和IL-4水平与PSD患者HAMD评分的相关性。结果 PSD组和非PSD组患者血清IL-2水平显著低于对照组,IL-4水平显著高于对照组(P <0. 01); PSD组患者血清IL-2水平显著低于非PSD组,IL-4水平显著高于非PSD组(P <0. 01)。中重度PSD组患者血清IL-2水平显著低于轻度PSD组,IL-4水平显著高于轻度PSD组(P <0. 01)。轻度PSD组和中重度PSD组患者NIHSS评分显著高于非PSD组(P <0. 01);中重度PSD组患者NIHSS评分显著高于轻度PSD组(P <0. 01)。ROC曲线分析显示,IL-2曲线下面积为0. 752(95%可信区间:0. 605～0. 899,P <0. 05),IL-2水平为7. 68μg·L-1时获得最大Youden指数0. 487,血清IL-2水平预测PSD的敏感度为75. 0%,特异度为26. 3%。IL-4曲线下面积为0. 706(95%可信区间:0. 541～0. 871,P <0. 05),IL-4水平为38. 38μg·L-1时获得最大Youden指数0. 529,血清IL-4水平预测PSD的敏感度为79. 2%,特异度26. 3%。血清IL-2水平与PSD患者HAMD评分呈显著负相关(r=-0. 773,P <0. 01),血清IL-4水平与PSD患者HAMD评分呈显著正相关(r=0. 764,P <0. 01)。结论 PSD患者血清IL-2水平降低,IL-4水平升高;血清IL-2水平与PSD患者抑郁程度呈负相关,血清IL-4水平与PSD患者抑郁程度呈正相关;血清IL-2和IL-4水平可在一定程度上预测ACI患者发生PSD的可能性。

Objective To investigate the relationship between the levels of serum interleukin-2 (IL-2) and interleukin-4 (IL-4) and post stroke depression (PSD) in patients with acute cerebral infarction (ACI).Methods Eighty patients with ACI in the First Affiliated Hospital of Xinxiang Medical University from February 10 to March 10,2018 were selected as subjects.All patients were followed up for 3 months after admission.According to the Hamilton Depression Scale (HAMD) score,the patients were divided into PSD group (HAMD score≥8,n=43) and non-PSD group (HAMD score≤7,n=37).The 43 PSD patients included 19 patients with mild PSD (mild PSD group) and 24 patients with moderate and severe PSD (moderate-severe PSD group).Another 40 healthy people who underwent physical examination at the same time were selected as the control group.Five milliliters of fasting venous blood was taken from ACI patients on the 7th day after admission and control subjects on the day of physical examination.The levels of serum IL-2 and IL-4 were detected by enzyme-linked immunosorbent assay (ELISA).The levels of serum IL-2 and IL-4 were compared among the groups.The sensitivity and specificity of serum IL-2 and IL-4 levels in predicting PSD were evaluated by receiver operating characteristic curve(ROC),and the Youden index was calculated to determine the best cut-off value.The correlation between the levels of serum IL-2 and IL-4 and HAMD score in PSD patients was analyzed by linear correlation.Results The level of serum IL-2 in the PSD group and non-PSD group was significantly lower than that in the control group,and the level of serum IL-4 was significantly higher than that in the control group (P<0.01).The level of serum IL-2 in the PSD group was significantly lower than that in the non-PSD group,and the level of serum IL-4 was significantly higher than that in the non-PSD group (P<0.01).The level of serum IL-2 in the moderate-severe PSD group was significantly lower than that in the mild PSD group,and the level of serum IL-4 was significantly higher than that in the mild PSD group (P<0.01).The NIHSS score in the mild PSD group and moderate-severe PSD group was significantly higher than that in the non-PSD group (P<0.01).The NIHSS score in the moderate-severe PSD group was significantly higher than that in the mild PSD group (P<0.01).ROC curve analysis showed that the area under curve of IL-2 was 0.752 (95% confidence interval:0.605-0.899,P<0.05),the maximum Youden index was 0.487 when the level of IL-2 was 7.68 μg·L^-1,and the sensitivity and specificity of the level of serum IL-2 in predicting PSD were 75.0% and 26.3%.The area under curve of IL-4 was 0.706 (95% confidence interval:0.541-0.871,P<0.05),the maximum Youden index was 0.529 when the level of serum IL-4 was 38.38μg·L^-1,and the sensitivity and specificity of the level of serum IL-4 in predicting PSD were 79.2% and 26.3%.The level of serum IL-2 was negatively correlated with HAMD score in patients with PSD (r=-0.773,P<0.01),and the level of serum IL-4 was positively correlated with HAMD score in patients with PSD (r=0.764,P<0.01).Conclusion The level of serum IL-2 decreased and the level of serum IL-4 increased in patients with PSD.The level of serum IL-2 is negatively correlated with depression,and the level of serum IL-4 is positively correlated with depression in patients with PSD.The levels of serum IL-2 and IL-4 can predict the possibility of PSD in patients with ACI to some extent.