卒中后抑郁患者血清肿瘤坏死因子α水平与认知功能:一项8周随访研究

Serum TNF-α levels and cognitive function in patients with post-stroke depression: an 8-week follow-up study

目的探讨卒中后抑郁患者治疗前后血清肿瘤坏死因子α(TNF-α)水平与认知功能的特点及相关性.方法回顾性连续纳入苏州市广济医院2016年7月至2019年6月的门诊及住院卒中后抑郁患者42例,列入研究组.入选同期医院年龄匹配的社会健康体检人员42名作为对照.对研究组患者给予常规口服抗抑郁药物治疗,根据患者具体情况,在1~2周内逐渐加量至治疗量.研究组治疗前(基线期)及治疗8周后,采用汉密尔顿抑郁量表(HAMD)评定患者抑郁严重程度,采用剑桥神经心理自动化成套测试(CANTAB)中的快速视觉信息处理(RVP)进行认知功能测试,采用酶联免疫吸附剂测定法测定患者空腹血清TNF-α浓度.对照组仅基线期测定认知功能及空腹血清TNF-α浓度,并进行两组间及研究组治疗前后各指标的比较.采用Pearson相关分析法观察研究组治疗前后血清TNF-α水平与RVP认知测试、HAMD-17总分的相关性.结果(1)治疗前,研究组血清TNF-α水平[(35.80±7.06)ng/L]高于对照组[(20.70±3.65)ng/L];认知测试中,RVP的命中率[(56.33±20.89)%]、总正确数(244.73±14.38)、总击中数(14.57±5.05)及A′统计量(0.88±0.05)均低于健康对照组[分别为(73.00±15.77)%、(260.72±11.77)、(19.00±4.70)、(0.92±0.05)],总漏击数(11.39±4.55)高于对照组(7.29±4.02),差异均有统计学意义(均P<0.01).相关性分析显示,研究组血清TNF-α水平与RVP中的命中率(r=-0.271)、总正确数(r=-0.345)、总击中数(r=-0.317)及A′统计量(r=-0.351)均呈负相关(均P<0.01),与总漏击数(r=0.420)、HAMD-17总分(r=0.756)呈正相关(均P<0.01).(2)治疗后,研究组血清TNF-α水平、RVP认知测试(总正确数、总击中数、A′统计量)及HAMD-17总分[分别为(22.30±4.04)ng/L、(253.01±15.63)、(18.58±4.79)、(0.90±0.06)、(7.52±2.12)分]均较治疗前改善,差异均有统计学意义(均P<0.05).结论卒中后抑郁患者血清TNF-α升高、认知功能下降,经治疗后血清TNF-α降低、认知功能改善;相关性分析提示治疗前卒中后抑郁患者血清TNF-α水平与认知功能相关.

Objectives To explore the characteristics and correlation of serum TNF-αlevels and cognitive function before and after treatment in patients with post-stroke depression.Methods A total of 42 patients with post-stroke depression in the inpatients and outpatients department of Suzhou Guangji Hospital from July 2016 to June 2019 were recruited as study group retrospectively.And 42 age matched social health examinees were selected as the control group.The patients in the study group were treated with conventional oral antidepressants.According to the specific situation of the patients,the dosage gradually increased to the treatment amount within 1-2 weeks.In the study group,before treatment and 8 weeks after treatment,the severity of depression was assessed by Hamilton Depression Scale(HAMD),the cognitive function was tested by rapid visual information processing(RVP)in Cambridge Neuropsychological Automated Test(CANTAB),and the serum TNF-αconcentration was measured by enzyme-linked immunosorbent assay.In the control group,cognitive function and fasting serum TNF-αwere measured only at baseline,and the indexes of the two groups and the indexes before and after treatment in the study group were compared.Pearson correlation analysis was used to study the correlation of TNF-αlevel with RVP cognitive test and HAMD-17 total score before and after treatment in the study group.Results(1)Before treatment,the serum TNF-αlevel in the study group(35.80±7.06)ng/L was higher than that in the control group(20.70±3.65)ng/L;in the cognitive test,the RVP hit rate(56.33±20.89),the total correct number(244.73±14.38),the total number of hits(14.57±5.05)and A'statistics(0.88±0.05)were lower than those in the healthy control group,while the total number of missed strokes in the study group(11.39±4.55)was higher than that in the control group(7.29±4.02),and the difference was statistically significant(P<0.05).The result of correlation analysis showed the serum TNF-αlevelin the study group was negatively correlated with the hit rate(r=-0.271),total correct number(r=-0.345),total number of hits(r=-0.317)and A′statistics(r=-0.351)in the RVP(P<0.01),and was positivelyrelated to the total missed number(r=0.420)and HAMD-17(r=0.756)(P<0.01).(2)After treatment,the serum TNF-αlevel,RVP cognition test(total correct number,total number of hits,A′statistic)and total HAMD-17 scores in the study group were(22.30±4.04)ng/L,(253.01±15.63),(18.58±4.79),(0.90±0.06)and(7.52±2.12),which were all improved,and the differences were statistically significant(all P<0.05).Conclusions Serum TNF-αincreases and cognitive function decreases in patients with post-stroke depression.Serum TNF-αdecreases and cognitive function improves after treatment.Correlation analysis suggests that serum TNF-αlevels are related to cognitive function in patients with post-stroke depression.