SSR、TNF-α对急性脑卒中后抑郁早期诊断的临床意义

Clinical value of SSR and TNF-αin early diagnosis of post-acute stroke depression

目的分析急性脑卒中患者的交感皮肤反应(SSR)检查结果及血浆肿瘤坏死因子-α(TNF-α)水平对脑卒中后抑郁早期诊断的临床意义。方法选择2016-2019年该院收治的103例急性脑卒中患者为观察组,同期在该院体检健康者50例为对照组,比较观察组与对照组SSR检查结果及血浆TNF-α水平。根据脑卒中后是否发生抑郁将观察组患者进一步分为非抑郁组(n=64)与抑郁组(n=39),比较非抑郁组与抑郁组SSR检查结果及血浆TNF-α水平,采用Pearson相关分析SSR检查结果及血浆TNF-α水平与脑卒中后抑郁的相关性。采用受试者工作特征(ROC)曲线分析SSR检查结果及血浆TNF-α水平对脑卒中后抑郁的诊断价值。结果观察组上肢正中神经、下肢胫后神经SSR潜伏期明显长于对照组,SSR波幅明显低于对照组,血浆TNF-α水平明显高于对照组,差异有统计学意义(P<0.05);抑郁组上肢正中神经、下肢胫后神经SSR潜伏期明显长于对照组,SSR波幅明显低于非抑郁组,血浆TNF-α水平明显高于非抑郁组,差异有统计学意义(P<0.05);上肢正中神经、下肢胫后神经SSR潜伏期及血浆TNF-α水平与脑卒中后抑郁呈正相关(r=0.471、0.438、0.623,P<0.001);上肢正中神经、下肢胫后神经SSR波幅与脑卒中后抑郁呈负相关(r=-0.411、-0.449,P<0.05);SSR检查结果及血浆TNF-α水平联合诊断脑卒中后抑郁的AUC为0.928,灵敏度为84.60%,特异度为87.50%,阳性预测值为91.77%,阴性预测值为91.63%,准确度为92.58%,上肢正中神经SSR潜伏期、上肢正中神经SSR波幅、下肢胫后神经SSR潜伏期、下肢胫后神经SSR波幅及血浆TNF-α水平的截断值依次为2.04 s、173.04μV、2.88 s、125.16μV、35.18 ng/L。结论SSR及血浆TNF-α水平联合检测对脑卒中后抑郁早期诊断具有重要临床指导意义。

Objective To analyze the clinical significance of sympathetic skin response(SSR)and plasma tumor necrosis factor-α(TNF-α)level in the early diagnosis of post-acute stroke depression patients.Methods A total of 103 cases of acute stroke patients were selected as observation group,50 cases of healthy subjects were recruited as control group at the same time,SSR and TNF-αwere compared between observation group and control group.According to whether patients in the observation group had suffered from depression after stroke,they were divided into non-depression group(n=64)and depression group(n=39),and the SSR and TNF-αwere compared in the two groups.Pearson correlation was used to analysis the correlations between SSR,TNF-αand post-acute stroke depression.The value of SSR and plasma TNF-αlevel in the diagnosis of post-acute stroke depression were analyzed by receiver operating characteristic(ROC)curve.Results The SSR latency of median nerve of upper limb and posterior tibial nerve of lower limb in observation group were significantly longer than those of control group and the SSR amplitudes were significantly lower than those of control group,the plasma level of TNF-αwas significantly higher than that of control group,the differences were statistically significant(P<0.05).The SSR latency of median nerve of upper limb and posterior tibial nerve of lower limb in depression group were significantly longer than those of non-depression group,the SSR amplitudes were significantly lower than those of non-depression group,the plasma level of TNF-αwas significantly higher than that of non-depression group,the differences were statistically significant(P<0.05).The latent period of SSR of median nerve of upper limb and posterior tibial nerve of lower limb,the plasma level of TNF-αpositively correlated with post-acute stroke depression(r=0.471,0.438,0.623,P<0.05).The SSR amplitude of median nerve of upper limb and posterior tibial nerve of lower limb negatively correlated with post-acute stroke depression(r=-0.411,-0.449,P<0.05).The AUC of SSR examination combined plasma TNF-αlevel in the diagnosis of post-acute stroke depression was 0.928,the sensitivity was 84.60%,the specificity was 87.50%,the positive predictive value was 91.77%,the negative predictive value was 91.63%,the accuracy was 92.58%,the cut-off values of latent period and amplitude of SSR of median nerve of upper limb,latent period and amplitude of SSR of posterior tibial nerve of lower limb,plasma level of TNF-αwere 2.04 s,173.04μV,2.88 s,125.16μV,35.18 ng/L respectively.Conclusion SSR and plasma TNF-αcombined detection has important clinical significance in early diagnosis of post-acute stroke depression.