急性脑梗死后抑郁患者血清iNOS,MIP-1α水平变化及其临床意义

Serum iNOS and MIP-1α level changes in patients with post-stroke depression and its clinical significance

目的探讨急性脑梗死后抑郁(Post-stroke depression,PSD)患者血清诱导型一氧化氮合酶(Inducible nitric oxide synthase,iNOS)、巨噬细胞炎性蛋白-1α(Macrophage inflammatory protein-1α,MIP-1α)水平变化及其临床意义。方法收集2017年6月-2020年4月本院收治的143例急性脑梗死患者为研究对象,根据患者发病后1个月内是否发生PSD分为PSD组(n=42)和非PSD组(n=101),并于同期随机选取60例体检健康者为对照组;采用酶联免疫吸附法检测各组血清iNOS,MIP-1α水平,绘制受试者工作特征(Receptor operating characteristic,ROC)曲线评估其对PSD的预测价值。结果 PSD组和非PSD组血清iNOS,MIP-1α水平高于对照组,且PSD组高于非PSD组(P<0.05);随着抑郁程度的加重,PSD组患者血清iNOS,MIP-1α水平逐渐升高(P<0.05);经Pearson积矩相关分析显示,PSD组患者血清iNOS,MIP-1α水平与HAMD评分呈正相关(r=0.692、0.658,P<0.05)。ROC曲线显示,iNOS水平预测PSD的AUC为0.862,灵敏度、特异性分别为83.33%、86.14%;MIP-1α水平预测PSD的AUC为0.832,灵敏度、特异性分别为78.57%、81.19%;iNOS联合MIP-1α水平预测PSD的AUC为0.902,灵敏度、特异性分别为88.10%、91.09%。结论 PSD患者血清iNOS,MIP-1α水平异常升高,并与病情严重程度密切相关,早期联合检测可作为预测急性脑梗死患者PSD发生风险的生化指标。

Objective To explore the serum inducible nitric oxide synthase(iNOS) and macrophage inflammatory protein-1α(MIP-1α) level changes in patients with post-stroke depression and its clinical significance. Methods A total of 143 patients with acute cerebral infarction admitted to our hospital from June 2017 to April 2020 were selected as research objects, who were divided into PSD group(n=42) and non-PSD group(n=101) according to whether PSD occurred within one month after the onset of acute cerebral infarction. At the same time, 60 healthy volunteers were randomly selected as control group. The serum iNOS and MIP-1α levels were measured by enzyme-linked immunosorbent assay, and the receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value for PSD. Results The serum iNOS and MIP-1α levels in PSD group and non-PSD group were higher than those in control group, and which in PSD group were higher than those in non-PSD group(P<0.05). With the aggravation of depression among patients with PSD, the serum iNOS and MIP-1α levels increased gradually(P<0.05). Pearson product moment correlation analysis showed that serum iNOS and MIP-1α levels were positively associated with HAMD score in patients with PSD. The ROC curve showed that the AUC of iNOS level in predicting PSD was 0.862, the sensitivity and specificity were 83.33% and 86.14% respectively. The AUC of MIP-1α level in predicting PSD was 0.832, the sensitivity and specificity were 78.57% and 81.19% respectively. The AUC of iNOS level combined with MIP-1α level in predicting PSD was 0.902, the sensitivity and specificity were 88.10% and 91.09% respectively. Conclusion Abnormal increase of serum iNOS and MIP-1α levels mediated the pathogenesis of PSD, which was closely related to the severity of the disease. Early detection of iNOS and MIP-1α levels could be used as biochemical parameters to predict the risk of PSD in patients with acute cerebral infarction.