血清GFAP、NPY水平与老年脑卒中后抑郁的相关性研究

Study on correlation between serum GFAP,NPY and post-stroke depression in the elder patients.

目的探讨血清神经胶质纤维酸性蛋白(GFAP)、神经肽Y(NPY)水平与老年脑卒中后抑郁(PSD)的相关性。方法回顾性选取保定市第二中心医院收治的215例老年脑卒中患者,采用老年抑郁评分表(GDS)分析出院后6个月是患者抑郁状况,根据抑郁发生情况和程度分组。收集患者性别、年龄、病变性质、病变类型的资料;检测入院时血清GFAP、NPY水平;采用日常生活活动量表(ADL)评价患者出院后6个月时日常活动能力;采用美国国立卫生研究院卒中量表(NIHSS)评估患者入院时神经功能缺损状况。采用Pearson相关性分析探讨GDS评分与NIHSS评分、ADL评分、血清GFAP、NPY水平的关系;采用多因素Logistic回归分析PSD发生的影响因素。结果215例脑卒中患者出院后6个月时PSD发生率为33.95%(73/215),其中轻度抑郁39例(53.42%),中重度抑郁34例(46.58%)。PSD组入院时NIHSS评分、血清GFAP水平为(12.55±3.69)分、(24.21±6.01)μg/L,高于非PSD组[(5.77±1.73)分、(18.55±2.49)μg/L],血清NPY水平及ADL评分为(241.58±58.16)ng/mL、(46.43±10.68)分,低于非PSD组[(380.14±67.35)ng/mL、(74.79±10.93)分],差异均有统计学意义(P<0.05)。中重度抑郁组患者入院NIHSS评分及血清GFAP水平为(16.17±3.58)分、(26.80±6.43)μg/L,高于轻度抑郁组[(9.38±2.88)分、(21.94±3.96)μg/L],而血清NPY水平及ADL评分为(213.16±39.66)ng/mL、(41.21±9.72)分,则呈显著低于轻度抑郁组[(266.36±60.73)ng/mL、(50.97±9.49)分],差异均有统计学意义(P<0.05)。NIHSS评分、血清GFAP水平与患者GDS评分呈显著正相关,而血清NPY水平及出院后ADL评分则与GDS评分呈明显负相关(P<0.05)。Logistic回归分析显示,入院时NIHSS评分、血清GFAP水平是PSD发生的独立危险因素,血清NPY水平及ADL评分是GDS的保护因素(P<0.05)。结论脑卒中患者神经功能缺损状况、出院后日常生活能力是影响PSD的重要因素,同时血清GFAP、NPY水平可作为预测PSD发病及病情的参考指标。

Objective To investigate the correlation between serum glial fibrillary acidic protein(GFAP),neuropeptide Y(NPY)and post-stroke depression(PSD)in the elder patients.Methods A total of 215 cases of senile stroke patients were retrospectively selected in Baoding Second Central Hospital.The depression status of patients 6 months post-discharge was analyzed by geriatric depression scale(GDS),and grouped according to the occurrence of depression.The data of gender,age,lesion nature and lesion type were collected.The serum GFAP and NPY levels were detected at admission.At 6 months after discharge,the patient's ability to perform daily activities was evaluated using the activity of daily living(ADL)scale;the patient's neurological deficits at admission were evaluated using the National Institutes of Health Stroke Scale(NIHSS).Pearson correlation was used to analyze the relationship between GDS score and NIHSS score,ADL score,serum GFAP and NPY levels;multivariate Logistic regression was used to analyze the influencing factors of PSD.Results The incidence of PSD was 33.95%(73/215)in 215 stroke patients 6 months post-discharge,of which 39 cases(53.42%)was mild depression and 34 cases(46.58%)was moderate and severe depression.The NIHSS score and serum GFAP level at admission of the PSD group were(12.55±3.69)points and(24.21±6.01)μg/L,which were higher than those of the non-PSD group[(5.77±1.73)points,(18.55±2.49)μg/L],serum NPY level and ADL score were(241.58±58.16)ng/L and(46.43±10.68)points,which were lower than those of non-PSD group[(380.14±67.35)μg/L,(74.79±10.93)points],and the differences were statistically significant(P<0.05).The NIHSS score and serum GFAP level at admission of the moderate and severe depression group were(16.17±3.58)points and(26.80±6.43)μg/L,which were higher than those of the mild depression group[(9.38±2.88)points and(21.94±3.96)μg/L],while the serum NPY level and ADL score were(213.16±39.66)ng/mL and(41.21±9.72)points,which were significantly lower than those of the mild depression group[(266.36±60.73)ng/mL and(50.97±9.49)points],the differences were statistically significant(P<0.05).NIHSS score,serum GFAP level were significantly positively correlated with GDS score,while serum NPY level and ADL score were significantly negatively correlated with GDS score(P<0.05).Logistic regression analysis showed that NIHSS score,serum GFAP level at admission were independent risk factors for GDS,serum NPY level and ADL score were protective factors for PSD(P<0.05).Conclusion Neurological function deficit and post-discharge daily living ability of stroke patients are important factors affecting GDS,and serum GFAP and NPY levels can be used as reference indexes to predict the incidence and condition of PSD.