红细胞分布宽度与急性缺血性卒中后抑郁的相关性研究

Correlation between red blood cell distribution width and post-stroke depression

目的探讨入院时红细胞分布宽度(red blood cell distribution width,RDW)与急性缺血性卒中后抑郁(post-stroke depression,PSD)的关系。方法连续纳入2017年5月-2020年5月于安徽理工大学附属亳州市人民医院神经内科收治的急性缺血性卒中患者。记录患者的临床资料,入院后2 d晨采用全自动五分类血细胞分析仪检测RDW。以门诊或住院方式随访3 m,根据是否诊断为抑郁,分为PSD组和非PSD组。采用多因素Logistic回归模型分析与PSD相关的独立影响因素,绘制ROC曲线分析RDW对PSD的预测价值。结果最终纳入413例患者,女性169例(40.92%),年龄40~86岁,平均65.89岁。88例(21.31%)发生PSD,325例(78.69%)未发生PSD。多因素Logistic回归模型分析显示,入院NIHSS评分(OR=1.134,95CI 1.049~1.225,P<0.001),关键部位梗死(OR=1.363,95CI 1.205~1.641,P<0.001),女性(OR=1.888,95CI 1.097~3.249,P=0.022),RDW(OR=3.730,95CI 2.229~6.051,P<0.001)是PSD的独立危险因素。ROC曲线分析显示,RDW的预测PSD的ROC曲线下面积为0.709(95%CI 0.656~0.763,P<0.001),最佳截值13.01%,敏感度77.6%,特异度55.7%。结论RDW是急性缺血性卒中患者发病3 m内发生抑郁的独立预测因素,对PSD有一定的预测价值。

Objective To investigate the relationship between red blood cell distribution width(RDW)and post-stroke depression in patients with acute ischemic stroke.Methods Continuous collection of patients with acute cerebral infarction admitted to our hospital from May 2017 to May 2020.All cases were divided into the non PSD group and PSD group according to whether they were diagnosed with depression at 3 months.The clinical data of the patients were recorded,and RDW was detected by automatic five-classification blood cell analyzer in the morning of the second day after admission.Multivariate Logistic regression analysis were used to screen the risk factors of PSD.The ROC curve analysis was performed to evaluate the predictive value.Results A total of 413 eligible patients were included,with an average age of 65.89 years(aged 40 to 86 years)and 169 males(40.92%).During the follow-up 3 months after onset,the total number of patients diagnosed with depression was 88例(21.31%).Multivariate Logistic regression analysis showed that the admission NIHISS score(OR=1.134,95%CI 1.049~1.225,P<0.001)and infarction of key areas(OR=1.363,95%CI 1.205~1.641,P<0.001),Female(OR=1.888,95%CI 1.097~3.249,P=0.022)RDW(OR=3.730,95%CI 2.229~6.051,P<0.001)were independent risk factors for PSD.The area under the ROC curve(AUC)of RDW for predicting poor prognosis was 0.709(95%CI 0.656~0.763,P<0.001),the optimal cut-off value was 13.01%,the sensitivity was 77.6%and the specificity was 55.7%.Conclusion RDW was an independent risk factor for post-stroke depression at 3 months in acute ischemic stroke patients.