C反应蛋白联合中性粒细胞与淋巴细胞比值预测缺血性脑卒中患者卒中后抑郁的价值

Value of C-reactive protein combined with neutrophil to lymphocyte ratio in predicting post-stroke depression of patients with ischemic stroke

目的探讨C反应蛋白(CRP)联合中性粒细胞与淋巴细胞比值(NLR)预测缺血性脑卒中患者卒中后抑郁(PSD)的价值。方法选取发病72 h内的急性缺血性脑卒中患者为研究对象,并收集患者临床资料。随访3个月,根据PSD发生情况分为非PSD组和PSD组,比较2组患者的一般资料。分析NLR与PSD的关系,探讨NLR联合CRP预测PSD的价值。PSD组患者又依据汉密尔顿抑郁量表(HAMD)评分分为轻度抑郁组和中重度抑郁组,比较2组炎症指标的差异。结果与非PSD组相比,PSD组女性患者比率、体质量指数(BMI)、糖尿病比率、NLR、CRP水平、前循环梗死比率、入院美国国立卫生研究院卒中量表(NIHSS)评分、住院时间、HAMD评分均较高,差异有统计学意义(P<0.05)。轻度抑郁组患者NLR、CRP依次为(2.69±0.81)和(3.79±1.22)mg/dL,均低于中重度抑郁组患者的(2.87±0.84)和(4.44±1.37)mg/dL,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,女性、NIHSS评分、CRP、NLR是PSD发生的独立危险因素。NLR联合CRP预测PSD的曲线下面积(AUC)为0.86,敏感度为92.14%,特异度为83.26%。结论NLR联合CRP预测PSD的敏感性及特异性较高,具有更高的预测价值。

Objective To investigate the value of C-reactive protein(CRP) combined with neutrophil to lymphocyte ratio(NLR) in predicting post-stroke depression(PSD) of patients with ischemic stroke. Methods Patients with acute ischemic stroke within 72 hours of onset were selected as research objects, and their clinical materials were collected. After 3 months of follow up, the patients were divided into non-PSD group and PSD group according to the occurrence of PSD, and the general materials of the two groups were compared. The relationship between NLR and PSD was analyzed, and the value of NLR combined with CRP in predicting PSD was discussed. PSD patients were further divided into mild depression group and moderate to severe depression group according to score of the Hamilton Depression Scale(HAMD), and the differences of inflammatory indexes were compared between the two groups. Results Compared with non-PSD group, the ratio of female patients, body mass index(BMI), ratio of diabetes patients, NLR, CRP level, the ratio of anterior circulation infarction, the score of National Institutes of Health Stroke Scale(NIHSS) on hospital admission, hospitalization time and HAMD score in the PSD group were significantly higher(P<0.05). NLR and CRP in the mild depression group were(2.69±0.81) and(3.79±1.22) mg/dL respectively, which were significantly lower than(2.87±0.84) and(4.44±1.37) mg/dL in the moderate to severe depressiongroup(P<0. 05). Multiple Logistic regression analysis showed that female, NIHSS score, CRP leveland NLR were independent risk factors for PSD. Area under the curve(AUC) of NLR combinedwith CRP in predicting PSD was 0. 86, the sensitivity was 92. 14%, and the specificity was83. 26%.Conclusion NLR combined with CRP has higher sensitivity and specificity in predictingPSD, which means it has a higher prediction value.