卒中后抑郁程度与血清Th细胞因子及单胺类递质水平的相关性

Correlation analysis of post-stroke depression and serum Th cytokines and monoamine transmitters

目的 分析卒中后抑郁程度与血清Th细胞因子及单胺类递质水平的相关性,为PSD患者早期发现和适当的管理获得更好的干预结果提供参考。方法 选择承德医学院附属医院2020-05—2021-05收治的脑卒中治愈后患者108例,依据汉密尔顿抑郁量表(HAMD)评分分为抑郁组(HAMD评分≥8分者,共58例)与非抑郁组(HAMD评分1~7分者,共50例)。同时抑郁组细分为轻度组15例(HAMD评分8~16分),中度组18例(HAMD评分17~23分),重度组25例(HAMD评分>24分)。分析5组患者在脑卒中后病程第28天的白细胞介素-2(IL-2)、IL-6和肿瘤坏死因子α(TNF-α)、去甲肾上腺素(NE)、5-羟吲哚乙酸(HIAA)、5-羟色胺(5-HT)水平。结果 抑郁组患者的IL-2(45.83±4.13)μg/L、IL-6(14.83±3.82)μg/L、TNF-α(35.71±7.62)μg/L水平均显著高于非抑郁组[(TNF-α)μg/L、(7.24±2.44)μg/L、(20.52±4.46)μg/L](P<0.01)。抑郁组患者重度组的IL-2(48.85±6.62)μg/L、IL-6(16.74±4.28)μg/L、TNF-α(42.87±7.94)μg/L水平均显著高于中度组[IL-2(40.61±5.33)μg/L、IL-6(12.35±3.43)μg/L、TNF-α(35.35±6.34)μg/L]、轻度组[IL-2(33.96±3.42)μg/L、IL-6(8.81±2.77)μg/L、TNF-α(29.34±4.83)μg/L](P<0.01),而中度组的IL-2、IL-6、TNF-α水平均显著高于轻度组(P<0.01)。抑郁组患者的5-HT(108.33±13.25)μg/L、NE(1.94±0.43)μg/L水平均显著低于非抑郁组[(148.14±18.13)μg/L、(4.46±0.69)μg/L](P<0.01),HIAA(0.57±0.07)μg/L水平均显著高于非抑郁组(0.18±0.04)μg/L(P<0.01)。抑郁组患者中重度组的5-HT、NE水平均显著低于中度组、轻度组(P<0.05),而中度组的5-HT、NE水平均显著低于轻度组(P<0.05);抑郁组患者中重度组的HIAA水平均显著高于中度组、轻度组(P<0.05),而中度组的HIAA水平均显著高于轻度组(P<0.05)。将卒中患者作为整体,以卒中后抑郁为因变量进行Logistic回归分析,发现IL-2、IL-6、TNF-α、5-HT、NE、HIAA的独立危险因素(P<0.05)。结论 卒中后抑郁患者IL-2、IL-6、TNF-α水平明显上升,5-HT、NE水平显著降低,HIAA水平明显上升,同时IL-2、IL-6、TNF-α、5-HT、NE、HIAA是卒中后抑郁患者的独立危险因素。

Objective To analyze the correlation between post-stroke depression,serum Th cytokines and monoamine transmitters,and provide references for early detection and proper management of PSD patients to obtain better intervention results.Methods A retrospective selection of 108 patients who were treated in our hospital from May 2020 to May 2021 after healed stroke were divided into depression group based on the Hamilton Depression Scale(HAMD) score(HAMD score≥8 points,A total of 58 cases) and the non-depressive group(with a HAMD score of 1 to 7,a total of 50 cases).At the same time,the depression group is subdivided into mild group(HAMD score 8-16 points,15 cases in total),moderate group(HAMD score 17-23 points,18 cases in total) and severe group(HAMD score> 24 points,25 cases in total) example).The interleukin-2(IL-2),IL-6,tumor necrosis factor α(TNF-α),and norepinephrine in 5 groups of patients on the 28 th day after stroke Levels of Norepinephrine(NE),5-hydroxyindole acetic acid(HIAA),and5-hydroxytryptamine(5-HT) were analyzed.Result The levels of IL-2(45.83±4.13) μg/L,IL-6(14.83±3.82) μg/L,TNF-α(35.71±7.62) μg/L in the depression group were significantly higher than those in the non-depression group [(TNF-α) μg/L,(7.24±2.44) μg/L,(20.52±4.46) μg/L](P<0.01).The levels of IL-2(48.85±6.62) μg/L,IL-6(16.74±4.28) μg/L,TNF-α(42.87±7.94) μg/L in the severe groups of the depression group were significantly higher than those in the moderate [IL-2(40.61±5.33) μg/LIL-6(12.35±3.43) μg/L;TNF-α(35.35±6.34)μg/L]and mild [IL-2(33.96±3.42) μg/L,IL-6(8.81±2.77) μg/L,TNF-α(29.34±4.83) μg/L]groups(P<0.01),while the levels of IL-2,IL-6 and TNF-α in the moderate group,the level was significantly higher than that of the mild group(P<0.01).The levels of 5-HT(108.33±13.25).g/L and NE(1.94±0.43)μg/L in the depression group were significantly lower than those in the non-depressed group [(148.14±18.13) μg/L,(4:46±0.69) μg/L L](P<0.01),HIAA(0.57±0.07) μg/L levels were significantly higher than non-depressed group(0.18±0.04) μg/L(P<0.01).The levels of IL-2,IL-6,and TNF-α of the depression group were significantly lower than those of the moderate and mild groups(P<0.05),while the 5-HT and NE levels of the moderate group were significantly lower In the mild group(P<0.05);the HIAA level of the moderate to severe group in the depression group was significantly higher than that of the moderate group and mild group(P<0.05),while the HIAA level of the moderate group was significantly higher than that of the mild group(P<0.05).Taking stroke patients as a whole,logistic regression analysis with post-stroke depression as the dependent variable found independent risk factors for IL-2,IL-6,TNF-α,5-HT,NE,and HIAA(P<0.05).Conclusion The levels of IL-2,IL-6,and TNF-α in patients with post-stroke depression were significantly increased,the levels of 5-HT and NE were significantly reduced,and the levels of HIAA were significantly increased.At the same time,the levels of IL-2,IL-6,TNF-α,5-HT,NE and HIAA are independent risk factors for patients with post-stroke depression.