老年脑卒中后抑郁水平与5-HT、炎性因子和BDNF水平的关系

The relationship between depression level and levels of 5-HT,inflammatory factors and BDNF in the elderly after stroke

目的 探究老年脑卒中后患者抑郁水平与血清单胺类递质(5-HT)、炎性因子(TNF-α、IL-6)和脑源性神经营养因子(BDNF)水平的关系。方法 选取2019年3月至2021年12月承德医学院附属医院神经内科收治的老年脑卒中后患者223例为研究对象,采用汉密尔顿抑郁量表(HAMD)评估患者抑郁水平,将HAMD评分≥9分的95例患者纳入抑郁组,HAMD评分<9分的128例患者纳入非抑郁组。检测所有患者血清5-HT、TNF-α、IL-6和BDNF水平,并绘制ROC曲线分析上述因子对老年脑卒中后抑郁的诊断价值。结果 非抑郁组血清5-HT、BDNF水平均高于抑郁组,差异有统计学意义(t=3.559,2.773,P<0.05);非抑郁组血清TNF-α、IL-6水平均低于抑郁组,差异有统计学意义(t=15.032,9.976,P<0.05)。多因素Logistic回归分析显示,5-HT(β=317,OR=1.373)、TNF-α(β=0.273,OR=1.314)、IL-6(β=0.916,OR=2.838)是老年脑卒中后抑郁的独立影响因素(P<0.05)。ROC曲线显示,血清5-HT、TNF-α和IL-6三者联合检测的AUC为0.924,敏感性、特异性分别为94.74%、86.72%,优于单一检测(P<0.05)。结论 老年脑卒中后患者抑郁的发生可能与其血清单胺类递质分泌减少、血清炎性因子水平升高有关。

Objective To explore the relationship between depression level and serum monoamine transmitter(5-HT),inflammatory factors(TNF-α,IL-6)and brain-derived neurotrophic factor(BDNF)levels in elderly post-stroke patients. Methods A total of 223 elderly post-stroke patients admitted to the Department of Neurology,Affiliated Hospital of Chengde Medical College from March 2019 to December 2021 were selected as the research objects. The Hamilton Depression Scale(HAMD)was used to evaluate the depression level of the patients,and the HAMD score was ≥ 9 points. 95 patients were included in the depression group,and 128 patients with HAMD score<9 were included in the non-depressed group. Serum levels of 5-HT,TNF-α,IL-6 and BDNF were detected in all patients,and the ROC curves were drawn to analyze the diagnostic value of the above factors for post-stroke depression in the elderly. Results The serum levels of 5-HT and BDNF in the non-depressed group were higher than those in the depression group,and the difference was statistically significant(t=3.559,2.773,P<0.05). The serum levels of TNF-α and IL-6 in the non-depressed group were lower than those in the depression group,the difference was statistically significant(t=15.032,9.976,P<0.05). Multivariate Logistic regression analysis showed that 5-HT(β=317,OR=1.373),TNF-α(β=0.273,OR=1.314),IL-6(β=0.916,OR=2.838)were associated with post-stroke independent influencing factors of depression(P<0.05). The ROC curve showed that the AUC of the combined detection of serum 5-HT,TNF-α and IL-6 was 0.924,and the sensitivity and specificity were 94.74% and 86.72%,respectively,which were better than single detection(P<0.05). Conclusion The occurrence of depression in elderly post-stroke patients may be related to the the decrease of serum monoamine transmitter secretion and the increase of serum inflammatory factor levels.