急性脑梗死患者早期血清中β2-微球蛋白和胱抑素-C水平与卒中后抑郁的关系

The relationship between serumβ2-microglobulin and cystatin-C levels and post-stroke depression in patients with acute cerebral infarction

目的探讨急性脑梗死患者早期血清β2-微球蛋白(β2-microglobulin,β2-MG)和胱抑素-C(Cystatin C,Cys-C)水平与卒中后抑郁(post-stroke depression,PSD)的相关性及其临床意义。方法连续收集首次发病72 h以内的急性脑梗死患者,诊断符合《中国急性缺血性卒中诊治指南2018》的诊断标准,均经头部磁共振DWI证实,参照PSD的诊断标准和汉密尔顿抑郁评分量表24项版本(Hamilton Depression Scale-24,HAMD-24)评分纳入患者。评分≥8分纳入研究组(PSD组),PSD组再根据HAMD得分情况分为轻度和中-重度两个亚组。入院时收集血清β2-MG、Cys-C和生化等实验室指标及临床资料。结果174例急性脑梗死患者中诊断为PSD者64例、发生率为37%。与对照组相比,研究组患者在年龄、高血压、高密度脂蛋白胆固醇(high-density lipoprotein,HDL-C)、肌酐(serum creatinine,Scr)、β2-MG和Cys-C有统计学差异,经多因素Logistic回归分析结果显示年龄、β2-MG和Cys-C可能是PSD发生的独立危险因素;同时发现,β2-MG和Cys-C水平与PSD的严重程度成正相关(P<0.01)。应用ROC曲线对血清β2-MG和Cys-C在PSD诊断中的作用进行分析显示,β2-MG的AUC为0.781,敏感性为0.672、特异性为0.909;Cys-C的AUC为0.785,敏感性为0.828、特异性为0.736;联合诊断的AUC为0.815,敏感性为0.656、特异性为0.909。结论年龄、血清β2-MG和Cys-C可能是PSD发生的独立危险因素,且血清β2-MG和Cys-C与PSD的严重程度相关;β2-MG和Cys-C可能对PSD的发生有一定的诊断价值,二者联合诊断价值更高。

Objective To investigate the correlation between early serumβ2-microglobulin(β2-MG)and cystatin-C(Cys-C)levels and post-stroke depression(PSD)in patients with acute cerebral infarction and their clinical significance.Methods Patients with acute cerebral infarction within 72 hours of the first onset were consecutively collected,and the diagnosis met the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018,all confirmed by head MRI DWI,with reference to the diagnostic criteria of PSD and the 24-item version of the Hamilton Depression Scale-24(HAMD-24)scores were included in the patients.Scores≥8 were included in the study group(PSD group),and the PSD group was further divided into two subgroups,mild and moderate-severe,according to the HAMD score.Laboratory indicators such as serumβ2-MG,Cys-C and biochemistry and clinical data were collected on admission.Results 64 of 174 patients with acute cerebral infarction were diagnosed with PSD,with an incidence of 37%.Compared with the control group,there were statistical differences in age,hypertension,high-density lipoprotein cholesterol(HDL-C),serum creatinine(Scr),β2-MG and Cys-C in the study group,and the results of multifactorial logistic regression analysis showed that age,β2-MG and Cys-C might be the most important factors.β2-MG and Cys-C may be independent risk factors for the occurrence of PSD;meanwhile,the levels ofβ2-MG and Cys-C were found to be positively correlated with the severity of PSD(P<0.01).The analysis of the role of serumβ2-MG and Cys-C in the diagnosis of PSD by applying ROC curves showed that the AUC ofβ2-MG was 0.781,with a sensitivity of 0.672 and specificity of 0.909;the AUC of Cys-C was 0.785,with a sensitivity of 0.828 and specificity of 0.736;the AUC of the combined diagnosis was 0.815,with a sensitivity of 0.656 and specificity of 0.909.Conclusion Age,serumβ2-MG and Cys-C may be independent risk factors for the occurrence of PSD,and serumβ2-MG and Cys-C are associated with the severity of PSD;β2-MG and Cys-C may have some diagnostic value for the occurrence of PSD,and the combined diagnostic value of the two is higher.