有效再灌注的急性缺血性脑卒中患者卒中后抑郁相关因素分析

Analysis of related factors of post-stroke depression in acute ischemic stroke patients with effective reperfusion

目的探讨有效再灌注的急性缺血性脑卒中(AIS)患者机械取栓术后90 d发生卒中后抑郁(PSD)的影响因素。方法回顾性分析2019年1月至2020年12月海军军医大学(第二军医大学)第一附属医院脑血管病中心有效再灌注的AIS患者的临床资料,有效再灌注定义为机械取栓治疗血管成功再通(改良脑梗死溶栓分级≥2b)且90 d功能预后良好(改良Rankin量表评分≤3分)。收集患者入院时基线资料,包括入院时白细胞计数、淋巴细胞/单核细胞比值(LMR)等炎症指标和机械取栓治疗相关资料,并采用9条目患者健康问卷抑郁量表(PHQ-9)评估患者的抑郁情绪。将患者分为PSD组(PHQ-9评分≥10分)和无PSD组(PHQ-9评分<10分),分析两组患者临床特征的差异。采用多因素二元logistic回归模型分析PSD的独立影响因素,采用ROC曲线分析LMR及多因素联合预测PSD的价值。结果共纳入206例有效再灌注的AIS患者,其中PSD组68例(33.01%)、无PSD组138例(66.99%)。多因素二元logistic回归分析显示年龄(OR=0.946,P=0.011)、术前Alberta脑卒中计划早期计算机断层扫描评分(OR=0.707,P=0.008)、入院时白细胞计数(OR=0.729,P=0.006)和入院时LMR(OR=0.596,P=0.003)是有效再灌注的AIS患者机械取栓术后90 d发生PSD的独立影响因素。ROC曲线分析显示,上述4项因素联合预测PSD的AUC值为0.795;LMR单独预测PSD的AUC值为0.711,最佳临界值是2.96,灵敏度为71.0%,特异度为64.7%。LMR≤2.96(86例)和LMR>2.96(120例)的患者取栓术后90 d的PSD发生率分别为51.16%(44/86)和20.00%(24/120),差异有统计学意义(χ^(2)=22.00,P<0.001)。结论机械取栓术后获得有效再灌注的AIS患者约1/3会发生PSD。年轻、发病时缺血范围大和入院时LMR与白细胞计数低是PSD发生的独立危险因素。

Objective To investigate the influencing factors of post-stroke depression(PSD)90 d after mechanical thrombectomy(MT)in acute ischemic stroke(AIS)patients with effective reperfusion.Methods The clinical data of AIS paitents with effective reperfusion in Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2019 to Dec.2020 were retrospectively analyzed.Effective reperfusion was defined as successful recanalization(modified thrombolysis in cerebral infarction grade≥2b)and good functional prognosis(modified Rankin scale score≤3)90 d after MT.The baseline data of patients at admission were collected,including inflammatory indicators such as white blood cell(WBC)count and lymphocyte-to-monocyte ratio(LMR),and clinical data related to MT.The depression of patients was evaluated by patient health questionnaire-9(PHQ-9).The patients were divided into PSD group(PHQ-9 score≥10)and non-PSD group(PHQ score<10),and the differences of clinical characteristics between the 2 groups were analyzed.Multivariate binary logistic regression model was used to analyze the independent influencing factors of PSD,and receiver operating characteristic(ROC)curve was used to analyze the value of LMR alone and multivariate combination in predicting PSD.Results A total of 206 AIS patients with effective reperfusion were enrolled,including 68 patients(33.01%)in PSD group and 138 patients(66.99%)in non-PSD group.Multivariate binary logistic regression analysis showed that age(odds ratio[OR]=0.946,P=0.011),Alberta Stroke Program early computed tomography score(ASPECTS)before thrombectomy(OR=0.707,P=0.008),WBC at admission(OR=0.729,P=0.006)and LMR at admission(OR=0.596,P=0.003)were independent influencing factors for PSD 90 d after MT in AIS patients with effective reperfusion.The ROC curve analysis showed that the area under curve(AUC)value of combination of the above 4 factors in predicting PSD was 0.795,and the AUC value of LMR alone in predicting PSD was 0.711.The optimal cut-off value of LMR was 2.96,with a sensitivity of 71.0%and a specificity of 64.7%.The incidence of PSD 90 d after MT in patients with LMR≤2.96(86 cases)and LMR>2.96(120 cases)was 51.16%(44/86)and 20.00%(24/120),respectively,and the difference was statistically significant(χ^(2)=22.00,P<0.001).Conclusion About 1/3 of AIS patients with effective reperfusion will develop PSD.Young age,large ischemic area at the beginning of onset,and low LMR and WBC count at admission are independent risk factors for PSD.