老年高血压脑出血术后创伤性应激障碍发生与rs806377位点多态性的关系

Relationship of PTSD after hypertensive intracerebral hemorrhage and rs806377 polymorphism of CNR1 gene in elderly patients

目的探讨老年高血压脑出血术后创伤性应激障碍(PTSD)风险模型构建及其与内源性大麻素受体(cannabinoidreceptor1,CNR1)基因rs806377位点多态性的关系。方法选择2020年1月至2022年8月海南省老年病医院神经内科和海南医学院第一附属医院神经外科收治的老年高血压脑出血患者215例,根据PTSD量表分为PTSD组43例(>50分)和非PTSD组172例(0~50分)。应用基因测序法检测2组CNR1基因rs806377位点多态性,采用单因素和多因素logistic回归分析老年高血压脑出血与PTSD的易感性。选取同期老年高血压脑出血患者103例作为验证组,并建立预测模型。结果2组年龄、家庭年收入、出血量、心理弹性评分、社会支持评分比较,差异有统计学意义(P<0.05,P<0.01)。PTSD组TT基因型和T等位基因频率明显高于非PTSD组(P<0.05,P<0.01)。Logistic回归分析显示,年龄(OR=2.020,95%CI:1.115~3.658)、家庭年收入(OR=1.799,95%CI:1.232~2.626)、出血量(OR=1.507,95%CI:1.243~1.826)、心理弹性评分(OR=2.059,95%CI:1.068~3.969)、社会支持评分(OR=1.664,95%CI:1.122~2.467)、rs806377TT基因型(OR=1.861,95%CI:1.485~2.331)和rs806377T等位基因(OR=3.777,95%CI:2.049~6.962)是老年高血压脑出血患者术后PTSD发生的影响因素(P<0.05,P<0.01)。ROC曲线分析显示,验证组敏感性为69.57%,特异性为71.25%,曲线下面积为0.762(95%CI:0.708~0.813),模型存在一定准确性。结论CNR1基因rs806377位点多态性是PTSD易感性的影响因素,且rs806377TT基因型和rs806377T等位基因可预测老年高血压脑出血术后发生PTSD。

Objective To construct a risk prediction model of post-traumatic stress disorder(PTSD)after hypertensive intracerebral hemorrhage in elderly patients and analyze the correlation of PTSD with rs806377 polymorphism of cannabinoid receptor 1(CNR1)gene.Methods A total of 215 elderly patients with hypertensive cerebral hemorrhage admitted to the Department of Neurology of Geriatric Hospital of Hainan and Department of Neurosurgery of the First Affiliated Hospital of Hainan Medical University from January 2020 to August 2022 were enrolled in this study.According to the results of PTSD scale(scoring>50 or 0~50)after surgical treatment,they were divided into PTSD group(43 cases)and non-PTSD group(172 cases).The rs806377 polymorphism of CNR1 gene was detected in both groups by gene sequencing.Univariate and multivariate logistic regression analyses were used to analyze the susceptibility to PTSD among the elderly after hypertensive intracerebral hemorrhage.Another 103 elderly patients with hypertensive intracerebral hemorrhage during the same period were also subjected and served as verification set.A prediction model was constructed.Results There were significant differences in age,family annual income,blood loss amount,psychological resilience score and social support score between the PTSD group and non-PTSD group(P<0.05,P<0.01).The PTSD group had obviously larger proportion of TT genotype carriers and higher T allele frequency than the non-PTSD group(P<0.05,P<0.01).Logistic regression analysis showed that age(OR=2.020,95%CI:1.115-3.658),family annual income(OR=1.799,95%CI:1.232-2.626),blood loss(OR=1.507,95%CI:1.243-1.826),psychological resilience score(OR=2.059,95%CI:1.068-3.969),social support score(OR=1.664,95%CI:1.122-2.467),rs806377 TT genotype(OR=1.861,95%CI:1.485-2.331)and rs806377 T allele(OR=3.777,95%CI:2.049-6.962)were the influencing factors of postoperative PTSD in these patients(P<0.05,P<0.01).ROC curve analysis indicated that the sensitivity was 69.57%,the specificity was 71.25%,and the AUC value was 0.762(95%CI:0.708-0.813)in the verification group,indicating a certain accuracy of our model.ConclusionCNR1 gene rs806377 locus polymorphism is an influencing factor for PTSD susceptibility,and rs806377 TT genotype and rs806377 T allele can predict PTSD in elderly patients after hypertensive intracerebral hemorrhage.