CALLY指数对缺血性脑卒中后抑郁的预测价值

Predictive value of CALLY index for depression after ischemic stroke

目的探讨CALLY指数对缺血性脑卒中后抑郁(PSD)的预测价值。方法纳入179例缺血性脑卒中患者的临床资料,收集患者的人口学信息、病史、卒中严重程度、入院时实验室指标等。随访6个月,采用17项汉密尔顿抑郁量表(HAMD-17)对所有患者进行抑郁症状评估,将患者分为PSD组(48例)和非PSD组(131例),比较2组患者临床特征的差异。根据C反应蛋白(CRP)、白蛋白(ALB)和淋巴细胞计数计算CALLY指数。采用受试者工作特征(ROC)曲线分析CALLY指数对PSD的预测价值。Spearman相关分析PSD患者CALLY指数与神经和认知功能的相关性。K-M曲线和Cox回归分析CALLY指数对PSD发生的影响。结果179例患者CALLY指数范围为0.54~1.79,中位数1.08。ROC曲线分析显示,CALLY指数预测PSD的最佳临界值为1.09,ROC曲线下面积为0.757(95%CI:0.687~0.818)。与非PSD组相比,PSD组女性比例升高,受教育年限较短,合并高脂血症患者比例升高,血清CRP升高,ALB、CALLY指数下降(P<0.05)。K-M曲线显示,CALLY≤1.08的患者PSD发生率明显高于>1.08者(33.0%vs.20.5%,Log rankχ^(2)=8.553,P=0.004)。Cox回归分析显示,校正其他协变量后,CALLY指数下降是PSD发生的独立危险因素(HR=2.651,95%CI:1.269~5.540,P<0.05)。结论CALLY指数对急性缺血性脑卒中患者发生PSD有一定的预测价值,有助于早期识别和及时干预,改善患者预后。

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression(PSD).Methods The clinical data of 179 patients with ischemic stroke were included,and the demographic information,medical history,stroke severity and laboratory indicators at admission were collected.After 6 months of follow-up,all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale(HAMD-17).Patients were divided into the PSD group(48 cases)and the non-PSD group(131 cases).Differences in clinical characteristics were compared between the PSD group and the non-PSD group.CALLY index was calculated from C-reactive protein(CRP),albumin(ALB)and lymphocyte counts.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CALLY index to PSD.Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients.K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD.Results The CALLY index of 179 patients ranged from 0.54 to 1.79,with a median of 1.08.ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09,and the area under ROC curve was 0.757(95%CI:0.687-0.818).Compared with the non-PSD group,the proportion of females was higher in the PSD group,and the proportion of patients with hyperlipidemia was increased with shorter years of education.The serum C-reactive protein(CRP)was higher,and albumin(ALB)and CALLY index were lower(P<0.05).The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group(CALLY≤1.08)than that in the higher CALLY index group(CALLY>1.08,33.0%vs.20.5%,Log rankχ^(2)=8.553,P=0.004).Cox regression analysis showed that after adjusting for other covariates,the decreased CALLY index was an independent risk factor for PSD(HR=2.651,95%CI:1.269-5.540,P<0.05).Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients,which is helpful for early identification and timely intervention to improve the prognosis of patients.