入院时血清超敏C反应蛋白水平等指标对脑卒中后抑郁的预测价值

Predictive value of serum high-sensitivity C-reactive protein level at admission on post-stroke depression

目的探究急性脑卒中患者入院时血清hs-CRP水平等指标与脑卒中后抑郁(post stroke depression,PSD)的相关性及其对PSD的预测价值。方法选择2015年6月—2017年6月本院诊治的98例急性脑卒中患者进行前瞻性分析,根据是否发生PSD分为PSD组(36例)和非PSD组(62例),比较两组患者的一般资料、NIHSS评分、HAMD评分以及血清hs-CRP、Hcy水平,应用多因素Logistic回归模型探究影响PSD发生的独立危险因素,并应用受试者工作特征曲线评估不同指标对PSD的预测价值。结果PSD组患者的平均年龄、BMI、既往卒中史比例以及NIHSS评分和HAMD评分均明显高于非PSD组(P<0.05),两组患者的性别比例、糖尿病史、房颤史、卒中类型和就诊时间等临床资料间均无统计学差异(P> 0.05)。PSD患者的LDL-c、Hcy和hs-CRP水平明显高于非PSD组(P<0.05)。多因素Logistic回归分析显示,HAMD评分(OR=3.221,P=0.026)、NIHSS评分(OR=6.312,P=0.002)、hs-CRP水平(OR=39.251,P=0.010)和Hcy水平(OR=34.661,P=0.010)是影响PSD发生的独立危险因素。入院时hs-CRP水平预测急性脑卒中患者发生PSD的AUC明显高于HAMD评分、Hcy和NIHSS评分单独应用(Z=3.481,2.070,2.089,P=0.001,0.039,0.036),Youden指数显示hs-CRP的最佳截点为≥1.64 mg/d L,此时其灵敏度和特异度分别为94.44%和75.47%。结论 HAMD评分、NIHSS评分、Hcy和hs-CRP水平是影响PSD发生的独立危险因素;入院时hs-CRP水平对预测急性脑卒中患者发生PSD具有较高的诊断效能。

Objective To investigate the correlation between serum levels of hypersensitive C-reactive protein(hs-CRP)at admission and post-stroke depression(PSD)and its predictive value for PSD in acute stroke patients.Methods From May 2016 to June 2017,98 cases of patients with acute stroke in our hospital were prospectively analyzed.All patients were divided into PSD group(36 cases)and non-PSD group(62 cases)according to whether PSD occurred.The general data,NIHSS score,Hamilton Depression Scale(HAMD)score and serum levels of hs-CRP and Hcy of the two groups were compared.The multivariate logistic regression model was used to explore independent risk factors for PSD,and the predictive value of different indicators for PSD was assessed by the receiver operating characteristic curves.Results The average age,BMI,proportion of previous stroke history,NIHSS score and HAMD score in PSD group were significantly higher than those in non-PSD group(P<0.05).There was no significant difference between the two groups in sex ratio,diabetes mellitus history,atrial fibrillation history,stroke type and time of treatment(P>0.05).The levels of LDL-c,Hcy and hs-CRP in PSD patients were significantly higher than those in the non-PSD group(P<0.05).Multivariate logistic regression analysis showed that HAMD score(OR=3.221,P=0.026),NIHSS score(OR=6.312,P=0.002),concentration of hs-CRP(OR=39.251,P=0.010)and Hcy(OR=34.661,P=0.010)were independent risk factors for PSD.The AUC of hs-CRP in predicting PSD in patients with acute stroke was significantly higher than HAMD score,Hcy and NIHSS scores(Z=3.481,2.070,2.089,P=0.001,0.039,0.036).Youden index showed that the best cut-off point of hs-CRP was equal or greater than 1.64 mg/dL,and the sensitivity and specificity were 94.44%and 75.47%respectively.Conclusions HAMD score,NIHSS score and hs-CRP level are independent risk factors for PSD,and the level of hs-CRP at admission has a high diagnostic efficiency for predicting the occurrence of PSD in patients with acute stroke.