卒中后抑郁患者血清BDNF水平变化的临床意义
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摘要
目的分析卒中后抑郁患者血清脑源性神经营养因子(BDNF)水平与病情严重程度相关性。方法选择2015年8月—2018年1月海南省安宁医院心理咨询治疗中心治疗卒中后抑郁患者82例作为病例组,另纳入同期体检的健康者90例作为对照组,对2组患者的临床资料及卒中后抑郁患者BDNF水平与病情严重程度相关性进行分析。结果病例组患者血清BDNF水平低于对照组[(12.94±5.88)ng/ml vs.(23.25±8.79)ng/ml,t=-8.959,P <0.001],抑郁评分和NIHSS评分高于对照组患者(t=9. 767、5.054, P均<0.001);在病例组患者中,不同病灶体积、不同抑郁评分、不同NIHSS评分患者的血清BDNF-水平比较差异均具有统计学意义(t=-6. 616、F=15. 204、t=-7.273,,P均<0.001);血清BDNF水平与病灶体积、抑郁评分、NIHSS评分之间均呈负相关(r=-0. 397、-0.432、-0.411,P均<0.001);利用血清BDNF水平、抑郁评分和NIHSS评分对卒中后抑郁患者进行诊断,最佳截断值分别为21.72 ng/ml、11.56分、16.78分,诊断准确度分别为57.34%、64.17%、58.89%。结论卒中后抑郁患者的血清BDNF水平明显降低,随着患者的病情加重,血清BDNF水平也下降趋势,其对卒中后抑郁具有一定的诊断意义。
Objective To analyze the correlation between serum brain derived neurotrophic factor( BDNF) level and severity of post stroke depression. Methods From August 2015 to January 2018,82 patients with post-stroke depression were treated by the Psychological Counseling and Therapy Center of Anning Hospital of Hainan Province as case group, and 90 healthy persons were included in the same period as control group. The clinical data of the two groups and the correlation between BDNF level and severity of post-stroke depression were analyzed. Results The serum BDNF level of patients in the case group was lower than that in the control group [(12.94+5. 88) ng/ml vs.(23.25 +8. 79) ng/ml, t =-8.959, P <0.001 ],and the depression score and NIHSS score were higher than those in the control group(t=9.767,t=5.054, P <0.001). In the case group, the serum BDNF levels of patients with different lesion volume, different depression score and different NIHSS score were significantly different. Significance( t =-6.616, F=15.204, t =-7.273, P < 0.001);serum BDNF level was negatively correlated with lesion volume, depression score and NIHSS score(r =-0.397, r=-0.432, r =-0.411, P <0.001); serum BDNF level, depression score and NIHSS score were used to diagnose post-stroke depression patients, and the best cut-off values were 21.72 ng/ml, 11.56, 16.78, respectively. The accuracy was 57.34%, 64. 17%and 58.89% respectively. Conclusion The level of serum BDNF in patients with post-stroke depression decreased significantly. With the aggravation of patients' condition, the level of serum BDNF also decreased. The level of serum BDNF has certain diagnostic significance for post-stroke depression.
Objective To analyze the correlation between serum brain derived neurotrophic factor( BDNF) level and severity of post stroke depression. Methods From August 2015 to January 2018,82 patients with post-stroke depression were treated by the Psychological Counseling and Therapy Center of Anning Hospital of Hainan Province as case group, and 90 healthy persons were included in the same period as control group. The clinical data of the two groups and the correlation between BDNF level and severity of post-stroke depression were analyzed. Results The serum BDNF level of patients in the case group was lower than that in the control group [(12.94+5. 88) ng/ml vs.(23.25 +8. 79) ng/ml, t =-8.959, P <0.001 ],and the depression score and NIHSS score were higher than those in the control group(t=9.767,t=5.054, P <0.001). In the case group, the serum BDNF levels of patients with different lesion volume, different depression score and different NIHSS score were significantly different. Significance( t =-6.616, F=15.204, t =-7.273, P < 0.001);serum BDNF level was negatively correlated with lesion volume, depression score and NIHSS score(r =-0.397, r=-0.432, r =-0.411, P <0.001); serum BDNF level, depression score and NIHSS score were used to diagnose post-stroke depression patients, and the best cut-off values were 21.72 ng/ml, 11.56, 16.78, respectively. The accuracy was 57.34%, 64. 17%and 58.89% respectively. Conclusion The level of serum BDNF in patients with post-stroke depression decreased significantly. With the aggravation of patients' condition, the level of serum BDNF also decreased. The level of serum BDNF has certain diagnostic significance for post-stroke depression.
引文
[1]汪文娟,周霞,孙中武,等.脑卒中前痴呆与脑卒中后认知损害对脑卒中患者3个月短期预后的影响[J].中国老年学杂志,2018,38(8):1799-1801. DOI:10. 3969/j. issn. 1005-9202. 2018. 08.004.
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[3]顾竞春,李勤,顾怡勤,等.Kano模型在区域脑卒中人群服务模式建立中的探索与实践[J].中国全科医学,2018,21(18):2201-2208. DOI:10.3969/j. issn. 1007-9572.2018.00.216.
[4]李丽君,胡卫疆,高雅坤,等.抗抑郁药联合重复经颅磁刺激治疗卒中后抑郁的meta分析[J].中国心理卫生杂志,2017,31(4):274-277. DOI:10. 3969/j. issn. 1000-6729.2017.04.004.
[5]李宝玲,段婧婧,岳永花,等.疏脑解郁汤对卒中后抑郁大鼠学习记忆能力的影响及作用机理研究[J].中成药,2016,38(5):1147-1150. DOI:10.3969/j. issn. 1001-1528.2016.05.040.
[6]鲁豫,田小军,史莉瑾,等.MiR-137在缺血性卒中后抑郁患者外周血中的表达及其临床意义[J].临床神经病学杂志,2017,30(3):217-220. DOI:10.3969/j. issn. 1004-1648.2017.03.016.
[7]常静,沈仲夏,蔡敏,等.卒中后抑郁患者抗抑郁治疗血清S100B蛋白的变化分析[J].医学研究生学报,2016,29(7):737-740.DOI:10. 16571/j. cnki. 1008-8199. 2016.07.014.
[8]姚丽君,刘兆庆,周锦,等.通督调神针刺法结合认知疗法干预卒中后抑郁患者临床研究[J].世界科学技术:中医药现代化,2017,19(8):1319-1323. DOI:10. 11842wst.2017.08.010.
[9] Matsuzaki S,Hashimoto M,Yuki S, et al. The relationship between post-stroke depression and physical recovery[J]. Journal of AffectiveDisorders,2015,176(11):56-60. DOI:10. 1016/j. jad. 2015. 01.020.
[10] Ilchibaeva TV, Kondaurova EM,Tsybko AS, et al. Brain-derived neurotrophic factor(BDNF)and its precursor(proBDNF)in genetically defined fear-induced aggression[J]. Behavioural Brain Research:An International Journal,2015,290(8):45-50. DOI:10.1016/j. bbr. 2015.04.041.
[11]王兵,姜玉章,沈冲,等.血脂与缺血性脑卒中危险因素的相关分析[J].中华老年心脑血管病杂志,2013,15(1):92. DOI:10.3969/j. issn. 1009-0126.2013.01.029.
[12]王垚,李春波.研究域标准框架研究进展[J].中华精神科杂志,2018,51(3):209-212. DOI:10. 3760/cma. j. issn. 1006-7884.2018.03.011.
[13]姚传芳·情感性精神障碍[M].长沙:湖南科学技术出版社,1998:210-213.
[14]罗高权,曾凡杰,武肖娜,等.组建脑卒中中心对急性缺血性脑卒中患者诊疗指标的影响[J].实用医学杂志,2018,34(6):885-889. DOI:10.3969/j. issn. 1006-5725.2018.06.003.
[15]苑杰,路月英,郭鑫,等.卒中后抑郁患者的临床异质性研究[J].中国全科医学,2017,20(31):3941-3946. DOI:10. 3969/j. issn.1007-9572.2017.31.022.
[16]王思博,王慧彬,曲慧玲,等.卒中后抑郁的影响因素及其对生活质量的影响[J].中国医科大学学报,2017,46(9):844-847.DOI:10. 12007/j. issn. 0258-4646.2017.09.017.
[17]崔燕,魏峰,阎文静,等.脑卒中后抑郁发病的影响因素[J].山东医药,2017,57(9):89-91. DOI:10. 3969/j. issn. 1002-266X.2017.09.031.
[18]李平,张巧莲,李双英,等.卒中后抑郁与血清炎性细胞因子水平及神经功能损害的相关性分析[J].中国应用生理学杂志,2017,33(2):121-123,145. DOI:10.12047/j. cjap.5512.2017.031.
[19]钱淑霞,庄建华,岳卫清,等.基于分类回归树模型的卒中后抑郁预测研究[J].临床神经病学杂志,2018,31(2):143-145.DOI:10. 3969/j. issn. 1004-1648.2018.02.019.
[20]王培培,王雪丹,刘凤丽,等.依达拉奉对急性脑梗死患者血清BDNF水平影响及疗效的多中心研究[J].中国生化药物杂志,2015,2(2):137-139.
[21]杨永刚,张建平,赵会颖,等.远程缺血后适应对短暂性脑缺血发作患者的脑氧代谢及血清BDNF、MMP-9的影响[J].疑难病杂志,2017,16(11):1081-1084.
[22]赵洪庆,韩远山,柳卓,等.焦虑性抑郁模型大鼠脑区单胺递质含量与神经因子表达的变化[J].中国实验动物学报,2017,25(4):373-379. DOI:10.3969/j. issn. 1005-4847.2017.04.006.
[23]黄宏亮,杨莉莉,黄崴,等.脑卒中患者血清PARK7、LPA和D-D水平与颈动脉粥样硬化及神经缺损程度的关系[J].疑难病杂志,2017,16(8):776-779,783.
[24]刘华慧.甲钴胺治疗老年脑梗死伴高同型半胱氨酸血症及卒中后抑郁的临床效果[J].中国医药,2017,12(11):1652-1655.
[25] Silva A,Naia L,Dominguez A, et al. Overexpression of BDNF and full-length trkB Receptor ameliorate striatal neural survival in huntington's disease[J]. Neuro-degenerative Diseases, 2015,15(4):207-218. DOI:10.1159/000375447.
[26]徐倩,安宏伟,韩真贤,等.安非他酮治疗卒中后抑郁的临床疗效及其对脑源性神经营养因子的影响[J].中国健康心理学杂志,2017,25(6):835-838. DOI:10. 13342/j. cnki. cjhp. 2017. 06.010.
[27]冯琬,杨耀军.针灸辅助治疗对脑卒中后抑郁患者血清细胞因子、神经递质的影响[J].海南医学院学报,2017,23(14):2010-2013. DOI:10. 13210/j. cnki. jhmu. 20170726.008.
[2]王建玲,贾爱兰,闫志新,等.导尿管腹部固定法对脑卒中患者泌尿系感染及舒适度的影响[J].中华医院感染学杂志,2017,27(2):327-329,340. DOI:10. 11816/cn. ni. 2017-162423.
[3]顾竞春,李勤,顾怡勤,等.Kano模型在区域脑卒中人群服务模式建立中的探索与实践[J].中国全科医学,2018,21(18):2201-2208. DOI:10.3969/j. issn. 1007-9572.2018.00.216.
[4]李丽君,胡卫疆,高雅坤,等.抗抑郁药联合重复经颅磁刺激治疗卒中后抑郁的meta分析[J].中国心理卫生杂志,2017,31(4):274-277. DOI:10. 3969/j. issn. 1000-6729.2017.04.004.
[5]李宝玲,段婧婧,岳永花,等.疏脑解郁汤对卒中后抑郁大鼠学习记忆能力的影响及作用机理研究[J].中成药,2016,38(5):1147-1150. DOI:10.3969/j. issn. 1001-1528.2016.05.040.
[6]鲁豫,田小军,史莉瑾,等.MiR-137在缺血性卒中后抑郁患者外周血中的表达及其临床意义[J].临床神经病学杂志,2017,30(3):217-220. DOI:10.3969/j. issn. 1004-1648.2017.03.016.
[7]常静,沈仲夏,蔡敏,等.卒中后抑郁患者抗抑郁治疗血清S100B蛋白的变化分析[J].医学研究生学报,2016,29(7):737-740.DOI:10. 16571/j. cnki. 1008-8199. 2016.07.014.
[8]姚丽君,刘兆庆,周锦,等.通督调神针刺法结合认知疗法干预卒中后抑郁患者临床研究[J].世界科学技术:中医药现代化,2017,19(8):1319-1323. DOI:10. 11842wst.2017.08.010.
[9] Matsuzaki S,Hashimoto M,Yuki S, et al. The relationship between post-stroke depression and physical recovery[J]. Journal of AffectiveDisorders,2015,176(11):56-60. DOI:10. 1016/j. jad. 2015. 01.020.
[10] Ilchibaeva TV, Kondaurova EM,Tsybko AS, et al. Brain-derived neurotrophic factor(BDNF)and its precursor(proBDNF)in genetically defined fear-induced aggression[J]. Behavioural Brain Research:An International Journal,2015,290(8):45-50. DOI:10.1016/j. bbr. 2015.04.041.
[11]王兵,姜玉章,沈冲,等.血脂与缺血性脑卒中危险因素的相关分析[J].中华老年心脑血管病杂志,2013,15(1):92. DOI:10.3969/j. issn. 1009-0126.2013.01.029.
[12]王垚,李春波.研究域标准框架研究进展[J].中华精神科杂志,2018,51(3):209-212. DOI:10. 3760/cma. j. issn. 1006-7884.2018.03.011.
[13]姚传芳·情感性精神障碍[M].长沙:湖南科学技术出版社,1998:210-213.
[14]罗高权,曾凡杰,武肖娜,等.组建脑卒中中心对急性缺血性脑卒中患者诊疗指标的影响[J].实用医学杂志,2018,34(6):885-889. DOI:10.3969/j. issn. 1006-5725.2018.06.003.
[15]苑杰,路月英,郭鑫,等.卒中后抑郁患者的临床异质性研究[J].中国全科医学,2017,20(31):3941-3946. DOI:10. 3969/j. issn.1007-9572.2017.31.022.
[16]王思博,王慧彬,曲慧玲,等.卒中后抑郁的影响因素及其对生活质量的影响[J].中国医科大学学报,2017,46(9):844-847.DOI:10. 12007/j. issn. 0258-4646.2017.09.017.
[17]崔燕,魏峰,阎文静,等.脑卒中后抑郁发病的影响因素[J].山东医药,2017,57(9):89-91. DOI:10. 3969/j. issn. 1002-266X.2017.09.031.
[18]李平,张巧莲,李双英,等.卒中后抑郁与血清炎性细胞因子水平及神经功能损害的相关性分析[J].中国应用生理学杂志,2017,33(2):121-123,145. DOI:10.12047/j. cjap.5512.2017.031.
[19]钱淑霞,庄建华,岳卫清,等.基于分类回归树模型的卒中后抑郁预测研究[J].临床神经病学杂志,2018,31(2):143-145.DOI:10. 3969/j. issn. 1004-1648.2018.02.019.
[20]王培培,王雪丹,刘凤丽,等.依达拉奉对急性脑梗死患者血清BDNF水平影响及疗效的多中心研究[J].中国生化药物杂志,2015,2(2):137-139.
[21]杨永刚,张建平,赵会颖,等.远程缺血后适应对短暂性脑缺血发作患者的脑氧代谢及血清BDNF、MMP-9的影响[J].疑难病杂志,2017,16(11):1081-1084.
[22]赵洪庆,韩远山,柳卓,等.焦虑性抑郁模型大鼠脑区单胺递质含量与神经因子表达的变化[J].中国实验动物学报,2017,25(4):373-379. DOI:10.3969/j. issn. 1005-4847.2017.04.006.
[23]黄宏亮,杨莉莉,黄崴,等.脑卒中患者血清PARK7、LPA和D-D水平与颈动脉粥样硬化及神经缺损程度的关系[J].疑难病杂志,2017,16(8):776-779,783.
[24]刘华慧.甲钴胺治疗老年脑梗死伴高同型半胱氨酸血症及卒中后抑郁的临床效果[J].中国医药,2017,12(11):1652-1655.
[25] Silva A,Naia L,Dominguez A, et al. Overexpression of BDNF and full-length trkB Receptor ameliorate striatal neural survival in huntington's disease[J]. Neuro-degenerative Diseases, 2015,15(4):207-218. DOI:10.1159/000375447.
[26]徐倩,安宏伟,韩真贤,等.安非他酮治疗卒中后抑郁的临床疗效及其对脑源性神经营养因子的影响[J].中国健康心理学杂志,2017,25(6):835-838. DOI:10. 13342/j. cnki. cjhp. 2017. 06.010.
[27]冯琬,杨耀军.针灸辅助治疗对脑卒中后抑郁患者血清细胞因子、神经递质的影响[J].海南医学院学报,2017,23(14):2010-2013. DOI:10. 13210/j. cnki. jhmu. 20170726.008.