脑卒中后抑郁与血清胆红素及非高密度脂蛋白胆固醇的关系
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摘要
目的分析脑卒中后抑郁(PSD)与血清胆红素及非高密度脂蛋白胆固醇(non-HDL-C)水平的关系,探讨PSD的影响因素。方法脑卒中患者130例根据汉密尔顿抑郁量表(HAMD)将患者分为PSD组与非PSD组,分别测定其血清胆红素及血脂水平,并采用神经功能缺损量表(NIHSS)和日常生活活动能力量表(ADL)对其进行测评。结果 PSD发生率为34. 6%,HAMD得分(14. 40±10. 51)分; PSD组与非PSD组性别、年龄、体重指数(BMI)、婚姻状态、抑郁家族史、NIHSS得分、ADL得分、血清总胆红素、直接胆红素及non-HDL-C水平比较,差异均有统计学意义(P<0. 05); PSD与血清直接胆红素及non-HDL-C水平均呈显著正相关(P<0. 05); NIHSS得分、血清直接胆红素及non-HDL-C水平对PSD具有正向预测力(P<0. 05)。结论 PSD与血清直接胆红素及non-HDL-C水平有关,高血清直接胆红素及non-HDL-C水平可能是PSD的预测因素。
Objective To investigate the relationship between post stroke depression( PSD) and serum bilirubin,non-high-density Lipoprotein cholesterol( non-HDL-C) on stroke patients and explore the influencing factors of depression.Methods 130 strokepatients were admitted from October 2016 to June 2017 in Affiliated Tangshan Workers Hospital,North China University of Science andTechnology. According to the Hamilton Depression Scale( HAMD) score,the patients were divided into PSD group and non-PSDgroup. The serum bilirubin and blood lipid levels were measured respectively,and the National Institutes of Health Stroke Scale( NIH-SS) and activity of daily living scale( ADL) were used to measure and assess them.Results The detection rate of PSD was 34.62%,the score of HAMD was 14.40±10.51. There were statistically significant differences in gender,age,body mass index( BMI),maritalstatus,family history of depression,the score of NIHSS and ADL,the level of serum total bilirubin,direct bilirubin and non-HDL-Cbetween PSD and non-PSD groups( P<0.05). After controlling the factors of gender,age,BMI,marital status and family history of de-pression,there were positive correlation between PSD and the level of serum direct bilirubin and non-HDL-C( P<0.05). The score ofNIHSS and the level of serum direct bilirubin and non-HDL-C had significantly positive predictive power on PSD( P<0.05).Conclu-sions PSD is related to gender,age,marital status,BMI,the score of NIHSS and serum direct bilirubin and non-HDL-C levels. Highserum direct bilirubin and non-HDL-C might be the predictors of PSD.
Objective To investigate the relationship between post stroke depression( PSD) and serum bilirubin,non-high-density Lipoprotein cholesterol( non-HDL-C) on stroke patients and explore the influencing factors of depression.Methods 130 strokepatients were admitted from October 2016 to June 2017 in Affiliated Tangshan Workers Hospital,North China University of Science andTechnology. According to the Hamilton Depression Scale( HAMD) score,the patients were divided into PSD group and non-PSDgroup. The serum bilirubin and blood lipid levels were measured respectively,and the National Institutes of Health Stroke Scale( NIH-SS) and activity of daily living scale( ADL) were used to measure and assess them.Results The detection rate of PSD was 34.62%,the score of HAMD was 14.40±10.51. There were statistically significant differences in gender,age,body mass index( BMI),maritalstatus,family history of depression,the score of NIHSS and ADL,the level of serum total bilirubin,direct bilirubin and non-HDL-Cbetween PSD and non-PSD groups( P<0.05). After controlling the factors of gender,age,BMI,marital status and family history of de-pression,there were positive correlation between PSD and the level of serum direct bilirubin and non-HDL-C( P<0.05). The score ofNIHSS and the level of serum direct bilirubin and non-HDL-C had significantly positive predictive power on PSD( P<0.05).Conclu-sions PSD is related to gender,age,marital status,BMI,the score of NIHSS and serum direct bilirubin and non-HDL-C levels. Highserum direct bilirubin and non-HDL-C might be the predictors of PSD.
引文
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2 刘启玲,王志忠,张颖,等.社区中老年人抑郁状况与血尿酸等生化指标的相关性调查[J].海南医学,2014;25(3):443-6.
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4 郑海兰,田艳华,万琪,等.脑卒中后抑郁状态68例临床分析[J].陕西医学杂志,2000;29(4):217-25.
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8 张敏.卒中患者急性期的抑郁筛查及与卒中后抑郁相关因素的研究[D].武汉:华中科技大学,2013.
9 Pietra Pedroso VS,Rachid MA,Teixeira AL.Biomarkers in poststroke depression[J].Curr Neurovasc Res,2016;13(2):163-73.
10 Tang WK,Liang H,Chu WC,et al.Association between high serum total bilirubin and post-stroke depression[J].Psychiatry Clin Neurosci,2013;67(4):259-64.
11 Miyaoka T,Yasukawa R,Yasuda H,et al.Urinary excretion of biopyrrins,oxidative metabolites of bilirubin,increases in patients with psychiatric disorders[J].Eur Neuropsychopharmacol,2005;15(3):249-52.
12 Yamaguchi T,Shioji I,Sugimoto A,et al.Psychological stress increases bilirubin metabolites in human urine[J].Biochem Biophys Res Commun,2002;293(1):517-20.
13 Ostwald SK,Bernal MP,Cron SG,et al.Stress experienced by stroke survivors and spousal caregivers during the first year after discharge from inpatient rehabilitation[J].Top Stroke Rehabil,2011;16(2):93-104.
14 Schlotz W,Hammerfald K,Ehlert U,et al.Individual differences in the cortisol response to stress in young healthy men:testing the roles of perceived stress reactivity and threat appraisal using multiphase latent growth curve modeling[J].Biol Psychol,2011;87(2):257-64.
15 Lee YH,Shin MH,Choi JS,et al.Gender differences in the association between depressive symptoms and carotid atherosclerosis among middle-aged and older Koreans:the Namwon study[J].J Korean Med Sci,2014;29(11):1507-13.
16 陈维林,丁辉,刘国江,等.颈动脉内膜中层厚度及动态动脉硬化指数与抑郁症的关系研究[J].实用心脑肺血管病杂志,2015;23(5):76-9.
17 Pizzi C,Santarella L,Costa MG,et al.Pathophysiological mechanisms linking depression and atherosclerosis:an overview[J].J Biol Regul Homeost Agents,2012;26(4):775-82.
2 刘启玲,王志忠,张颖,等.社区中老年人抑郁状况与血尿酸等生化指标的相关性调查[J].海南医学,2014;25(3):443-6.
3 苑杰,齐文风,刘勉,等.抑郁与动脉粥样硬化关系的研究进展[J].中国全科医学,2016;19(8):982-5.
4 郑海兰,田艳华,万琪,等.脑卒中后抑郁状态68例临床分析[J].陕西医学杂志,2000;29(4):217-25.
5 Jiao JT,Cheng C,Ma YJ,et al.Association between inflammatory cytokines and the risk of post-stroke depression,and the effect of depression on outcomes of patients with ischemic stroke in a 2-year prospective study[J].Exp Ther Med,2016;12(3):1591-8.
6 Wei N,Yong W,Li X,et al.Post-stroke depression and lesion location:a systematic review[J].J Neurol,2015;262(1):81-90.
7 Kotila M,Numminen H,Waltimo O,et al.Depression after stroke:results of the FINNSTROKE Study[J].Stroke,1998;29(2):368-72.
8 张敏.卒中患者急性期的抑郁筛查及与卒中后抑郁相关因素的研究[D].武汉:华中科技大学,2013.
9 Pietra Pedroso VS,Rachid MA,Teixeira AL.Biomarkers in poststroke depression[J].Curr Neurovasc Res,2016;13(2):163-73.
10 Tang WK,Liang H,Chu WC,et al.Association between high serum total bilirubin and post-stroke depression[J].Psychiatry Clin Neurosci,2013;67(4):259-64.
11 Miyaoka T,Yasukawa R,Yasuda H,et al.Urinary excretion of biopyrrins,oxidative metabolites of bilirubin,increases in patients with psychiatric disorders[J].Eur Neuropsychopharmacol,2005;15(3):249-52.
12 Yamaguchi T,Shioji I,Sugimoto A,et al.Psychological stress increases bilirubin metabolites in human urine[J].Biochem Biophys Res Commun,2002;293(1):517-20.
13 Ostwald SK,Bernal MP,Cron SG,et al.Stress experienced by stroke survivors and spousal caregivers during the first year after discharge from inpatient rehabilitation[J].Top Stroke Rehabil,2011;16(2):93-104.
14 Schlotz W,Hammerfald K,Ehlert U,et al.Individual differences in the cortisol response to stress in young healthy men:testing the roles of perceived stress reactivity and threat appraisal using multiphase latent growth curve modeling[J].Biol Psychol,2011;87(2):257-64.
15 Lee YH,Shin MH,Choi JS,et al.Gender differences in the association between depressive symptoms and carotid atherosclerosis among middle-aged and older Koreans:the Namwon study[J].J Korean Med Sci,2014;29(11):1507-13.
16 陈维林,丁辉,刘国江,等.颈动脉内膜中层厚度及动态动脉硬化指数与抑郁症的关系研究[J].实用心脑肺血管病杂志,2015;23(5):76-9.
17 Pizzi C,Santarella L,Costa MG,et al.Pathophysiological mechanisms linking depression and atherosclerosis:an overview[J].J Biol Regul Homeost Agents,2012;26(4):775-82.