载脂蛋白E基因多态性、同型半胱氨酸对老年卒中后抑郁的预测价值
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摘要
目的探讨载脂蛋白E(apolipoprotein E,APOE)基因多态性、同型半胱氨酸(homocysteine,Hcy)对老年卒中后抑郁的预测价值。方法选取脑卒中患者109例,根据患者是否出现抑郁症分为脑卒中组(65例)与脑卒中后抑郁组(44例)。检测2组APOE基因多态性(包括基因型分布与等位基因ε2、ε3、ε4频率)和血清Hcy水平。比较2组ε2/ε2、ε2/ε3、ε2/ε4、ε3/ε3、ε3/ε4、ε4/ε4基因型分布,等位基因ε2、ε3、ε4频率,血清Hcy水平,计算不同基因型预测老年卒中后抑郁的敏感度,绘制血清Hcy预测卒中后抑郁的受试者工作特征(receiver operating characteristic,ROC)曲线。结果 2组基因型均以ε3/ε3最常见,6种不同基因型分布差异无统计学意义(P>0.05)。2组ε2与ε3基因频率差异无统计学意义(P>0.05),脑卒中后抑郁组ε4基因频率高于脑卒中组,差异有统计学意义(P<0.05)。不同基因型中,ε4/ε4预测老年脑卒中后抑郁的敏感度最高,为83.33%(5/6)。脑卒中后抑郁组血清Hcy水平高于脑卒中组,差异有统计学意义(P<0.05)。2组不同基因型患者血清Hcy水平差异无统计学意义(P>0.05)。血清Hcy水平预测老年脑卒中后抑郁的ROC曲线下面积为0.744,敏感度为64.70%,特异度为81.20%,临界值为18.455μmol/L。结论 APOE基因多态性与血清Hcy可作为老年脑卒中后抑郁的预测指标,从而为老年脑卒中患者的干预提供参考,以降低脑卒中后抑郁发生率。
Objective To investigate the predictive value of apolipoprotein E(APOE)gene polymorphisms and homocysteine(Hcy)on post-stroke depression in the elderly.Methods A total of 109 stroke patients admitted were selected and divided into stroke group(65 cases)and post-stroke depression group(44 cases)according to whether the patient had depression.Both groups were tested for APOE polymorphisms(including genotype distribution and alleleε2,ε3,ε4 frequencies)and serum Hcy levels.The genotype distributions ofε2/ε2,ε2/ε3,ε2/ε4,ε3/ε3,ε3/ε4,ε4/ε4,the frequencies of allelesε2,ε3,ε4,serum Hcy levels were compared between the two groups.Different genotypes were calculated to predict the sensitivity of post-stroke depression in the elderly.The sensitivity of post-stroke depression was plotted and the receiver operating characteristic(ROC)curve was plotted for serum Hey to predict post-stroke depression.Results The genotypes of the two groups were most common withε3/ε3,and the distribution of the six different genotypes was not statistically significant(P>0.05).There was no significant difference in the frequency ofε2 andε3 gene between the two groups(P>0.05).The frequency ofε4 gene in the post-stroke depression group was higher than that in the stroke group(P<0.05).Among different genotypes,theε4/ε4 had the highest sensitivity of 83.33%(5/6)to predict poststroke depression.The serum Hcy levels in the post-stroke depression group were higher than those in the stroke group(P<0.05).There were no significant difference in serum Hcy levels in different genotypes between the two groups(P>0.05).The serum Hcy level predicts ROC curve area for post-stroke depression in the elderly with 0.744,a sensitivity of 64.70%,a specificity of81.20%,and a critical value of 18.455μmol/L.Conclusion The serum homocysteine and APOE gene polymorphisms can be used as predictors of post-stroke depression in elderly stroke patients and provide references for elderly stroke patients to reduce the incidence of post-stroke depression.
Objective To investigate the predictive value of apolipoprotein E(APOE)gene polymorphisms and homocysteine(Hcy)on post-stroke depression in the elderly.Methods A total of 109 stroke patients admitted were selected and divided into stroke group(65 cases)and post-stroke depression group(44 cases)according to whether the patient had depression.Both groups were tested for APOE polymorphisms(including genotype distribution and alleleε2,ε3,ε4 frequencies)and serum Hcy levels.The genotype distributions ofε2/ε2,ε2/ε3,ε2/ε4,ε3/ε3,ε3/ε4,ε4/ε4,the frequencies of allelesε2,ε3,ε4,serum Hcy levels were compared between the two groups.Different genotypes were calculated to predict the sensitivity of post-stroke depression in the elderly.The sensitivity of post-stroke depression was plotted and the receiver operating characteristic(ROC)curve was plotted for serum Hey to predict post-stroke depression.Results The genotypes of the two groups were most common withε3/ε3,and the distribution of the six different genotypes was not statistically significant(P>0.05).There was no significant difference in the frequency ofε2 andε3 gene between the two groups(P>0.05).The frequency ofε4 gene in the post-stroke depression group was higher than that in the stroke group(P<0.05).Among different genotypes,theε4/ε4 had the highest sensitivity of 83.33%(5/6)to predict poststroke depression.The serum Hcy levels in the post-stroke depression group were higher than those in the stroke group(P<0.05).There were no significant difference in serum Hcy levels in different genotypes between the two groups(P>0.05).The serum Hcy level predicts ROC curve area for post-stroke depression in the elderly with 0.744,a sensitivity of 64.70%,a specificity of81.20%,and a critical value of 18.455μmol/L.Conclusion The serum homocysteine and APOE gene polymorphisms can be used as predictors of post-stroke depression in elderly stroke patients and provide references for elderly stroke patients to reduce the incidence of post-stroke depression.
引文
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[9]阿米那·阿吾提,古力那子·阿不都热和满,帕丽达·阿布来提,等.血清同型半胱氨酸、胱抑素C、白细胞介素-6水平与老年冠心病合并抑郁情绪的关系[J].中国临床保健杂志,2013,16(3):251-253.
[10]邱会卿,张忠霞,刘娜,等.急性缺血性脑卒中患者心率变异性与同型半胱氨酸的相关性分析[J].河北医科大学学报,2017,38(9):993-996,1000.
[11]苏永臣,郭欣,曹雪峰.HHcy患者血糖、血脂水平的变化特点[J].河北医科大学学报,2016,37(6):659-662,666.
[12]韩永凯,李静,张朝辉,等.载脂蛋白E基因多态性与脑卒中后抑郁患者血脂水平的相关性[J].中国老年学杂志,2013,33(21):5230-5232.
[13] Scott RG,Paulson DL.Independent effects of Apolipoprotein E and cerebrovascular burden on later-life depression:The wisconsin longitudinal study[J].J Clin Psychiatry,2017,78(7):891-896.
[14] Taylor WD,Boyd B,Turner R,et al.APOEε4associated withpreservedexecutivefunctionperformanceand maintenance of temporal and cingulate brain volumes in younger adults[J].Brain Imaging Behav,2017,11(1):194-204.
[15]宗小芬,胡茂林,唐劲松,等.载脂蛋白E基因多态性与老年期抑郁症的关联性[J].中华行为医学与脑科学杂志,2015,24(4):319-322.
[16]韩永凯,李斯娜,王旭生,等.ApoE基因多态性与卒中后抑郁的关联研究[J].中风与神经疾病杂志,2015,32(4):311-314.
[2]温尊甲,吴超,沈梅芬,等.首次卒中患者卒中部位与卒中后抑郁相关性的Meta分析[J].重庆医学,2017,46(19):2677-2682.
[3]丁琪,陈旭.急性缺血性脑卒中预后影响因素研究[J].中华老年心脑血管病杂志,2016,18(11):1182-1185.
[4] Ku PW,Steptoe A,Chen LJ.Prospective associations of exercise and depressive symptoms in older adults:the role of apolipoprotein E4[J].Qual Life Res,2017,26(7):1799-1808.
[5]张莹,方岩,徐辉,等.老年缺血性脑卒中患者远期卒中后抑郁与发病部位的相关性分析[J].中华老年医学杂志,2017,36(7):755-758.
[6]杜娟,陈念东,张雪玲,等.急性缺血性脑卒中后抑郁与脑小血管病负荷的相关性研究[J].中华老年心脑血管病杂志,2017,19(12):1287-1290.
[7]张国平,王莉莉,王海燕.老年脑卒中后抑郁与卒中缺损程度及血清脑源性神经营养因子的相关性研究[J].中华老年医学杂志,2015,34(6):612-615.
[8]胥丽霞,王景涛.载脂蛋白E基因多态性与阿尔茨海默病精神行为症状的关系[J].中国老年学杂志,2016,36(10):2484-2486.
[9]阿米那·阿吾提,古力那子·阿不都热和满,帕丽达·阿布来提,等.血清同型半胱氨酸、胱抑素C、白细胞介素-6水平与老年冠心病合并抑郁情绪的关系[J].中国临床保健杂志,2013,16(3):251-253.
[10]邱会卿,张忠霞,刘娜,等.急性缺血性脑卒中患者心率变异性与同型半胱氨酸的相关性分析[J].河北医科大学学报,2017,38(9):993-996,1000.
[11]苏永臣,郭欣,曹雪峰.HHcy患者血糖、血脂水平的变化特点[J].河北医科大学学报,2016,37(6):659-662,666.
[12]韩永凯,李静,张朝辉,等.载脂蛋白E基因多态性与脑卒中后抑郁患者血脂水平的相关性[J].中国老年学杂志,2013,33(21):5230-5232.
[13] Scott RG,Paulson DL.Independent effects of Apolipoprotein E and cerebrovascular burden on later-life depression:The wisconsin longitudinal study[J].J Clin Psychiatry,2017,78(7):891-896.
[14] Taylor WD,Boyd B,Turner R,et al.APOEε4associated withpreservedexecutivefunctionperformanceand maintenance of temporal and cingulate brain volumes in younger adults[J].Brain Imaging Behav,2017,11(1):194-204.
[15]宗小芬,胡茂林,唐劲松,等.载脂蛋白E基因多态性与老年期抑郁症的关联性[J].中华行为医学与脑科学杂志,2015,24(4):319-322.
[16]韩永凯,李斯娜,王旭生,等.ApoE基因多态性与卒中后抑郁的关联研究[J].中风与神经疾病杂志,2015,32(4):311-314.