血清谷氨酸水平与卒中后抑郁的相关性

摘要

目的：探讨血清谷氨酸水平与卒中后抑郁(post-stroke depression, PSD)之间的相关性。方法连续纳入急性缺血性卒中患者。收集患者的人口统计学和临床资料,并在入院次日清晨空腹采血,采用高效液相色谱法检测患者血清谷氨酸水平。在发病后3个月根据《美国精神障碍诊断与统计手册(第4版)》躯体疾病所致心境障碍诊断标准进行 PSD 诊断,并用汉密尔顿抑郁量表(Hamilton Depression Rating Scale, HAMD)评估 PSD 患者的抑郁症状严重程度。对 PSD 组与非 PSD组人口统计学和基线临床资料进行比较和分析。结果共纳入177例急性缺血性卒中患者,PSD 组55例,非 PSD 组122例。 PSD 组年龄[(64．4±7．8)岁对(60．1±11．1)岁；t =-2．575,P =0．012]、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分[中位数和四分位数间距：6(5~8)分对3(2~5)分；Z =-5．463,P =0．002]、血清高半胱氨酸[(16．9±4．9)μmol/L 对(14．3±3．9)μmol/L；t =-3．929,P =0．001]、高敏 C 反应蛋白[1．0(0．8~1．7)mg/L 对0．4(0．7~1．3)mg/L；Z =-3．439,P =0．002]及谷氨酸水平[279(205~345)μmol/L 对161(110~209)μmol/L；Z =-6．172,P =0．001]以及女性患者的构成比(50．9%对34．4%；χ2=4．308,P =0．038)显著高于非PSD 组,而受教育程度显著低于非 PSD 组(χ2=9．679,P =0．003)。 Spearman 相关分析显示,血清谷氨酸水平与 HAMD 评分呈显著正相关(r =0．491,P <0．001)。多变量 logistic 回归分析显示,血清谷氨酸水平升高(优势比1．016,95%可信区间1．010~1．023；P =0．002)是急性缺血性卒中患者发生PSD 的独立危险因素。结论血清谷氨酸水平增高可能是 PSD 的独立危险因素。%Objective To investigate the correlation between serum glutamate levels and post-stroke depression (PSD). Methods The consecutive patients with acute ischemic stroke were enroled. At 3 month after onset, the PSD diagnosis was conducted according to the American Diagnostic and Statistical Manual of Mental Disorders (4th Edition) somatic disease caused mood disorder and Hamilton depression scale (HAMD) was used to evaluate the severity of depressive symptoms in patients with PSD. The demographics and baseline clinical data were compared and analyzed in the PSD group and the non-PSD group. Results A total of 177 patients were enroled in the study, including 55 in the PSD group and 122 in the non-PSD group. The age (64. 4 ± 7. 8 years vs. 60. 1 ± 11. 1 years; t = - 2. 575, P = 0. 012), NIHSS scores (median and interquartile: 6 [5 - 8] vs. 3 [2 - 5 ]; Z = - 5. 463, P = 0. 002 ), serum homocysteine (16. 9 ± 4. 9 μmol/L vs. 14. 3 ± 3. 9 μmol/L; t = - 3. 929, P = 0. 001 ), high-sensitivity C-reactive protein (1. 0 [0. 8 - 1. 7] mg/L vs. 0. 4 [0. 7 - 1. 3] mg/L; Z = - 3. 439, P = 0. 002 ), glutamate levels (279 [205 - 345] μmol/L vs. 161 [110 - 209] μmol/L; Z = - 6. 172, P = 0. 001 ), as wel as the proportion of women (50. 9% vs. 34. 4% ; χ2 = 4. 308, P = 0. 038) in the PSD group were significantly higher than those in the non-PSD group, while the education level was significantly lower than that in the non-PSD group (χ2 = 9. 679, P = 0. 003). Spearman correlation analysis showed that serum glutamate levels were significant positive correlated with HAMD scores ( r = 0. 491, P < 0. 001 ). Multivariate logistic regression analysis showed that the increased serum glutamate level (odd ratio 1. 016, 95% confidence interval 1. 010 - 1. 023; P = 0. 002) was an independent risk factor for PSD in patients with acute ischemic stroke. Conclusions The increased serum glutamate level may be an independent risk factor for PSD.