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血清脂联素预测缺血性卒中患者的卒中后抑郁

Serum adiponectin predicts post-stroke depression in patients with ischemic stroke

摘要:

目的 探讨血清脂联素(adiponectin, APN )预测缺血性卒中患者卒中后抑郁( post-stroke depression, PSD )的价值.方法 前瞻性纳入2016年9月至2018年1月广州医科大学附属脑科医院和东莞市常平医院神经内科住院的急性缺血性卒中患者,入院次日采用放射免疫法测定血清APN水平,出院1个月后采用《精神障碍诊断与统计手册(第4版)》进行PSD诊断.比较PSD组与非PSD组的基线临床特征,应用多变量logistic回归分析确定PSD的危险因素.应用受试者工作特征(receiver operating characteristic, ROC )曲线分析APN对PSD的预测价值.结果 共纳入220例患者,其中PSD 组57例(25.9%),非PSD组163例(74.1%). PSD组糖尿病(P=0.020)和独居患者的构成比(P=0.012)以及年龄(P=0.017)、高半胱氨酸( P=0.009)、超敏C 反应蛋白水平( P=0.001)及美国国立卫生研究院卒中量表评分(P=0.007)均显著高于非PSD组,而APN 水平则显著低于非PSD组(P=0.003).多变量logistic回归分析结果示,以血清APN水平第4四分位数组为参考,APN水平第1四分位数组是PSD的独立危险因素(优势比4.202,95%可信区间1.401~12.067;P=0.013). ROC 曲线分析显示,血清APN 水平预测PSD 的曲线下面积为0.642(95%可信区间0.564~0.721;P=0.001),最佳截断值为6.4 mg/L,其预测 PSD 的敏感性为 63.2%,特异性为63.8%,阳性预测值为83.3%,阴性预测值为57.7%.结论 血清APN对缺血性卒中患者PSD有一定的预测价值.

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Objective To investigate the predictive value of serum adiponectin (APN) for post-stroke depression (PSD) in patients with ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, and Dongguan Changping Hospital were enrolled prospectively from September 2016 to January 2018. Serum APN levels were measured by radioimmunoassay the next day after admission. PSD was diagnosed by using the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) at one month after discharge. The baseline clinical features in the PSD group and the non-PSD group were compared. Multivariable logistic regression analysis was used to determine the risk factors for PSD. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of APN for PSD. Results A total of 220 patients were enrolled, including 57 (25.9%) in the PSD group and 163 (74.1%) in the non-PSD group. The proportion of patients with diabetes (P=0.020) and living alone (P=0.012), as well as age (P=0.17), homocysteine (P=0.009), C-reactive protein ( P=0.001), and National Institutes of Health Stroke Scale score ( P=0.007) in the PSD group were significantly higher than those in the non-PSD group, while the APN level was significantly lower than that in the non-PSD group (P=0.003). Multivariate logistic regression analysis showed that the 4th quartile of serum APN level was used as a reference, the 1st quartile of APN level was an independent risk factor for PSD (odds ratio, 4 .202, 95% confidence interval 1.401-12.067; P=0.013). ROC curve analysis showed that the area under the curve of serum APN level for predicting PSD was 0.642 (95% confidence interval 0.564-0.721; P=0.001). The optimal cutoff value was 6.4 mg/L, and its sensitivity of predicting PSD was 63.2%, the specificity was 63.8%, the positive predictive value was 83.3%, and the negative predictive value was 57 .7%. Conclusion Serum APN has a certain predictive value for PSD in patients with ischemic stroke.

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