血清胱抑素C水平与急性缺血性脑卒中后抑郁共病状态的关系

The relationship between serum levels of cystatin C and depression after acute ischemic stroke

摘要:

目的 探讨血清胱抑素C水平与急性缺血性脑卒中后抑郁共病状态的关系。方法 采用前瞻性研究方法，选取2019年1月—2022年6月承德医学院附属医院100例急性缺血性脑卒中患者作为研究对象，根据发病2周时的汉密尔顿抑郁量表（HAMD-17）评分分为抑郁组与非抑郁组。对比两组临床资料及实验室指标，分析血清胱抑素C水平与急性缺血性脑卒中后抑郁共病状态的关系。结果 抑郁组大动脉粥样硬化型占比低于非抑郁组，影像学病变累及占比高于非抑郁组（P <0.05）。抑郁组与非抑郁组性别、年龄、梗死部位、吸烟史、入院时HAMD评分比较，差异无统计学意义（P >0.05）。抑郁组血清胱抑素C、同型半胱氨酸水平高于非抑郁组（P <0.05）。抑郁组与非抑郁组甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较，差异无统计学意义（P >0.05）。小动脉闭塞型组胱抑素C、同型半胱氨酸水平高于其他TOAST分型组（P <0.05）。累及组胱抑素C、同型半胱氨酸水平高于未累及组（P <0.05）。多因素一般Logistic回归分析结果显示：高胱抑素C［O^R=26.330（95% CI：3.797，182.566）］、高同型半胱氨酸［O^R=1.241（95% CI：1.105，1.393）］是急性缺血性脑卒中后发生抑郁共病状态的危险因素（P <0.05）。经点二列相关性分析结果显示，血清胱抑素C、同型半胱氨酸水平与急性缺血性脑卒中后发生抑郁共病状态呈正相关（r =0.371和0.424，均P <0.05）。胱抑素C预测急性缺血性脑卒中发生抑郁共病状态的截断值为0.795 mg/L，敏感性为0.714（95% CI：0.596，0.815），特异性为0.813（95% CI：0.745，0.884），AUC为0.724（95% CI：0.619，0.828）（P <0.05）。结论 血清胱抑素C、同型半胱氨酸水平与急性缺血性脑卒中抑郁共病状态密切相关，可能是急性缺血性脑卒中患者并发抑郁的危险因素。

Abstract:

Objective To analyze the relationship between serum levels of cystatin C and depression after acute ischemic stroke.Methods A total of 100 patients with acute ischemic stroke admitted to our hospital from January 2019 to June 2022 were prospectively selected and divided into depression and non-depression groups according to the Hamilton Depression Rating Scale (HAMD-17) scores at 2 weeks after the onset of disease. The clinical data and laboratory indicators of the two groups were compared, and the relationship between serum levels of cystatin C and depression after acute ischemic stroke was analyzed.Results The proportion of patients with large artery atherosclerotic stroke in the depression group was lower than that in the non-depression group, while the proportion of patients with involvement of cortical and subcortical structures associated with emotions on imaging examinations in the depression group was higher than that in the non-depression group (P < 0.05). There was no difference in the sex composition, age, areas of infarction, history of smoking or HAMD-17 scores at admission between the depression group and the non-depression group (P > 0.05). The serum levels of cystatin C and homocysteine were higher in the depression group than in the non-depression group (P < 0.05), whereas the levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were not different between the two groups (P > 0.05). The serum levels of cystatin C and homocysteine in patients with small artery occlusion stroke were higher than those with other types of stroke (P < 0.05). Besides, the serum levels of cystatin C and homocysteine in the involvement group were higher than those in the non-involvement group (P < 0.05). Multivariate Logistic regression analysis exhibited that high levels of cystatin C [O^R = 26.330, (95% CI: 3.797, 182.566) ] and homocysteine [O^R = 1.241, (95% CI: 1.105, 1.393) ] were risk factors for the occurrence of depression after acute ischemic stroke (P < 0.05). The point-biserial correlation analysis showed that the serum levels of cystatin C and homocysteine were positively correlated with the occurrence of depression after acute ischemic stroke (r = 0.371 and 0.424, both P < 0.05). The cutoff value of the level of cystatin C for predicting the occurrence of depression after acute ischemic stroke was 0.795 mg/L, with the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) being 0.714 (95% CI: 0.596, 0.815), 0.813 (95% CI: 0.745, 0.884), and 0.724 (95% CI: 0.619, 0.828), respectively.Conclusions Serum levels of cystatin C and homocysteine are closely related to depression after acute ischemic stroke, and may be factors affecting the co-occurrence of depression in acute ischemic stroke patients.