血清瘦素水平升高与中风后抑郁有关。

High serum levels of leptin are associated with post-stroke depression.

作者信息

Jiménez I, Sobrino T, Rodríguez-Yáñez M, Pouso M, Cristobo I, Sabucedo M, Blanco M, Castellanos M, Leira R, Castillo J

机构信息

Department of Neurology, Neuropsychology Laboratory, Clinical Neuroscience Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.

出版信息

Psychol Med. 2009 Jul;39(7):1201-9. doi: 10.1017/S0033291709005637. Epub 2009 Apr 9.

DOI:10.1017/S0033291709005637

PMID:19356259

Abstract

BACKGROUND

Depression is a frequent mood disorder that affects around 33% of stroke patients and has been associated with both poorer outcome and increased mortality. Our aim was to test the possible association between inflammatory and neurotrophic molecular markers and the development of post-stroke depression.

METHOD

We studied 134 patients with a first episode of ischemic stroke without previous history of depression or speech disorders. We screened for the existence of major depression symptoms in accordance with DSM-IV criteria and a Yesavage Geriatric Depression Scale (GDS) score >11 at discharge and 1 month after stroke. At these times, serum levels of molecular markers of inflammation [interleukin (IL)-1beta, IL-6, intracellular adhesion molecule 1 (ICAM-1), tumor necrosis factor (TNF)-alpha, leptin and high-sensitivity C-reactive protein (hs-CRP)] and neurotrophic factors [brain-derived neurotrophic factor (BDNF)] were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Twenty-five patients (18.7%) were diagnosed as having major depression at discharge. Out of 104 patients who completed the follow-up period, 23 were depressed at 1 month (22.1%). Patients with major depression showed higher serum leptin levels at discharge [43.4 (23.4-60.2) v. 6.4 (3.7-16.8) ng/ml, p<0.001] and at 1 month after stroke [46.2 (34.0-117.7) v. 6.4 (3.4-12.2) ng/ml, p<0.001). Serum levels of leptin >20.7 ng/ml were independently associated with post-stroke depression [odds ratio (OR) 16.4, 95% confidence interval (CI) 5.2-51.5, p<0.0001]. Leptin levels were even higher in the eight patients who developed depression after discharge [114.6 (87.6-120.2) v. 7.2 (3.6-13.6) ng/ml, p<0.0001].

CONCLUSIONS

Serum leptin levels at discharge are found to be associated with post-stroke depression and may predict its development during the next month.

摘要

背景

抑郁症是一种常见的情绪障碍，影响约33%的中风患者，并且与较差的预后和死亡率增加相关。我们的目的是测试炎症和神经营养分子标志物与中风后抑郁症的发生之间可能存在的关联。

方法

我们研究了134例首次发生缺血性中风且无抑郁症或言语障碍病史的患者。我们根据《精神疾病诊断与统计手册》第四版标准以及出院时和中风后1个月时Yesavage老年抑郁量表（GDS）评分>11来筛查是否存在重度抑郁症状。在这些时间点，通过酶联免疫吸附测定（ELISA）测量炎症分子标志物[白细胞介素（IL）-1β、IL-6、细胞间黏附分子1（ICAM-1）、肿瘤坏死因子（TNF）-α、瘦素和高敏C反应蛋白（hs-CRP）]和神经营养因子[脑源性神经营养因子（BDNF）]的血清水平。

结果

25例患者（18.7%）在出院时被诊断为重度抑郁症。在完成随访期的104例患者中，23例在1个月时患有抑郁症（22.1%）。重度抑郁症患者在出院时[43.4（23.4 - 60.2）对6.4（3.7 - 16.8）ng/ml，p<0.001]和中风后1个月时[46.2（34.0 - 117.7）对6.4（3.4 - 12.2）ng/ml，p<0.001]的血清瘦素水平较高。血清瘦素水平>20.7 ng/ml与中风后抑郁症独立相关[比值比（OR）16.4，95%置信区间（CI）5.2 - 51.5，p<0.0001]。在出院后出现抑郁症的8例患者中，瘦素水平甚至更高[114.6（87.6 - 120.2）对7.2（3.6 - 13.6）ng/ml，p<0.0001]。