Chen Chung-Yao, Chen Chia-Ling, Yang Yao-Hung, Ho Chien-Hui, Tseng Wen-Chun
From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan (C-Y C, Y-H Y, C-H H, W-C T); the School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-Y C, Y-H Y, C-H H, W-C T); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C-L C); and the Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-L C).
J Neuropsychiatry Clin Neurosci. 2018 Spring;30(2):139-144. doi: 10.1176/appi.neuropsych.17050108. Epub 2018 Jan 25.
Poststroke depression is independently associated with poor health outcomes, such as increased mortality, disability, anxiety, and lower quality of life. Identifying the potential biomarkers and detailed mechanisms of poststroke depression may improve the effectiveness of therapeutic intervention. In this cross-sectional study, the authors recruited patients with subacute ischemic stroke who were consecutively admitted for neurorehabilitation. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9), with a cutoff based on a summed-items score of 10. Polysomnography and laboratory tests for oxidative stress and inflammation were arranged. In total, 139 patients (97 men [69.8%] and 42 women [30.2%]; mean age: 63.2 years [±13.4]) with recent ischemic stroke were recruited and divided into two groups based on their depressive symptoms. Body mass index (BMI), the Barthel Index, percentage of antidepressant usage, and percentage of rapid eye movement (REM) sleep differed significantly between the two groups. The PHQ-9 score was significantly correlated with the levels of total antioxidant capacity, C-reactive protein, and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG). Urinary 8-OHdG, a marker of oxidative stress to DNA, remained significantly and positively correlated with PHQ-9 scores after adjusting for BMI, sleep-onset latency, Barthel Index, mean oxyhemoglobin saturation, age, antidepressant usage, and percentage of REM sleep by using multivariate linear regression. Depressive symptoms were related to increased oxidative DNA damage in patients with subacute ischemic stroke. Urinary 8-OHdG may serve as a potential biomarker for poststroke depression. Further longitudinal studies are needed to elucidate the causal relationship between poststroke depression and elevated oxidative stress level.
卒中后抑郁与不良健康结局独立相关，如死亡率增加、残疾、焦虑以及生活质量降低。识别卒中后抑郁的潜在生物标志物和详细机制可能会提高治疗干预的有效性。在这项横断面研究中，作者招募了因神经康复而连续入院的亚急性缺血性卒中患者。使用患者健康问卷-9（PHQ-9）评估抑郁，以总分10分作为临界值。安排了多导睡眠图检查以及氧化应激和炎症的实验室检测。总共招募了139例近期发生缺血性卒中的患者（97例男性[69.8%]和42例女性[30.2%]；平均年龄：63.2岁[±13.4]），并根据他们的抑郁症状分为两组。两组之间的体重指数（BMI）、巴氏指数、抗抑郁药使用百分比和快速眼动（REM）睡眠百分比存在显著差异。PHQ-9评分与总抗氧化能力、C反应蛋白和尿8-羟基-2'-脱氧鸟苷（8-OHdG）水平显著相关。尿8-OHdG是DNA氧化应激的标志物，在通过多元线性回归调整BMI、入睡潜伏期、巴氏指数、平均氧合血红蛋白饱和度、年龄、抗抑郁药使用和REM睡眠百分比后，仍与PHQ-9评分显著正相关。亚急性缺血性卒中患者的抑郁症状与氧化DNA损伤增加有关。尿8-OHdG可能是卒中后抑郁的潜在生物标志物。需要进一步的纵向研究来阐明卒中后抑郁与氧化应激水平升高之间的因果关系。
