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目的比较分析脑卒中后不同时段抑郁障碍(PSD)患者的血清IL-1β、IL-6的水平变化特点。方法脑卒中住院连续病例223例,于脑卒中后72 h予HAMD(24项版)评分,评分≥8分者,随机分为对照组(第2组)、抗抑郁药物干预组(第1组);对未达标者于脑卒中后1月再次予HAMD评分,评分≥8分者同方法再随机分为对照组(第4组)、抗抑郁药物干预组(第3组);对1月时HAMD评分<8分者于脑卒中后2月再次予HAMD评分,评分≥8分者同方法再随机分为对照组(第6组)、抗抑郁药物干预组(第5组);2月时HAMD评分<8分者于脑卒中后3月再次予HAMD评分,得出评分≥8分组(第7组)、<8分组(第8组)。所有入选病例于发病72 h、1个月、3个月予血清IL-1β、IL-6水平检测。结果 (1)发病72 h发生PSD组(第1+2组)与未发生PSD组(第3+4+5+6+7+8组)血清IL-1β、IL-6水平比较无统计学差异(P>0.05);脑卒中后1个月发生PSD组(第3+4组)与未发生PSD组(第5+6+7+8组)血清IL-1β、IL-6水平比较有显著性差异(P<0.001);脑卒中后3个月发生PSD组(第7组)与未发生PSD组(第8组)血清IL-1β、IL-6水平比较均无统计学差异(P>0.05)。(2)不同时段发生PSD组(第2、4、6、7组)之间,在脑卒中后72 h,4组血清IL-1β、IL-6水平均无统计学差异(P>0.05);脑卒中后1月4组血清IL-1β、IL-6水平有显著性差异(P<0.001);脑卒中后3月4组血清IL-1β、IL-6水平有显著性差异(P<0.001,P<0.01)。结论脑卒中早期检测血清IL-1β、IL-6水平对预测PSD的发生意义较小;炎症细胞因子IL-1β、IL-6在脑卒中后1月PSD中起重要作用,且该时段检测血清IL-1β、IL-6水平可能在推测PSD发生的大致时间方面有一定的指导意义;脑卒中后中晚期发生PSD与炎症细胞因子的相关性有待于进一步深入探讨。
Objective To compare the changes of serum levels of IL-1β and IL-6 in patients with depressive disorder (PSD) at different stages after stroke. Methods A total of 223 consecutive hospitalized patients with stroke were enrolled in this study. HAMD (24th edition) was scored at 72 hours after stroke, and the score was ≥8. The patients were randomly divided into control group (group 2), antidepressant intervention group (group 1) ); Those who did not meet the criteria after stroke in January again HAMD score, score ≥ 8 points were randomly divided into control group (group 4), antidepressant intervention group (group 3); the same month Patients with HAMD score <8 were again given HAMD score at 2 months after stroke and those with score> 8 were randomly divided into control group (group 6), antidepressant intervention group (group 5) Patients with a HAMD score of <8 were re-rated to HAMD at 3 months after stroke, resulting in a score of ≥8 (group 7) and <8 (group 8). All the selected cases were tested for serum IL-1β and IL-6 levels at 72 h, 1 month and 3 months after onset. Results (1) There was no significant difference in serum IL-1β and IL-6 levels between PSD group (group 1 + 2) and PSD group (group 3 + 4 + 5 + 6 + 7 + 8) (P> 0.05). The levels of serum IL-1β and IL-6 in PSD group (group 3 + 4) and non-occurring PSD group (group 5 + 6 + 7 + 8) (P <0.001). There was no significant difference in serum IL-1β and IL-6 levels between PSD group (group 7) and PSD group (group 8) at 3 months after stroke > 0.05). (2) There was no significant difference in serum IL-1β and IL-6 levels between PSD group (groups 2, 4, 6, and 7) and 72 h after stroke (P <0.001). Serum levels of IL-1β and IL-6 in stroke group after 4 months of stroke were significantly different (P < 0.001, P <0.01). Conclusions The serum level of IL-1β and IL-6 in the early stage of stroke is less significant for predicting PSD. The inflammatory cytokines IL-1β and IL-6 play an important role in PSD at 1 month after stroke, The level of IL-1β and IL-6 may have some guiding significance in estimating the approximate time of occurrence of PSD. The correlation between PSD and inflammatory cytokines in the middle and later stages of stroke remains to be further explored.