CAJ | 학술논문

目的探索血浆神经递质与出血性卒中急性期抑郁相关性.方法从连续住院急性卒中患者中筛选研究对象.在入院第2天取空腹血样,液相色谱-高分辨质谱测定血浆神经递质.在发病后2周根据第四版美国精神疾病诊断与统计手册诊断抑郁.在卒中发病后1年随访改良神经功能评分(mRS).Pearson相关分析血清神经递质浓度与汉密尔顿抑郁量表(HAMD)-17项评分相关性.logistic回归分析神经递质浓度与抑郁和卒中后1年结局关系.结果 181例患者纳入本研究.伴抑郁的出血性卒中患者γ氨基丁酸(GABA)显著降低[6.1(5.0,8.2)μg/L比8.1(6.3,14.7)μg/L,P＜0.05],谷氨酸(GAA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)差异无统计学意义.GABA浓度与HAMD-17评分呈负相关(r=-0.131,P＜0.05)；GABA每增加1μg/L,出血性卒中急性期抑郁患病风险降低5.6％(OR0.944,95％ CI0.893～0.997).GAA每增加1μg/L,卒中后1年不良结局风险增加0.1％,但显著水平处于边缘状态(OR 1.001,95％CI 1.000 ～ 1.002).结论脑出血急性期血浆GABA降低者,发生抑郁的风险增加,该递质可能对出血性卒中后抑郁发生具有保护作用.GAA浓度升高可能会增加卒中后1年不良结局风险.
목적 탐색혈장신경체질여출혈성졸중급성기억욱상관성.방법 종련속주원급성졸중환자중사선연구대상.재입원제2천취공복혈양,액상색보-고분변질보측정혈장신경체질.재발병후2주근거제사판미국정신질병진단여통계수책진단억욱.재졸중발병후1년수방개량신경공능평분(mRS).Pearson상관분석혈청신경체질농도여한밀이돈억욱량표(HAMD)-17항평분상관성.logistic회귀분석신경체질농도여억욱화졸중후1년결국관계.결과 181례환자납입본연구.반억욱적출혈성졸중환자γ안기정산(GABA)현저강저[6.1(5.0,8.2)μg/L비8.1(6.3,14.7)μg/L,P＜0.05],곡안산(GAA)、5-간색알(5-HT)、거갑신상선소(NE)차이무통계학의의.GABA농도여HAMD-17평분정부상관(r=-0.131,P＜0.05)；GABA매증가1μg/L,출혈성졸중급성기억욱환병풍험강저5.6％(OR0.944,95％ CI0.893～0.997).GAA매증가1μg/L,졸중후1년불량결국풍험증가0.1％,단현저수평처우변연상태(OR 1.001,95％CI 1.000 ～ 1.002).결론 뇌출혈급성기혈장GABA강저자,발생억욱적풍험증가,해체질가능대출혈성졸중후억욱발생구유보호작용.GAA농도승고가능회증가졸중후1년불량결국풍험.
Objective To explore the relation between plasm neurotransmitters (Glutamic acid,GAA; γ-aminobutyric acid,GABA; 5-hydroxytryptamine,5-HT; and noradrenaline,NE) and depression in acute hemorrhagic stroke.Methods Objectives were screened from consecutive hospitalized patients with acute stroke.Fasting blood samples were taken on the day next to hospital admission,and neurotransmitters were examined by the liquid chromatography-high resolution mass spectrometry (LC-HRMS).The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅳ) was used to diagnose depression at two weeks after onset of stroke.The modified Ranking Scale (mRS) was followed up at 1 year.Pearson test was used to analyse the correlation between serum concentration of neurotransmitters and the Hamilton Depression scale-17items (HAMD-17) score.Logistic regression was used to analyse the relation of serum concentration of neurotransmitters and depression and outcome of stroke.Results One hundred and eightyone patients were included in this study.GABA significantly decreased [6.1 (5.0-8.2) μg/L vs 8.1 (6.3-14.7) μg/L,P ＜ 0.05] in patients with depression in hemorrhagic stroke,and there was no significant difference in GAA,5-HT,or NE.GABA concentration was negatively correlated with HAMD-17 score (r =-0.131,P ＜ 0.05) ; while concentration of serum GABA rose by 1 μg/L,risk of depression in acute phase of hemorrhagic stroke was reduced by 5.6％ (OR 0.944,95％ CI 0.893-0.997).While concentration of serum GAA rose by 1 μg/L,risk of worse outcome at 1 year was raised by 0.1％,although a statistic level was on marginal status (OR 1.001,95％ CI 1.000-1.002).Conclusions In patients with depression in the acute phase of hemorrhagic stroke,there was a significant reduction in plasm GABA concentration.GABA may have a protective effect on depression in acute phase of hemorrhagic stroke.Increased concentrations of serum GAA may increase the risk of worse outcomes at 1 year after stroke.