CAJ | 학술논문

目的：探讨血清谷氨酸水平与卒中后抑郁(post-stroke depression, PSD)之间的相关性。方法连续纳入急性缺血性卒中患者。收集患者的人口统计学和临床资料,并在入院次日清晨空腹采血,采用高效液相色谱法检测患者血清谷氨酸水平。在发病后3个月根据《美国精神障碍诊断与统计手册(第4版)》躯体疾病所致心境障碍诊断标准进行 PSD 诊断,并用汉密尔顿抑郁量表(Hamilton Depression Rating Scale, HAMD)评估 PSD 患者的抑郁症状严重程度。对 PSD 组与非 PSD组人口统计学和基线临床资料进行比较和分析。结果共纳入177例急性缺血性卒中患者,PSD 组55例,非 PSD 组122例。 PSD 组年龄[(64．4±7．8)岁对(60．1±11．1)岁；t =-2．575,P =0．012]、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分[中位数和四分位数间距：6(5~8)分对3(2~5)分；Z =-5．463,P =0．002]、血清高半胱氨酸[(16．9±4．9)μmol/L 对(14．3±3．9)μmol/L；t =-3．929,P =0．001]、高敏 C 反应蛋白[1．0(0．8~1．7)mg/L 对0．4(0．7~1．3)mg/L；Z =-3．439,P =0．002]及谷氨酸水平[279(205~345)μmol/L 对161(110~209)μmol/L；Z =-6．172,P =0．001]以及女性患者的构成比(50．9%对34．4%；χ2=4．308,P =0．038)显著高于非PSD 组,而受教育程度显著低于非 PSD 组(χ2=9．679,P =0．003)。 Spearman 相关分析显示,血清谷氨酸水平与 HAMD 评分呈显著正相关(r =0．491,P <0．001)。多变量 logistic 回归分析显示,血清谷氨酸水平升高(优势比1．016,95%可信区间1．010~1．023；P =0．002)是急性缺血性卒中患者发生PSD 的独立危险因素。结论血清谷氨酸水平增高可能是 PSD 的独立危险因素。
목적：탐토혈청곡안산수평여졸중후억욱(post-stroke depression, PSD)지간적상관성。방법련속납입급성결혈성졸중환자。수집환자적인구통계학화림상자료,병재입원차일청신공복채혈,채용고효액상색보법검측환자혈청곡안산수평。재발병후3개월근거《미국정신장애진단여통계수책(제4판)》구체질병소치심경장애진단표준진행 PSD 진단,병용한밀이돈억욱량표(Hamilton Depression Rating Scale, HAMD)평고 PSD 환자적억욱증상엄중정도。대 PSD 조여비 PSD조인구통계학화기선림상자료진행비교화분석。결과공납입177례급성결혈성졸중환자,PSD 조55례,비 PSD 조122례。 PSD 조년령[(64．4±7．8)세대(60．1±11．1)세；t =-2．575,P =0．012]、미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale, NIHSS)평분[중위수화사분위수간거：6(5~8)분대3(2~5)분；Z =-5．463,P =0．002]、혈청고반광안산[(16．9±4．9)μmol/L 대(14．3±3．9)μmol/L；t =-3．929,P =0．001]、고민 C 반응단백[1．0(0．8~1．7)mg/L 대0．4(0．7~1．3)mg/L；Z =-3．439,P =0．002]급곡안산수평[279(205~345)μmol/L 대161(110~209)μmol/L；Z =-6．172,P =0．001]이급녀성환자적구성비(50．9%대34．4%；χ2=4．308,P =0．038)현저고우비PSD 조,이수교육정도현저저우비 PSD 조(χ2=9．679,P =0．003)。 Spearman 상관분석현시,혈청곡안산수평여 HAMD 평분정현저정상관(r =0．491,P <0．001)。다변량 logistic 회귀분석현시,혈청곡안산수평승고(우세비1．016,95%가신구간1．010~1．023；P =0．002)시급성결혈성졸중환자발생PSD 적독립위험인소。결론혈청곡안산수평증고가능시 PSD 적독립위험인소。
Objective To investigate the correlation between serum glutamate levels and post-stroke depression (PSD). Methods The consecutive patients with acute ischemic stroke were enroled. At 3 month after onset, the PSD diagnosis was conducted according to the American Diagnostic and Statistical Manual of Mental Disorders (4th Edition) somatic disease caused mood disorder and Hamilton depression scale (HAMD) was used to evaluate the severity of depressive symptoms in patients with PSD. The demographics and baseline clinical data were compared and analyzed in the PSD group and the non-PSD group. Results A total of 177 patients were enroled in the study, including 55 in the PSD group and 122 in the non-PSD group. The age (64. 4 ± 7. 8 years vs. 60. 1 ± 11. 1 years; t = - 2. 575, P = 0. 012), NIHSS scores (median and interquartile: 6 [5 - 8] vs. 3 [2 - 5 ]; Z = - 5. 463, P = 0. 002 ), serum homocysteine (16. 9 ± 4. 9 μmol/L vs. 14. 3 ± 3. 9 μmol/L; t = - 3. 929, P = 0. 001 ), high-sensitivity C-reactive protein (1. 0 [0. 8 - 1. 7] mg/L vs. 0. 4 [0. 7 - 1. 3] mg/L; Z = - 3. 439, P = 0. 002 ), glutamate levels (279 [205 - 345] μmol/L vs. 161 [110 - 209] μmol/L; Z = - 6. 172, P = 0. 001 ), as wel as the proportion of women (50. 9% vs. 34. 4% ; χ2 = 4. 308, P = 0. 038) in the PSD group were significantly higher than those in the non-PSD group, while the education level was significantly lower than that in the non-PSD group (χ2 = 9. 679, P = 0. 003). Spearman correlation analysis showed that serum glutamate levels were significant positive correlated with HAMD scores ( r = 0. 491, P < 0. 001 ). Multivariate logistic regression analysis showed that the increased serum glutamate level (odd ratio 1. 016, 95% confidence interval 1. 010 - 1. 023; P = 0. 002) was an independent risk factor for PSD in patients with acute ischemic stroke. Conclusions The increased serum glutamate level may be an independent risk factor for PSD.