血清5-HT、Obestatin、APRIL与老年脑卒中患者神经功能的相关性及对卒中后抑郁的预测价值

摘要 目的：探讨血清5-羟色胺（5-HT）、肥胖抑制素（Obestatin）、增殖诱导配体（APRIL）与老年脑卒中患者神经功能的相关性及对卒中后抑郁（PSD）的预测价值。方法：选择2019年5月至2022年5月内蒙自治区人民医院收治的老年脑卒中患者120例为研究对象。入院时采集血样本，采用酶联免疫吸附法（ELISA）检测血清5-HT、Obestatin和APRIL水平。患者出院后随访6个月，根据是否发生PSD分为PSD组和非PSD组，比较两组血清5-HT、Obestatin、APRIL水平。采用Pearson相关分析法分析5-HT、Obestatin、APRIL与美国国立卫生研究院卒中量表（NIHSS）的相关性；采用多因素Logistic回归模型分析PSD的影响因素；采用受试者工作特征（ROC）曲线分析血清5-HT、Obestatin联合APRIL对老年脑卒中患者出院后PSD的预测价值。结果：PSD组血清5-HT低于非PSD组（P＜0.05），血清Obestatin、APRIL和NIHSS评分高于非PSD组（P＜0.05）。血清5-HT与NIHSS评分呈负相关（P＜0.05）；血清Obestatin、APRIL与NIHSS评分呈正相关（P＜0.05）。单因素分析显示，老年脑卒中患者出院后PSD与体质量指数（BMI）、吸烟史、饮酒史有关（P＜0.05）。多因素Logistic回归分析显示，血清Obestatin、APRIL及NIHSS评分升高是脑卒中患者出院后发生PSD的危险因素（P＜0.05），血清5-HT升高是其保护因素（P＜0.05）。ROC曲线分析结果显示，血清5-HT、Obestatin、APRIL及联合检测对预测PSD的曲线下面积（AUC）分别为0.735（0.483～0.978）、0.765（0.595～0.918）、0.707（0.464～0.954）、0.867（0.742～0.972），联合检测的预测效能优于各指标单独检测。结论：血清5-HT水平降低、Obestatin、APRIL水平及NIHSS评分升高是老年脑卒中患者出院后发生PSD的独立危险因素，还可导致神经功能损伤，血清5-HT、Obestatin和APRIL可预测老年脑卒中患者出院后PSD，且联合预测价值更高。

Correlation with Neurological Function of Serum 5-HT and Obestatin and APRIL in Elderly Stroke Patients and Its Predictive Value for Post Stroke Depression

ABSTRACT Objective: To explore the correlation with neurological function of serum 5-hydroxytryptamine (5-HT), obestatin (Obestatin) and a proliferation inducing ligand (APRIL) in elderly stroke patients and its predictive value for post stroke depression (PSD). Methods: 120 elderly stroke patients who were admitted to the Inner Mongolia Autonomous Region People''s Hospital from May 2019 to May 2022 were selected as the study subjects. The blood samples were collected on admission, the serum levels of 5-HT, Obestatin and APRIL were measured by enzyme-linked immunosorbent assay (ELISA). The patients were followed up for 6 months after discharge, and they were divided into PSD group and non-PSD group based on whether PSD occurred, the serum levels of 5-HT, Obestatin and APRIL were compared between the two groups. The correlation of 5-HT, Obestatin, APRIL and national institute of health stroke scale (NIHSS) were analyzed by Pearson correlation analysis. The influencing factors of PSD were analyzed by multivariate Logistic regression model. The predictive value of serum 5-HT, Obestatin combined with APRIL for PSD in elderly stroke patients after discharge was analyzed by receiver operating characteristic (ROC) curve. Results: The serum 5-HT was lower in the PSD group than that in the non-PSD group (P<0.05), and the serum Obestatin, APRIL and NIHSS score in the PSD group were higher than those in the non-PSD group (P<0.05). The serum 5-HT was negatively correlated with NIHSS score (P<0.05). The serum Obestatin and APRIL were positively correlated with NIHSS score (P<0.05). Univariate analysis showed that, PSD was associated with body mass index (BMI), smoking history and drinking history in elderly stroke patients after discharge(P<0.05). Multivariate Logistics regression analysis showed that, elevated serum Obestatin, APRIL and NIHSS score were the risk factors for PSD in stroke patients after discharge (P<0.05), and elevated serum 5-HT was a protective factor(P<0.05). The results of the ROC curve analysis showed that, the area under the curve (AUC) of serum 5-HT, Obestatin, APRIL and combined detection for predicting PSD were 0.735(0.483~0.978), 0.765(0.595~0.918), 0.707(0.464~0.954) and 0.867(0.742~0.972) respectively, the predictive performance of combined detection is better than that of individual detection for each indicator. Conclusion: Decreased levels of serum 5-HT, increased levels of Obestatin, APRIL and NIHSS score are independent risk factors for PSD in elderly stroke patients after discharge, it can also cause neurological damage, the serum 5-HT, Obestatin and APRIL can predict PSD in elderly stroke patients after discharge, and the combine prediction value is higher.