The Association Between Inflammatory Factor Level And Post-stroke Depression In Patients With Ischemic Stroke

BackgroundPost-stroke depression(PSD)is one of the most common neuropsychiatric sequelae of stroke.PSD is closely related to a series of adverse clinical results.Compared with patients of simple depression,PSD patients have more serious dysfunction.Early detection of depressive symptoms and drug treatment can obtain a better prognosis.However,at present,there is no definite diagnostic standard for PSD,which mainly depends on clinical manifestations and related nervous system function scores,lack of specific diagnostic indicators to help clinicians identify PSD patients early,and intervene as soon as possible.There is no unified understanding of the pathogenesis of PSD.It is believed that the joint action of biological factors and social psychological factors leads to the occurrence of PSD.The biological factors include the location effect of stroke injury and the inflammatory response after stroke.There are some differences in the pathogenesis of different PSD patients because of the damage of signal transduction and the influence of genetic polymorphism.Some studies have shown that inflammation and cell-mediated immune inflammation are the key factors of depression,which directly affect the injury and repair of the central nervous system,and are directly related to depression,cognitive impairment and other complications as well as long-term prognosis.ObjectiveTo investigate the relationship between inflammatory factor levels and PSD in patients with Cerebral ischemic stroke(CIS).MethodFrom March 2016 to October 2017,63 patients with acute CIS who were treated inthe Department of Neurology,the first affiliated Hospital of Xinxiang Medical College,were included in the study.63 patients with ischemic stroke were followed up and evaluated at 6 months after stroke.According to the score of Hamilton Depression scale(HAMD-17),all the patients were divided into two groups,the complicated with depression group includes 28 patients whose HAMD-17 score no less than 7,the non-complicated with depression group includes 35 patients whose HAMD-17 score less than 7.The general data(including gender,age,education,complications)and neurological scores(including the Neurologic Institutes of Health strock score,NIHSS,Barthel Index,BI,Mini-mental State Examination,MMSE)were collected from the two groups.The levels of interleukin-1β(IL-1β),interleukin-23(IL-23)and transforming growth factor-β1(TGF-β1)were measured by enzyme-linked immunosorbent assay(Elisa)in the fasting venous blood of the two groups at admission and 6 months after stroke.The levels of hypersensitive C-reactive protein(hs-CRP)and homocysteine(Hcy)were measured by immunoturbidimetric method and circulating enzyme method respectively.Result(1)There was no significant difference in age,education level and complications between the two groups,but the proportion of female patients in PSD group was higher than that in non-PSD group(P < 0.05).(2)The hs-CRP,IL-1β and TGF-β1 levels of patients in the PSD group were higher than those in the non-PSD group at 6th month after stroke(P < 0.05).(3)There was no significant difference in IL-23 and Hcy levels between the two groups at 6th month after stroke(P > 0.05).(4)The Youden index showed that the best cut point of hs-CRP was more than 2.64 mg / L,the sensitivity was 0.821,the specificity was 0.600,and the best cut point of IL-1βwas more than 20.595 pg / mL,the sensitivity was 0.893,the specificity was 0.714.ConclusionFemale with CIS are high-risk people with PSD.The CIS will activate the immune-inflammatory system and lead to the increase of hs-CRP,IL-1β and TGF-β1,participate in the occurrence of PSD.Six months after stroke,hs-CRP more than 2.64 mg/L and IL-1βmore than 20.595 pg/mL could be used as relevant indicators to predict the occurrence of PSD.