Characterization Of Intestinal Flora And Related Influencing Factors In Depressed Patients After Ischemic Stroke

Objective:Post-stroke depression(PSD)is a depressive state that seriously affects the prognosis and quality of life of following the occurrence of stroke.In this study,16 S r RNA gene sequencing was performed on fecal specimens of PSD patients to study the composition characteristics of intestinal flora,and to analyze the correlation between changes in the intestinal flora of ischemic stroke patients and their depression status and clinical indicators,providing a basis for the elaboration of the pathogenesis of PSD and the application of intestinal flora to clinical treatment.Methods:Seventy patients with ischemic stroke were selected as the experimental group and divided into PSD group and non-post-stroke depression(NO-PSD)group according to the follow-up results three months after discharge.In addition,twenty-two healthy controls were selected as the healthy control group according to age and gender matching.The general clinical data,serum inflammatory and metabolic indicators of the subjects were collected.Fresh fecal samples were collected from the subjects,and the DNA sequences of the three groups of intestinal flora were detected by 16 S r RNA gene sequencing technology and analyzed for intestinal flora diversity and species composition,and the LEf Se analysis was used to find the differential flora between the three groups.The differences of clinical baseline data among the three groups were compared,and the correlation between intestinal flora and depression status and clinical indicators was analyzed.Results:1.The BMI value,the prevalence of hypertension and diabetes in the healthy control group were lower than those in the NO-PSD group and the PSD group,and the family function was better.The years of education in patients with PSD were lower than those in NO-PSD group and healthy control group.The differences were statistically significant(P <0.05).2.The expression levels of serum total cholesterol,low density lipoprotein,lipoprotein-associated phospholipase A2,homocysteine,white blood cell,neutrophil and neutrophil-to-lymphocyte ratio in patients with PSD were higher than those in the other two groups.The expression levels of serum triglyceride,high-sensitivity C-reactive protein,glycated hemoglobin,platelet and platelet-to-lymphocyte ratio in the healthy control group were lower than those in the other two groups,and the level of high-density lipoprotein was higher than that in the other two groups(P<0.05).Multivariate logistic regression analysis was used to analyze the differences between the PSD group and the NO-PSD group.The results showed that the increase of phospholipase A2 and neutrophil and neutrophil-to-lymphocyte was an independent risk factor for depression in ischemic stroke patients(OR=1.033,P=0.002;OR=2.711,P=0.038).3.Species composition analysis showed that there were differences in the distribution of the three groups at the phylum,family and genus levels.Alpha diversity analysis suggested that the two groups of PSD and NO-PSD had higher species diversity and species richness than the healthy control group.Beta diversity analysis showed that there were differences among the three groups(P=0.001).Through LEf Se analysis,a total of 14 significantly different floras were identified at the phylum,family and genus levels(P < 0.05,LDA > 4).Among them,Ruminococcaceae,Prevotellaceae,Fecalibacterium,and Subdoligranulum were enriched in patients without depression after stroke.Proteobacteria,Enterobacteriaceae,Agathobacter,Escherichia-Shigella,and Merdibacter were enriched in patients with depression after stroke.Actinobacteria,Bifidobacterium,Lactobacillaceae,Bifidobacterium,and Veillonella were enriched in healthy control group.4.The relative contents of Proteobacteria,Enterobacteriaceae,and Escherichia-Shigella in the differential bacteria of patients with PSD and NO-PSD were positively correlated with total cholesterol levels(r=0.317、r=0.296、r=0.271,P<0.05).The Hamilton Depression Scale score of the two groups was positively correlated with the relative content of Proteobacteria,Enterobacteriaceae and Agathobacter(r=0.293、r=0.278、r=0.370,P<0.05),and negatively correlated with the relative content of Ruminococcaceae(r=0.-0.306,P<0.05).Conclusion:1.Compared with healthy control,the diversity of flora in patients with PSD and NO-PSD increased.There were differences in the composition of the intestinal flora in the three groups of subjects.2.Compared with healthy control and NO-PSD,patients with PSD had higher peripheral blood total cholesterol,low-density lipoprotein,lipoprotein-associated phospholipase A2,homocysteine,neutrophil-to-lymphocyte ratio and Hamilton Depression Scale scores,where changes in total cholesterol and Hamilton depression scale scores may be associated with different structural composition of the intestinal flora.3.Combined detection of laboratory indicators and intestinal flora to predict the risk of depression in patients with ischemic stroke is conducive to early detection of depression,timely clinical intervention,and avoiding disease progression.