The Risk Factors Of Post-stroke Depression And The Correlation Between The Degree Of Depression And Cytokines

Objective:Post-Stroke Depression is a common affective disease after stroke,which is easily overlooked and its morbidity,mortality,recurrence rate are higher.The incidence is different,most of the 40%-50%.Post-stroke depression patients often appear to low mood,loss of interest,loss of pleasure-based core symptoms,and it can be accompanied by loss of appetite,sleep disorders,weight changes and other negative emotional symptoms.These symptoms delay or even worsen their own nerve function,reduce their ability to live,increase treatment and costs and increase unnecessary medical waste.So,prevention,as early as possible diagnosis and treatment of post-stroke depression is extremely important.The aim was to study the correlated risk factors of post-stroke depression,the connection between the degree of depression in patients and cytokines,and control the intervening factors as soon as possible,and to give relevant treatment and reduce its morbidity and mortality.Methods:150 patients with stroke were picked,which were enrolled in the Department of Neurology,Affiliated Hospital of Hebei University from September 2015 to October 2016.The age was 50-80 years,with an average age of 65.13±8.11 years old,including 88 males and 62 females.The diagnosis was determined by head CT or MRI,and met the academic standards of the fourth national cerebrovascular.According to the Chinese Classification Of Mental Disorders and Diagnostic Criteria(CCMD-3)to determine the diagnosis of PSD.Two weeks of admission,all patients were assessed using the criteria of Hamilton Depression table 17 scores,which were divided into PSD group and non-PSD group.The HAMD score of PSD patients was greater than seven points,the HAMD score of patients with mild depression was eight to seventeen points,mild post-stroke depression group was eighteen to twenty-four points,and the severe post-stroke depression group was greater than or equal to twenty five points.collect the general information of the two groups of patients separately1.Basic population data:education,age,marriage,gender,personality,occupation,drinking,smoking,place of residence,family history of stroke,family income,stroke frequency,2.Underlying disease:coronary heart disease,hypertriglyceridemia,diabetes,hypercholesterolemia,hypertension.3.Carotid artery stenosis and the degree of stenosis:All stroke patients were screened by carotid artery ultrasound and the degree of stenosis of the carotid artery was evaluated by the criteria of he Society of Radiologists in Ultrasound in 2003.4.Stroke properties,lesion site,the number of lesions were all supported by head MRI findings.5.Neurological deficits:the neurological deficit was assessed by NIHSS,and the higher the score,the more severe the neurological function.6.Social support:Using the social support rating scale(SSRS).7.Hey:Fasting 12 hours after the next day at 6 o'clock to take venous blood and check the laboratory for testing.8.IL-18,TNF-a,IL-6:Fasting 12 hours after the next morning to take venous blood 5mL,4?3000r/min centrifugal 10 minutes and take the upper serum,store in refrigerator at-80?,and use the ELISA measure the content of cytokines.Results:1.A total of 150 patients,of which PSD patients were 57 cases(38%),mild PSD in 33 cases(22%),moderate in 17 cases(11.3%).severe in 7 cases(4.7%).2.The univariate analysis showed that the two groups had significant differences in family income,stroke frequency,family history of stroke,hypercholesterolemia,hypertension,the number of lesions,carotid artery stenosis,NHISS score and score of social support(P<0.05),these nine factors may be related to post-stroke depression.There were no connection between the stroke properties,sex,education,age,marriage,personality,occupation,drinking,place of residence,hypertriglyceridemia,smoking,coronary heart disease,diabetes,lesion site and post-stroke depression,which was not significant(P>0.05).Multivariate logistic showed that hypertension,carotid stenosis,hypercholesterolemia,NIHSS score,social support correlated to PSD(P<0.05).The hypertension,carotid artery stenosis,hypercholesterolemia,NIHSS score are risk factors of PSD,while social support is a protective factor of PSD.3.PSD group's social support score and its three aspects were lower than those in the non-PSD group(t=-4.311,-3.241,-3.889,-5,136;P<0.001).HAMD score was negatively correlated with the scores of social support,subjective support,objective support and iutilization degree of social support(r=-0.515,-0.442,-0.460,-0.507;P<0.01).Patients with lower social support were more prone to be depressive.4.Carotid artery stenosis was a risk factor of PSD(P<0.05),and HAMD score was positively related to carotid artery stenosis(r=0.417,P<0.01).The degree of carotid artery stenosis was higher,the higher the HAMD score,the more severe the PSD.5.The NIHSS score of the PSD group was higher than that of the non-PSD group(P<0.05),the HAMD score and the NIHSS score were positively correlated(r=0.693,P<0.01);The higher the NIHSS score,the more severe the PSD.6.The levels of Hey in the PSD group was significantly higher than that in the non-PSD group(P<0.05).The homocysteine contents in the patients with severe depression,moderate depression,mild and non-depression were 19.18 ± 5.01umol/L,24.29±4.18umol/L,28.71 ±1.60umol/L,14.91 ±3.76umol/L.The comparison between the two were statistically significant(P<0.05).The level of homocysteine was positively related to HAMD score(r=0.576,P<0.001).7.The levels of IL-18,TNF-a and IL-6 in PSD group were significantly higher than those in non-PSD group(P<0.05),and HAMD score was positively related to IL-18,TNF-? and IL-6(r=0.716,0.672,0.656;P<0.001).The levels of IL-18,TNF-? and IL-6 increased with the increase of depression.Conclusion:Post-stroke depression is affected by many factors,carotid artery stenosis,hypercholesterolemia,NHISS score,hypertension,Hyperhomocysteinemia are risk factors of PSD,social support is a protective factor of PSD,they are closely related to PSD.Combined with higher cholesterol and hypertension,severe neurological deficits and carotid stenosis,access to poor social support for stroke patients are more likely to post-stroke depression.Carotid artery stenosis,levels of Hcy and NIHSS score were positively related to HAMD score,the scores of social support was negatively correlated to HAMD score,with the higher the NIHSS score,levels of Hcy,the more severe carotid artery stenosis and lower social support,the increased severity of PSD.The levels of IL-18,TNF-?,IL-6 serum homocysteine in patients with PSD were positively related to the degree of depression in stroke and took an important role in the development of PSD.