| BackgroundPost-stroke depression?PSD?is a common complication after stroke,with an incidence of 40%to 50%,and the mortality rate of PSD patients is significantly higher than that of stroke patients without depression.The pathogenesis of PSD is more complicated.In recent years,the"PSD cytokine hypothesis"proposed by Spalletta et al provides a direction for exploring the etiology of PSD,that is,there may be an imbalance of inflammatory cytokine network in patients with PSD.Studies have shown that various cytokines such as interleukin-1,IL-2,IL-6 and tumor necrosis factor-??TNF-??are closely related to PSD.These cytokines not only can effectively regulate the immune status of the body,but also have a significant impact on the process of neurotransmitter secretion,synthesis and physiological metabolism,and play an important role in the pathogenesis of depression after cerebrovascular disease.Currently,there are no reliable biological indicators in the clinic to predict the occurrence of PSD.This study was to compare the serum IL-2 and IL-4 levels in patients with PSD and non-PSD cerebral infarction,and to explore the correlation between serum IL-2 and IL-4 levels and PSD.ObjectiveThe serum levels of interleukin-2?IL-2?and interleukin-4?IL-4?were measured in patients with acute cerebral infarction,and the post-stroke depression?PSD?was observed in the later stage.The relationship between inflammatory factors and PSD was studied.MethodsIn case group,80 patients with acute cerebral infarction confirmed by cranial MRI or CT were followed up continuously within 3 months after stroke.All the participants were followed up according to the diagnostic criteria of PSD and Hamilton Depression Scale?HAMD-17?.Finally,according to the follow-up results,the patients with cerebral infarction were divided into post-stroke depression group?PSD group?and non-post-stroke depression group?non-PSD group?.The PSD group was divided into two sub-groups according to the score level:mild and moderate to severe.Another 40 out-patients in the same period were selected as the control group.The levels of IL-2 and IL-4 in serum were detected by ELISA,and the differences between different groups were compared.According to the National Institute of Health stroke scale?NIHSS?,the correlation between neurological deficit score and PSD was analyzed.Results1.There was no significant difference in gender,age,medical history and other general data between the two groups?P>0.05?.2.The level of IL-2 in control group was higher than that in PSD group and non-PSD group,while the level of IL-4 was significantly lower than that in PSD group and non-PSD group?P<0.01?;the level of IL-2 in non-PSD group was significantly higher than that in PSD group,while the level of IL-4 was significantly lower than that in PSD group?P<0.01?.3.Serum IL-2 level in moderate and severe PSD group was significantly lower than that in mild PSD group,and IL-4 level was significantly higher than that in mild PSD group,the difference was statistically significant?P<0.01?.4.The NIHSS score of PSD group was significantly higher than that of non-PSD group?t=6.340,P<0.01?.The NIHSS score of moderate and severe PSD group was significantly higher than that of mild PSD group?t=2.511,P<0.01?.5.The area under the ROC curve of IL-2 was 0.752?95%confidence interval:0.605-0.899,P<0.05?,and the maximum Youden index of 0.487,serum IL-2 was obtained when the IL-2 level was 7.685?g·L-1.The sensitivity of the horizontal prediction PSD was75.0%and the specificity was 26.3%.The area under the ROC curve of IL-4 was 0.706?95%confidence interval:0.541-0.871,P<0.05?,and the maximum Youden index was0.529 when IL-4 level was 38.380?g·L-1.Serum IL-4 level prediction The sensitivity of PSD was 79.2%and the specificity was 26.3%.6.There was a significant negative correlation between serum IL-2 level and HAMD score in patients with PSD?r=-0.773,P<0.01?.Serum IL-4 level was positively correlated with HAMD score of PSD patients?r=0.764,P<0.01?.Conclusion1.The lower the level of IL-2 and the higher the level of IL-4,the higher the risk of PSD in the later stage of acute cerebral infarction.2.Severe neurological deficits are associated with the development of PSD. |
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