Relationship Between CRP?PLR?Lp-PLA2 And Post-stroke Depression In Patients With Acute Ischemic Stroke

Stroke has become the first cause of death in our country.It is the top three causes of death with heart disease and malignant tumor.At least one of every five people died of stroke.In recent years,stroke has made some progress in prevention and treatment,but it is still one of the major diseases threatening human health.Post-stroke depression(PSD)is the most common mental disorder after stroke,which is manifested as loss of original interest in things,poor appetite,insomnia,easy fatigue,low self-evaluation,self blame,and even repeated thoughts or behaviors of self injury and suicide,which has a huge impact on the quality of life of patients,which makes it a serious social public health problem.The occurrence of PSD has negative effects on the course and recovery of stroke,and increases the probability of recurrence of cerebrovascular events.It can be seen that early diagnosis and treatment of PSD can improve the prognosis of stroke patients.In recent years,some progress has been made in the research of PSD at home and abroad,but the pathogenesis of PSD is very complex,which is still not completely clear.It may be the result of many factors such as biological mechanism and social psychological mechanism.C-reactive protein(CRP)is an acute protein produced when the body is stimulated by inflammation.It is part of the body's early response to tissue damage,infection and tumor.In recent years,CRP has been widely used as a marker of systemic inflammation.Many studies at home and abroad have shown that CRP is closely related to PSD.Platelet to lymphocyte ratio(PLR)has also been proved to be a new type of indirect inflammatory marker,which is related to stroke,coronary heart disease and depression.Lipoprotein associated phospholipase A2(Lp-PLA2)is a novel and unique biomarker,which is highly specific for vascular inflammation and atherosclerosis,and also related to the occurrence of stroke.Lp-PLA2 is a kind of phospholipase A2(PLA2).PLA2 is the key enzyme of phospholipid metabolism.The abnormal phospholipid metabolism is related to many kinds of mental diseases.However,there are few studies on the relationship between PLR,Lp-PLA2 and PSD.Objective:the purpose of this study is to analyze the relationship between CRP,PLR,Lp-PLA2 levels and PSD in patients with acute ischemic stroke,and to find out the pathogenesis and predictors of PSD in combination with the degree of neurological impairment of patients,so as to provide a certain basis for early clinical prediction and diagnosis of PSD.Methods:the case group consisted of 100 patients with acute ischemic stroke who were hospitalized in the Department of Neurology,the First Affiliated Hospital of Yangtze University from January 2018 to December 2018.The diagnosis of all patients met the diagnostic criteria of China's guidelines for the diagnosis and treatment of acute ischemic stroke 2014,and they were the first time to develop acute cerebral infarction,which was confirmed by diffusion-weighted imaging of cranial MRI.According to the expert consensus on clinical practice of post-stroke depression,all patients were divided into PSD group and non PSD group according to the 17 version of Hamilton Depression Scale(HAMD-17),and then PSD group was divided into mild PSD group and moderate PSD group according to the HAMD-17 score.40 physical examinees in the physical examination center of our hospital were selected as the control group.General data of all participants were collected,including gender,age,marital status,previous hypertension,diabetes,coronary heart disease,smoking and alcohol history,etc.On the morning of the second day of admission,all patients were taken venous blood from the fasting state and sent to the laboratory of the hospital.Blood routine,liver function,renal function,blood glucose,blood lipid and other indicators were measured.PLR value was measured according to platelet count/lymphocyte count.The contents of CRP and Lp-PLA2 were detected by immunochromatography and double antibody sandwich principle.All patients completed NIHSS scores at admission.The general clinical data,laboratory test results and NIHSS scores were compared and analyzed by statistical method.Pearson's correlation analysis was made between each index and HAMD score,and multivariate logistic regression analysis was used to predict the risk factors of PSD.Results:1.A total of the 100 AIS patients who were followed up for three months,32 patients were diagnosed as PSD(13 males and 19 females),with a 32%incidence rate.Among them,19(19%)were mild depression,10(10%)were moderate depression,3(3%)were severe depression.2.There was no significant difference between PSD group,non PSD group and control group in age,gender,hypertension history,diabetes history,smoking history and coronary heart disease history(P>0.05).3.There was no significant difference in WBC,HB,PLR,TC,TG,LDL,alt,AST,creatinine and urea between PSD group,non PSD group and control group(P>0.05)The levels of CRP,PLR and Lp-PLA2 in PSD group were higher than those in non PSD group(P<0.05).The NIHSS score in PSD group was higher than that in non PSD group(P<0.05).4.There was no significant difference in age,gender,hypertension,diabetes,smoking and coronary heart disease between mild PSD group and moderate PSD group(P>0.05).5.The levels of CRP,PLR and Lp-PLA2 in mild PSD group were significantly lower than those in moderate and severe PSD group(P<0.05).6.NIHSS score of mild PSD group and moderate severe PSD group was significantly higher than that of non PSD group(P<0.05).The NIHSS score of moderate and severe PSD group was significantly higher than that of mild PSD group(P<0.05).7.Pearson correlation analysis was made between the level of CRP,PLR,Lp-PLA2,NIHSS and HAMD.The results showed that CRP(r=0.592,P=0.000),PLR(r=0.657,P=0·000),Lp-PLA2(r=0.618,P=0.000),NIHSS(r=0.612,P=0.000)were positively correlated with HAMD.8.Single factor and multi factor Logistic regression analysis was carried out for the statistically significant indexes(CRP,PLR,Lp-PLA2 level,NIHSS score).Single factor Logistic regression analysis showed that CRP,PLR,Lp-PLA2 and NIHSS scores may be the confounding factors of PSD patients.FactorConclusion:1.The incidence rate of PSD was 32%after AIS follow-up for three months,and mild depression was the major factor.2.The levels of CRP,PLR and Lp-PLA2 in the blood of patients with AIS complicated with PSD were significantly increased in the early stage.PSD was positively correlated with the levels of CRP,PLR and Lp-PLA2 in patients with AIS.The higher the levels of CRP,PLR and Lp-PLA2 were,the more severe the depression was.3.The occurrence of PSD is related to the degree of neurological deficit in AIS patients.The more severe the neurological deficit is,the more severe the depression is.4.CRP,PLR,Lp-PLA2 and NIHSS score were independent predictors of PSD.