Predictive Study Of NLR Combined With Hs-CRP In Patients With Depression After Acute Ischemic Stroke In Western Yunnan

【Obiective】By studying the relationship between serum high-sensitivity C-reactive protein(hs-CRP)and neutrophil to lymphocyte ratio(NLR)in patients with acute ischemic stroke,the relation between post-stroke depression and further analysis of the differences in patients with different degrees of depression,combined with clinical data and demographic data to explore the role of systemic inflammation in the pathophysiology of post-stroke depression,and provide a theoretical basis for primary clinicians to predict and identify post-stroke depression as soon as possible.【Method】Select 97 first-time acute ischemic stroke patients who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Dali University from September 2018 to September 2020.After admission,each patient was asked to use the "90-second four-question method" to ask questions.For stroke patients with negative depression after screening,complete the risk factor screening,and test hs-CRP and NLR indicators,and follow up(in-person consultation)patients in the hospital within 3months after discharge.Then according to the clinical symptom diagnosis of depression as the diagnostic criteria,combined with the Hamilton Depression Scale(HAMD-17)to assess the existence of depressive symptoms.Finally,according to the evaluation results,it is divided into post-stroke depression group(PSD group)and non-post-stroke depression group(non-PSD);the post-stroke depression group is divided into mild PSD group,moderate PSD group,and severe PSD according to the severity of symptoms group.32 healthy people who established health records in our hospital’s physical examination center during the same period were selected as the normal control group.Compare post-stroke depression,non-post-stroke depression and normal control group of cerebrovascular risk factors,neurological impairment(NIHSS),hs-CRP and NLR levels;further compare and analyze whether there are statistical differences in gender,smoking history,heart disease,infarct location,hs-CRP and NLR in the mild PSD group,moderate PSD group,and severe PSD group;calculate the area under the ROC curve of hs-CRP combined and NLR.【Results】1.In this study,97 patients with acute cerebral infarction,50 patients with PSD were diagnosed within 3 months after stroke;among the depressed patients,31 patients with mild depression and 14 patients with moderate depression were the main ones.2.The PSD group,non-PSD group,and normal control group had statistically significant differences in gender,education level,heart disease,and smoking history among the three groups(all P<0.05).According to the results of univariate analysis,multivariate logistic regression analysis showed that after adjusting for common risk factors,NLR and hs-CRP were independent risk factors for post-stroke depression(both P<0.05).3.There was no statistically significant difference in age,gender,education level,hypertension,heart disease,infarct location,NIHSS score,triglycerides,total cholesterol,smoking history,and drinking history in the mild PSD group,moderate PSD group,and severe PSD group(All P>0.05).4.The hs-CRP and NLR indicators of the PSD group were higher than those of the non-PSD group and the normal control group,and the differences were statistically significant(P<0.01).In the non-PSD group,the hs-CRP and NLR indicators were slightly higher than those in the normal control group,and the difference was not statistically significant(P>0.05).5.The hs-CRP and NLR indicators of the mild PSD group were significantly lower than those of the PSD group and the severe PSD group,and the differences were statistically significant(P<0.01).The hs-CRP and NLR indexes of the moderate PSD group were significantly lower than those of the severe PSD group,and the difference was not statistically significant(P>0.05).6.The area under the curve of hs-CRP value is 0.839(95% confidence interval:0.769~0.909,P<0.01),the maximum value of hs-CRP Youden index is 0.57,and the corresponding hs-CRP value is 5.93mg/L,The sensitivity of diagnosing PSD is 0.76,and the specificity is 0.81.The area under the curve value of NLR is 0.89(95% confidence interval: 0.832~0.948,P<0.01),the maximum value of NLR Youden index is 0.684,the corresponding NLR value is 3.025,the sensitivity of diagnosing PSD is 0.76,and the specificity is Is 0.924.The area under the curve of hs-CRP combined with NLR is 0.938(95% confidence interval 0.894~0.981,P<0.001).NLR is more valuable than hs-CRP in diagnosing post-stroke depression.hs-CRP combined with NLR is more effective in diagnosing post-stroke depression.【Conclusion】1.Within 3 months of acute cerebral infarction,the risk of post-stroke depression is higher,and patients with mild to moderate post-stroke depression are the main group.2.The hs-CRP and NLR indicators are the risk factors for the occurrence of depression 3 months after stroke.The hs-CRP and NLR indicators are increased in patients with post-stroke depression.hs-CRP combined with NLR is more effective in diagnosing post-stroke depression.