Study On The Relationship Between Serum BAFF And APRIL Levels And Post-stroke Depression In Patients With First-episode Acute Ischemic Stroke

Objective:The pathogenesis of post-stroke depression(PSD)is unclear.In recent years,more and more attention has been paid to the role of inflammatory immune dysfunction in the pathogenesis of PSD.As new members of the tumor necrosis factor superfamily,B cell activating factor(BAFF)and proliferation inducing ligand(APRIL)are closely related to B cell immune function and are abnormally expressed in depression.Therefore,we assume that BAFF and APRIL are involved in the occurrence and development of PSD.The purpose of this study was to explore the correlation between the levels of serum BAFF and APRIL and the degree of post-stroke depression and the risk factors of PSD in patients with first-episode acute ischemic stroke,and to evaluate whether BAFF and APRIL can be used as predictive indexes of PSD,so as to contribute to the early identification and diagnosis of PSD.Methods:166 patients with first acute ischemic stroke diagnosed in our hospital from January2019 to October 2020 were selected.The 24-item Hamilton Depression Scale(HAMD)was used to evaluate patients’ depressive status 9±2 days after admission.According to HAMD score,166 patients with ischemic stroke were divided into PSD group(mild,moderate and severe)and non-PSD group(NPSD group),and 50 healthy subjects in our hospital in the same period were selected as healthy control group.The neurological deficit of stroke patients was assessed by National Institutes of Health Stroke scale(NIHSS),the activities of daily living was assessed by(ADL),and the mental state and cognitive impairment were assessed by mini-mental state examination((MMSE)).The location of cerebral infarction was obtained according to the results of MRI,and the differences of HAMD scores in different infarct sites were compared.The levels of serum BAFF and APRIL were detected by enzyme-linked immunosorbent assay(ELISA).The correlation between BAFF,APRIL and HAMD score was evaluated by Pearson correlation analysis.The predictive effect of BAFF and APRIL on PSD was analyzed by receiver working curve(ROC).Logistic multivariate regression model was used to analyze the independent risk factors affecting the occurrence of PSD.Results:1.Incidence of PSD: a total of 166 patients with first acute ischemic stroke were included in this study.Among them,57 patients with PSD were diagnosed 9±2 days after onset,with an incidence of 34.3%,including 42 cases of mild depression(73.7%),14 cases of moderate depression(24.5%)and 1 case of severe depression(1.8%).The healthy control group included 50 cases.2.There was no significant difference in age,hypertension,diabetes,heart disease and drinking between PSD group,NPSD group and control group(P>0.05).The proportion of male and smoking in the PSD group was lower than that in the NPSD group,and the difference was statistically significant(P<0.05).NIHSS score of PSD group was higher than that of NPSD group and control group,ADL score was lower than that of NPSD group and control group,MMSE score was lower than that of control group,and the difference was statistically significant(P< 0.05).3.Comparison of serum BAFF and APRIL levels among PSD group,NPSD group and control group: serum BAFF and APRIL levels in PSD group were higher than those in NPSD group and control group,and the difference was statistically significant(P<0.05).There was no significant difference in serum BAFF and APRIL levels between mild PSD group and moderate and severe PSD group(P>0.05).There was no significant difference in HAMD scores of different infarct sites(cerebral hemisphere,cerebellum,brain stem)between PSD group and NPSD group(P>0.05).4.Analysis of correlation between serum BAFF,APRIL levels and HAMD score:there was a positive correlation between serum BAFF level and HAMD score in patients with acute ischemic stroke(r=0.162,P<0.05),and a positive correlation between serum APRIL level and HAMD score(r = 0.195,P<0.05).5.The predictive effect of serum BAFF and APRIL levels on the occurrence of PSD:the area under the ROC curve of serum BAFF was 0.654(95%CI:0.587-0.717 P<0.001),the sensitivity is 68.42%,the specificity is 62.89%,the cut-off value is > 38.52;the area under the ROC curve of serum APRIL is 0.643(95%CI:0.575-0.707 P<0.001),the sensitivity is 82.46%,the specificity is 44.03%,and the cutoff value is >71.39.6.Multivariate Logistic regression analysis of the incidence of PSD: Female,NIHSS score,BAFF,APRIL levels were the risk factors of PSD.Conclusion:The levels of serum BAFF and APRIL in patients with acute ischemic stroke play an important role in the pathogenesis of PSD,and can predict the possibility of PSD to a certain extent.