Abstract:

Objective To investigate the relationship between serum homocysteine (Hcy) level and plateletto- lymphocyte ratio (PLR) and post-stroke depression (PSD) in patients with acute ischemic stroke (AIS). Methods This prospective study included consecutive AIS patients admitted to department of neurology of our hospital from October 2018 to October 2019. Clinical data were collected, blood platelet and lymphocyte counts and serum Hcy level were measured in the next morning after admission. All cases were divided into PSD group and non-PSD group based on the diagnosis results of depression at 3 months. Multivariate logistic regression analysis was used to identify the risk factors of PSD. The ROC curve analysis was performed to evaluate the predictive value of Hcy and PLR for PSD. Results A total of 408 patients were included, with an average age of 65.86 ±8.61 years. During the follow-up 3 months after onset, 162 (39.70%) patients were diagnosed with depression. Multivariate analysis showed that the admission NIHSS score (OR 1.422, 95%CI 1.291-1.565, P =0.023) and high fasting blood glucose (OR 1.120, 95%CI 1.014-1.236, P =0.046), Hcy ≥12.36 μmol/L (OR 3.841, 95%CI 2.270-6.500, P <0.001), PLR ≥127.92 (OR 5.197, 95%CI 3.040-8.886, P <0.001) were independent risk factors for PSD. ROC analysis showed that the combination of Hcy and PLR had a maximum predictive value, and the AUC was 0.835 (95%CI 0.796-0.874, P <0.001), with a sensitivity and specificity of 64.5% and 88.27%, respectively. Conclusions Elevated PLR and serum Hcy level were independent risk factors for PSD, and the combination of these two factors had a high predictive value for PSD.

Key words: Homocysteine; Stroke; Post-stroke depression; Platelet-to-lymphocyte ratio

摘要：

目的 探讨血清同型半胱氨酸（h o m o cyste i n e，H cy）联合血小板与淋巴细胞比值（p l ate l et-to - lymphocyte ratio，PLR）对卒中后抑郁（post-stroke depression，PSD）的预测价值。 方法 连续纳入2018年10月-2019年10月安徽理工大学第一附属医院神经内科收治的急性缺血性 卒中患者。记录患者的临床资料，入院后第2天晨起检测血清Hcy、血小板及淋巴细胞计数。以住院或 门诊方式随访3个月，根据是否诊断为抑郁，分为PSD组和对照组。采用多因素Logistic回归模型分析与 PSD相关的因素，应用ROC曲线评估Hcy联合PLR对PSD的预测价值。 结果 共纳入408例患者，平均年龄65.86±8.61岁，发生PSD共162例（39.70%）。多因素Logistic 回归分析显示，入院时NIHSS评分（OR 1.422，95%CI 1.291～1.565，P =0.023）和空腹血糖水平升高 （OR 1.120，95%CI 1.014～1.236，P =0.046），以及Hcy≥12.36 μmol /L（OR 3.841，95%CI 2.270～6.500， P＜0.001）、PLR≥127.92（OR 5.197，95%CI 3.040～8.886，P＜0.001）是PSD的独立危险因素。ROC曲线 分析显示，Hcy联合PLR的预测价值最大，曲线下面积为0.835（95%CI 0.796～0.874，P＜0.001），敏感 度64.5%，特异度88.27%。 结论 血清Hcy水平和PLR升高是急性缺血性卒中患者发病3个月内发生抑郁的独立预测因素，两者 联合预测价值较好。

关键词: 同型半胱氨酸; 卒中; 卒中后抑郁; 抑郁; 血小板与淋巴细胞比值