作者：李月月，王聪聪，田小军，苏洲，郭双喜，王玉梅

单位：

453100河南省新乡市，新乡医学院第一附属医院神经内科

Units：

Department of Neurology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, China

关键词：

缺血性卒中；卒中后抑郁；核苷酸结合寡聚化结构域样受体蛋白3；诱导型一氧化氮合酶

Keywords：

Ischemic stroke; Post-stroke depression; Nucleotide-bound oligomerized domain-like receptor protein 3; Inducible nitric oxide synthase

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2024.00.087

Funds：

河南省医学科技攻关计划联合共建项目（LHGJ20200490）；新乡医学院第一附属医院青年培育基金项目（QN- 2022-B13）

摘要：

　目的　探讨急性缺血性脑卒中（AIS）患者血清核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）、诱 导型一氧化氮合酶（iNOS）水平与卒中后抑郁（PSD）的关系。方法　选取2022年8月—2023年8月新乡医学院第一附 属医院神经内科收治的AIS患者，收集患者临床资料，随访1个月时采用汉密尔顿抑郁量表17项（HAMD-17）评估患 者PSD发生情况，以HAMD-17评分≥8分为发生PSD，将发生PSD的患者纳入PSD组，其余患者纳入非PSD组；PSD组患 者根据HAMD-17评分进一步分为轻度抑郁（8分≤HAMD-17评分＜17分）和中-重度抑郁（HAMD-17评分≥17分）。 采用Pearson相关分析探讨PSD组患者血清NLRP3、iNOS水平及HAMD-17评分间的相关性；采用多因素Logistic回归分 析探讨AIS患者发生PSD的影响因素；采用ROC曲线分析血清NLRP3、iNOS水平及二者联合对AIS患者发生PSD的预测 价值。结果　本研究共纳入171例AIS患者，64例患者发生PSD，其中轻度抑郁34例、中-重度抑郁30例。PSD组患者美 国国立卫生研究院卒中量表（NIHSS）评分、LDL-C及血清NLRP3、iNOS水平高于非PSD组（P＜0.05）。中-重度抑郁 患者血清NLRP3、iNOS水平高于轻度抑郁患者（P＜0.05）。Pearson相关分析结果显示，PSD组患者血清NLRP3、iNOS 水平与HAMD-17评分呈正相关（P＜0.05），血清NLRP3水平与血清iNOS水平呈正相关（P＜0.05）。多因素Logistic回 归分析结果显示，NIHSS评分及血清NLRP3、iNOS水平是AIS患者发生PSD的独立影响因素（P＜0.05）。ROC曲线分 析结果显示，血清NLRP3、iNOS水平及二者联合预测AIS患者发生PSD的AUC分别为0.812、0.828、0.885。二者联合预 测AIS患者发生PSD的AUC大于血清NLRP3、iNOS水平预测AIS患者发生PSD的AUC（P＜0.05）。结论　血清NLRP3、 iNOS水平是AIS患者发生PSD的独立影响因素，并且与PSD严重程度相关。血清NLRP3水平联合血清iNOS水平对AIS患 者发生PSD具有一定预测价值。

Abstract：

Objective To investigate the relationship between serum nucleotide-bound oligomerized domain-like receptor protein 3 (NLRP3) and inducible nitric oxide synthase (iNOS) levels and post-stroke depression (PSD) in patients with acute ischemic stroke (AIS) . Methods Patients with AIS admitted to Department of Neurology in the First Affiliated Hospital of Xinxiang Medical University from August 2022 to August 2023 were selected. The clinical data of the patients were collected, and the occurrence of PSD was evaluated by Hamilton Depression Scale-17 (HAMD-17) . HAMD-17 score ≥ 8 points was indicated the occurrence of PSD, the patients with PSD included in the PSD group, and the remaining patients were included in the non-PSD group. Patients in PSD group were further divided into mild depression (8 points ≤ HAMD-17 score < 17 points) and moderate to severe depression (HAMD-17 score ≥ 17 points) according to HAMD-17 score. Pearson correlation analysis was used to explore the correlation between serum NLRP3, iNOS levels and HAMD-17 score in PSD group patients. Multivariate Logistic regression analysis was used to explore the influencing factors of PSD in patients with AIS. ROC curve was used to explore the predictive value of serum NLRP3 and iNOS levels and their combination for PSD in patients with AIS. Results A total of 171 AIS patients were enrolled, among whom 64 patients occurrenced PSD, including 34 patients with mild depression and 30 patients with moderate to severe depression. The National Institute of Health Stroke Scale (NIHSS) score, LDL-C and serum NLRP3 and iNOS levels in the PSD group were higher than those in the non-PSD group (P < 0.05) . The serum NLRP3 and iNOS levels in the patients with mild depression were higher than those in the patients with moderate to severe depression (P < 0.05) . Pearson correlation analysis showed that serum NLRP3 and iNOS levels were positively correlated with HAMD-17 score in PSD group patients (P < 0.05) , the serum NLRP3 level was positively correlated with serum iNOS level in PSD group patients (P < 0.05) . Multivariate Logistic regression analysis showed that NIHSS score, serum NLRP3 and iNOS levels were independent influencing factors of PSD in patients with AIS (P < 0.05) . ROC curve analysis showed that the AUC of serum NLRP3 and iNOS levels and their combination in predicting PSD in patients with AIS was 0.812, 0.828 and 0.885, respectively. The AUC of their combination in predicting PSD in patients with AIS was greater than the AUC of serum NLRP3 and iNOS levels in predicting PSD in patients with AIS (P < 0.05) . Conclusion Serum NLRP3 and iNOS levels were independent influencing factors of PSD in patients with AIS, and are correlated with the severity of PSD. Serum NLRP3 level combined with serum iNOS level has a certain predictive value on PSD in patients with AIS.

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