标题：血清谷氨酸水平对脑梗死后抑郁发病的影响

      作者：余学婕，徐鸿，周春秀    (百色市人民医院神经内科，广西 百色 533000)

      卷次： 2016年27卷21期

      【摘要】 目的 探讨血清谷氨酸水平对脑梗死后抑郁(PCID)发病的影响。方法 选取我院神经内科2013年11月至2015年8月期间收治的80例急性脑梗死患者，于脑梗死后第2周根据《美国精神障碍诊断与统计手册》躯体疾病所导致的心境障碍诊断标准，对80例患者进行脑梗死后抑郁诊断，采用汉密尔顿抑郁量表(HDRS)评估脑梗死后患者的抑郁程度，美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度，使用高效液相色谱技术检测梗死后抑郁患者与非梗死后抑郁患者血清谷氨酸水平，采用多因素Logistic回归分析血清谷氨酸水平对PCID发病的影响。结果 入组两周后，80例脑梗死患者共诊断为 PCID 28例，PCID发生率为 35.0%，其中轻度抑郁 15例(53.6%)，中度抑郁8例(28.6%)，重度抑郁5例(17.8%)；PCID患者入院时NIHSS评分为(7.4±2.4)分，梗死后两周评分为(5.6±1.8)分；非PCID患者入院时NIHSS评分为(6.1±1.7)分，梗死后2周评分为(3.4±1.2)分。PCID患者入院时及梗死后2周，NIHSS评分均显著高于非PCID患者，差异均有显著统计学意义(P<0.01)；PCID患者梗死后第2天和梗死后两周血清谷氨酸水平分别为(4.5±1.8) g/L、(6.9±2.3) g/L，非PCID患者梗死后第2天和梗死后两周血清谷氨酸水平分别为(6.8±2.1) g/L、(7.1±1.9) g/L，PCID患者脑梗死后两周血清谷氨酸水平显著高于第2天，差异有统计学意义(P<0.01)；非PCID患者血清谷氨酸水平前后比较差异无统计学意义(P>0.05)；梗死后第2天，PCID患者血清谷氨酸水平显著低于非PCID患者(P<0.01)，但梗死后两周，PCID患者和非PCID患者血清谷氨酸水平比较差异无统计学意义(P>0.05)；PCID患者脑梗死后第 2天血清谷氨酸水平与脑梗死后第两周HDRS评分呈负相关(r=-0.301，P<0.05)；多因素Logistic回归分析显示，脑梗死血清谷氨酸水平升高是PCID的发生独立危险因素(OR=0.335；95%可信区间为0.139~0.811；P<0.05)。结论 PCID的发生可能与卒中患者血清谷氨酸水平升高相关。
      【关键词】 谷氨酸；脑梗死；抑郁；危险因素
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2016）21—3485—03

Influence of serum glutamate on the incidence of depression in the patients with cerebral infarction.YU Xue-jie,XU Hong, ZHOU Chun-xiu.
Department of Neurology, the People's Hospital of Baise City, Baise 533000, Guangxi, CHINA
【Abstract】 Objective To explore influence of serum glutamate on the incidence of post cerebral infarction de-pression (PCID). Methods A total of 80 cases of acute cerebral infarction patients, who admitted to Department of Neu-rology of our hospital from November 2013 to August 2015, were selected and conducted for PCID diagnosis accordingto the diagnostic criteria of mood disorder caused by somatic diseases in the American Diagnostic and Statistical Manualof Mental Disorders in the second week after cerebral infarction. Hamilton Depression Rating Scale (HDRS) and Nation-al Institutes of Health Stroke Scale (NIHSS) were respectively used to evaluate the severity of depressive symptoms andthe neurological deficit in patients with PCID. The serum glutamate level of PCID patients and non-PCID patients wasdetected by high performance liquid chromatography, and the influence of serum glutamic level on the incidence ofPCID was analyzed by multifactor logistic regression analysis. Results After two weeks, 28 cases of 80 cerebral infarc-tion patients were diagnosed as PCID with the rate of 35.0%, including 15 cases of mild depression (53.6%), 8 cases ofmoderate depression (28.6%), 5 cases of severe depression (17.8%). NIHSS score of PCID patients was (7.4±2.4) pointson admission, and (5.6±1.8) points 2 weeks after the infarction; NIHSS score of non-PCID patients was (6.1±1.7) pointson admission, and (3.4±1.2) points 2 weeks after the infarction. Compared with non-PCID patients, NIHSS scores ofPCID patients were significantly increased on admission and two weeks after infraction (P<0.01). The serum glutamiclevel of PCID on the second days and two weeks after infarction were respectively (4.5±1.8) g/L, (6.9±2.3) g/L, and theserum glutamic level of non-PCID on the second days and two weeks after infarction were respectively (6.8±2.1) g/L,(7.1±1.9) g/L. The serum glutamate levels of PCID patients two weeks after infraction were significantly higher thanthose on the second day, and the difference was statistically significant (P<0.01). There was no significant difference onthe serum glutamate levels on the security day and two weeks after infraction (P>0.05). The serum glutamic level ofPCID patients on the second day of infarction was significantly lower than that of non PCID patients (P<0.01), but therewas no difference between PCID patients and non PCID patients 2 weeks after infarction (P>0.05). There was a negativecorrelation between the serum glutamate levels of the second day and the PCID HDRS score of the second week in cere-bral infarction patients (r=-0.301, P<0.05). Multivariate logistic regression analysis showed that the increasing serum·论 著·doi:10.3969/j.issn.1