Predictive value of serum TSPO, BDNF, and TNF-α levels for post-stroke depression in patients with acute ischemic stroke
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摘要:
目的 评估血清18 kDa易位蛋白(TSPO)、脑源性神经营养因子(BDNF)、肿瘤坏死因子-α(TNF-α)水平对急性缺血性卒中(AIS)患者发生卒中后抑郁(PSD)的临床意义。 方法 选取2022年1月—2024年1月新乡医学院第一附属医院收治的121例AIS患者，根据出院后3个月17项汉密尔顿抑郁量表(HDRS-17)评估是否出现PSD，将其分为PSD组(38例)和非PSD组(83例)。收集2组患者的人口学资料、临床特征，并比较2组患者血清TSPO、BDNF、TNF-α水平差异。采用logistic回归分析筛选PSD的独立危险因素，并绘制ROC曲线评估血清TSPO、BDNF、TNF-α水平联合检测对PSD的预测价值。 结果 PSD组患者血清TSPO、TNF-α水平高于非PSD组(P＜0.05)，而BDNF水平低于非PSD组(P＜0.05)。Logistic回归分析显示，血清TSPO水平升高(OR=2.065，95% CI：1.052~4.055，P＜0.05)、TNF-α水平升高(OR=1.374，95% CI：1.031~1.832，P＜0.05)均是PSD的危险因素，而BDNF水平升高(OR=0.696，95% CI：0.521~0.929，P＜0.05)是PSD的保护因素。ROC曲线分析显示，血清TSPO、BDNF、TNF-α水平联合检测对PSD的预测效能良好，AUC为0.797。 结论 血清TSPO、BDNF、TNF-α水平与AIS患者发生PSD密切相关，联合检测这3种生物标志物可能有助于早期识别PSD高危人群，为临床预防和治疗PSD提供依据。 -
关键词:
- 急性缺血性卒中 /
- 卒中后抑郁 /
- 18 kDa易位蛋白 /
- 脑源性神经营养因子 /
- 肿瘤坏死因子-α
Abstract:Objective To investigate the predictive value of serum translocator protein 18 kDa (TSPO), brain-derived neurotrophic factor (BDNF), and tumor necrosis factor-α (TNF-α) levels for post-stroke depression (PSD) in patients with acute ischemic stroke (AIS). Methods A total of 121 AIS patients admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2022 to January 2024 were enrolled in this study. Based on the 17-item Hamilton depression rating scale assessment at 3 months after discharge, patients were divided into PSD group (n=38) and non-PSD group (n=83). Demographic data, clinical characteristics, and serum levels of TSPO, BDNF, and TNF-α were compared between the two groups. Logistic regression analysis was used to identify independent risk factors for PSD, and a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value of combined detection of serum TSPO, BDNF, and TNF-α levels for PSD. Results Serum TSPO and TNF-α levels were significantly higher in the PSD group than those in the non-PSD group (P < 0.05), while BDNF levels were significantly lower in the PSD group (P < 0.05). Logistic regression analysis showed that elevated serum TSPO (OR=2.065, 95% CI: 1.052-4.055, P < 0.05) and TNF-α (OR=1.374, 95% CI: 1.031-1.832, P < 0.05) levels were risk factors for PSD, while elevated BDNF level (OR=0.696, 95% CI: 0.521-0.929, P < 0.05) was a protective factor. ROC curve analysis showed that the combined detection of serum TSPO, BDNF, and TNF-α levels had a good predictive value for PSD, with an area under the curve of 0.797. Conclusion Serum TSPO, BDNF, and TNF-α levels are closely related to the development of PSD in patients with AIS. The combined detection of these three biomarkers may be helpful for early identification of high-risk populations for PSD, providing a basis for clinical prevention and treatment of PSD. -
图 1 血清TSPO、BDNF和TNF-α预测AIS患者发生PSD的ROC曲线
Figure 1. ROC curve of serum TSPO, BDNF and TNF-α in predicting PSD of AIS patients
表 1 2组AIS患者基线资料比较
Table 1. Comparison of baseline data between the two groups of AIS patients
项目 PSD组(n=38) 非PSD组(n=83) 统计量 P值 年龄(x±s，岁) 69.32±8.15 65.78±9.02 2.063a 0.041 性别(男性/女性，例) 23/15 45/38 0.418b 0.524 高血压[例(%)] 28(73.7) 52(62.7) 1.405b 0.236 糖尿病[例(%)] 15(39.5) 22(26.5) 2.048b 0.152 吸烟史[例(%)] 18(47.4) 30(36.1) 1.361b 0.243 房颤[例(%)] 10(26.3) 15(18.1) 1.072b 0.301 高脂血症[例(%)] 22(57.9) 38(45.8) 1.517b 0.218 冠心病[例(%)] 12(31.6) 18(21.7) 1.357b 0.244 病变部位(前循环/后循环，例) 25/13 60/23 0.523b 0.470 入院时NIHSS评分(x±s，分) 9.21±2.89 6.85±3.12 4.502a < 0.001 mRS评分[M(P25, P75)，分] 3(2，3) 2(2，3) 1.035c 0.297 LDL-C(x±s，mmol/L) 3.42±0.87 2.85±0.79 3.568a 0.001 HbA1c(x±s，%) 6.35±1.23 5.78±1.09 2.563a 0.012 总胆固醇(x±s，mmol/L) 5.17±1.12 4.52±1.05 3.095a 0.002 甘油三酯(x±s，mmol/L) 1.68±0.75 1.52±0.68 1.163a 0.247 HDL-C(x±s，mmol/L) 1.12±0.28 1.05±0.25 1.376a 0.171 空腹血糖(x±s，mmol/L) 6.54±1.87 6.12±1.72 1.213a 0.228 脑钠肽(x±s，pg/mL) 115.23±48.51 108.68±42.33 0.749a 0.455 C反应蛋白[M(P25, P75)，mg/L] 9.96(3.61, 12.98) 8.81(2.83, 11.47) -0.754c 0.451 Hcy(x±s，μmol/L) 13.18±4.77 12.52±4.23 0.813a 0.418 注：a为t值，b为χ2值，c为Z值。 
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表 2 2组AIS患者血清TSPO、BDNF和TNF-α水平比较(x±s)
Table 2. Comparison of serum TSPO, BDNF and TNF-α levels between the two groups of AIS patients (x±s)
组别 例数 TSPO (ng/mL) BDNF (ng/mL) TNF-α (pg/mL) PSD组 38 3.25±1.08 10.52±3.65 7.85±2.12 非PSD组 83 2.78±0.95 12.85±4.12 6.92±1.85 t值 2.418 2.989 2.450 P值 0.017 0.003 0.016
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表 3 AIS患者PSD发生影响因素的单因素logistic回归分析
Table 3. Single factor and logistic regression analysis of the influencing factors of PSD occurrence of AIS patients
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.064 0.029 4.870 0.039 1.066 1.003~1.133 性别 0.218 0.412 0.280 0.542 1.243 0.601~2.572 高血压 0.445 0.387 1.322 0.221 1.560 0.764~3.186 糖尿病 0.871 0.401 4.718 0.028 2.389 1.098~5.198 吸烟史 0.405 0.381 1.130 0.273 1.500 0.721~3.121 房颤 0.367 0.581 0.399 0.401 1.443 0.598~3.484 高脂血症 0.647 0.354 3.340 0.085 1.910 0.914~4.000 冠心病 0.521 0.368 2.004 0.215 1.684 0.742~3.810 病变部位 -0.255 0.378 0.455 0.498 0.775 0.374~1.605 入院时NIHSS评分 0.279 0.084 11.032 0.003 1.310 1.098~1.565 总胆固醇 0.398 0.283 1.978 0.053 1.489 0.996~2.222 甘油三酯 0.357 0.251 2.023 0.203 1.429 0.821~2.486 HDL-C 0.562 0.321 3.065 0.151 1.754 0.818~3.761 LDL-C 0.511 0.231 4.893 0.027 1.667 1.001~2.777 空腹血糖 0.176 0.111 2.514 0.136 1.192 0.981~1.448 HbA1c 0.385 0.176 4.785 0.029 1.470 1.041~2.075 TSPO 0.832 0.357 5.431 0.020 2.298 1.141~4.626 BDNF -0.427 0.163 6.862 0.009 0.652 0.474~0.898 TNF-α 0.402 0.189 4.524 0.033 1.495 1.032~2.165 注：变量赋值如下，女性=0，男性=1；高血压、糖尿病、吸烟史、房颤、高脂血症、冠心病、赋值均为是=1，否=0；病变部位为前循环=1，后循环=0；其他变量为连续变量，均以实际值赋值。
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表 4 AIS患者PSD发生影响因素的多因素logistic回归分析
Table 4. Multi-factor and logistic regression analysis of the influencing factors of PSD occurrence of AIS patients
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.087 0.049 3.152 0.076 1.091 0.991~1.201 糖尿病 0.918 0.426 4.644 0.035 2.504 1.087~5.832 入院时NIHSS评分 0.241 0.088 7.540 0.006 1.273 1.071~1.514 LDL-C 0.583 0.251 5.395 0.020 1.792 1.078~2.978 HbA1c 0.431 0.191 5.092 0.019 1.539 1.091~2.174 TSPO 0.725 0.341 4.531 0.035 2.065 1.052~4.055 BDNF -0.362 0.157 5.316 0.011 0.696 0.521~0.929 TNF-α 0.318 0.148 4.617 0.036 1.374 1.031~1.832
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表 5 血清TSPO、BDNF和TNF-α预测AIS患者发生PSD的临床效能
Table 5. Clinical efficacy of serum TSPO, BDNF and TNF-α in predicting PSD of AIS patients
项目 SE AUC 95% CI 最佳临界值 灵敏度(%) 特异度(%) 约登指数 TSPO 0.055 0.684 0.593~0.765 3.00 ng/mL 71.05 65.06 0.36 BDNF 0.053 0.666 0.574~0.749 11.15 ng/mL 57.89 69.88 0.38 TNF-α 0.053 0.687 0.581~0.773 7.01 pg/mL 73.55 63.86 0.36 三者联合 0.044 0.797 0.715~0.865 82.72 75.93 0.57
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