山东医药

目的 分析青年进展性脑梗死(PIS)后发生抑郁的危险因素及其预测效能。方法 选取经MRI检查确诊的青年PIS患者160例，根据汉密尔顿抑郁量表结果将所有患者分为抑郁组(37例)和非抑郁组(123例)，采用单因素及多因素Logistic回归分析法分析青年PIS后发生抑郁的影响因素，利用ROC曲线分析危险因素对青年PIS后发生抑郁的预测价值。结果 单因素分析显示，抑郁组和非抑郁组血清皮质醇、NIHSS评分、脑梗死体积及血清炎症因子(白细胞介素6、肿瘤坏死因子α、C反应蛋白)比较，P均<0.05；多因素分析显示，血清皮质醇、NIHSS评分、脑梗死体积及血清炎症因子是青年PIS后发生抑郁的独立危险因素(P均<0.05)。当血清皮质醇的截断值为765.73 mmol/L时，其预测青年PIS后发生抑郁的灵敏度为0.902、特异度为0.875；当NIHSS评分的截断值为13分时，其预测青年PIS后发生抑郁的灵敏度为0.706、特异度为0.918；当脑梗死体积的截断值为1.4 mm³时，其预测青年PIS后发生抑郁的灵敏度为0.702、特异度为0.909；血清皮质醇、NIHSS评分、脑梗死体积联合血清炎症因子预测青年PIS后发生抑郁的灵敏度为0.955、特异度为0.879。结论 青年PIS后发生抑郁的危险因素有血清皮质醇、NIHSS评分、脑梗死体积及血清炎症因子，血清皮质醇水平、NIHSS评分、脑梗死体积可作为青年PIS后发生抑郁的预测指标，而血清皮质醇水平、NIHSS评分、脑梗死体积联合血清炎症因子水平对青年PIS后发生抑郁的预测价值更高。

Objective To analyze the risk factors and their predictive efficacy for depression after progressive cerebral infarction(PIS) in young people. Methods A total of 160 young patients with PIS diagnosed by MRI were selected and divided into the depression group(37 cases) and non-depression group(123 cases) according to the results of Hamilton Depression Scale. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of depression after PIS in young people, and receiver operating characteristic(ROC) curve was used to analyze the predictive value of risk factors for depression after PIS in young people. Results Univariate analysis showed that significant differences were found in the levels of serum cortisol, NIHSS score, cerebral infarction volume and serum inflammatory factors [interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and C-reactive protein(CRP)] between the depression group and the non-depression group(all P<0. 05). Multivariate analysis showed that serum cortisol, NIHSS score, cerebral infarction volume and serum inflammatory factors were independent risk factors for depression after PIS in young people(all P<0. 05). When the cut-off value of serum cortisol was 765. 73 mmol/L, the sensitivity and specificity in predicting depression after PIS in young people were 0. 902 and 0. 875, respectively; when the cut-off value of NIHSS score was 13, the sensitivity and specificity of NIHSS score in predicting depression after PIS in young people were 0. 706 and 0. 918, respectively; when the cut-off value of cerebral infarction volume was 1. 4 mm³, the sensitivity and specificity in predicting depression after youth PIS were 0. 702 and 0. 909, respectively; the sensitivity and specificity of serum cortisol, NIHSS score, cerebral infarction volume combined with serum inflammatory factors in predicting depression after PIS in young people were 0. 955 and 0. 879, respectively. Conclusions The risk factors of depression in young people after PIS include serum cortisol, NIHSS score, cerebral infarction volume and serum inflammatory factors. Serum cortisol level, NIHSS score and cerebral infarction volume can be used as predictors of depression in young people after PIS, while serum cortisol level, NIHSS score, cerebral infarction volume combined with serum inflammatory factors have higher predictive value for depression in young people after PIS.