基于列线图探讨糖酵解指标和尿酸水平对老年脑卒中病人抑郁发生及预后的预测价值

王漫; 金垚

基于列线图探讨糖酵解指标和尿酸水平对老年脑卒中病人抑郁发生及预后的预测价值

王漫,
金垚

Study on the predictive value of glycolysis index and uric acid level on the occurrence and prognosis of depression in elderly stroke patients based on the nomogram

WANG Man,
JIN Yao

摘要

摘要:
目的： 基于列线图探讨糖酵解指标和尿酸水平对老年脑卒中病人抑郁发生及预后的预测价值。
方法： 研究对255例轻度急性缺血性卒中病人进行了筛查。在卒中发作后3个月，汉密尔顿抑郁量表（HAMD）评分≥8分且满足世界卫生组织复合性国际诊断交谈3.0中文版诊断标准的72例受试者纳入卒中后抑郁（PSD）组，其余病人纳入非卒中后抑郁组（NPSD组）。通过LC/MS测定糖酵解、糖异生和TCA循环途径的代谢物的血浆浓度。
结果： 与NPSD组相比，PSD组入院时NIHSS评分、入院时mRS评分、房颤例数、尿酸水平、BDNF水平、乳酸水平均增加（P ＜ 0.05～P ＜ 0.01），入院时MMSE评分、丙酮酸和单磷酸己糖均降低（P ＜ 0.05～P ＜ 0.01）。入院时NIHSS评分（OR = 1.537，95%CI = 1.079 ~ 2.188）、入院时mRS评分（OR = 1.865，95%CI = 1.164 ~ 2.991）、房颤（OR = 4.756，95%CI = 1.086 ~ 20.816）、尿酸（OR = 1.007，95%CI = 1.004 ~ 1.010）、丙酮酸（OR = 0.815，95%CI = 0.690 ~ 0.963）和入院时MMSE评分（OR = 0.893，95%CI = 0.822 ~ 0.970）是缺血性卒中发作后3个月发生PSD的独立影响因素（P ＜ 0.05～P ＜ 0.01）。上述6个独立影响因素生成预测PSD发生的列线图的AUC为0.880（95%CI = 0.830 ~ 0.930）。校准曲线分析显示，列线图模型中PSD的预测风险和PSD的实际风险之间基本重合，表明预测和观察结果一致。
结论： 丙酮酸水平降低、尿酸水平升高是轻度急性缺血性卒中病人在发病后3个月诊断为PSD的独立危险因素；预测轻度急性缺血性卒中病人3个月PSD的列线图模型易于操作，具有良好的区分度和校准度。

Abstract:
Objective To explore the predictive value of glycolysis index and uric acid level on the occurrence and prognosis of depression in elderly stroke patients based on nomogram.
Methods A total of 255 patients with mild acute ischemic stroke were screened. At 3 months after stroke onset, 72 subjects with Hamilton Depression Scale (HAMD) score ≥8 and meeting the diagnostic criteria of the World Health Organization Compound International Diagnostic Dialogue 3.0 were included in the post-stroke depression (PSD) group, and the rest were included in the non-post-stroke depression (NPSD) group. The plasma concentrations of metabolites of glycolysis, gluconeogenesis and TCA cycle pathways were measured by LC/MS.
Results Compared with NPSD group, the scores of NIHSS, mRS, atrial fibrillation, uric acid, BDNF and lactic acid in the PSD group significantly increased (P ＜ 0.05), while the scores of pyruvate, hexose monophosphate and MMSE significantly decreased (P ＜ 0.05). The NIHSS score (OR = 1.537, 95%CI = 1.079-2.188) and mRS score (OR = 1.865,95%CI = 1.164-2.991) at admission, atrial fibrillation (OR = 4.756, 95%CI = 1.086-20.816), uric acid (OR = 1.007, 95%CI = 1.004-1.010), pyruvic acid (OR = 0.815, 95%CI = 0.690-0.963) and MMSE score at admission (OR = 0.893, 95%CI = 0.822-0.970) were the dependent influencing factor of PSD after 3 months of ischemic stroke (P ＜ 0.05 to P ＜ 0.01). The AUC of the above six independent influencing factors to generate a nomogram predicting the occurrence of PSD was 0.880 (95%CI = 0.830 ~ 0.930). The results of calibration curve analysis showed that the predicted risk of PSD in the nomogram model was basically coincident with the actual risk of PSD, which indicated that the predicted and observed results were consistent.
Conclusions The decrease of pyruvate level and increase of uric acid level are the independent risk factors of PSD after 3 months of the onset of mild acute ischemic stroke. The nomogram model for predicting 3-month PSD in mild acute ischemic stroke patients is easy to operate, and has good differentiation and calibration.

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