豫北地区老年卒中后抑郁患者危险因素及其与BDNF基因多态性的关系

目的 研究豫北地区老年卒中后抑郁(PSD)患者的危险因素及其与脑源性神经营养因子（BDNF）基因多态性的关系。方法 应用聚合酶链反应（PCR）-高分辨率溶解曲线 (HRM)的方法检测我院诊治的300例老年卒中患者血浆中BDNF rs2030324单核苷酸多态性，比较PSD组及非PSD组（NPSD）BDNF rs2030324单核苷酸多态性分布差异，并对患者发生PSD的危险因素进行单因素及多因素logistic回归分析。结果 PSD发生率为41.7%（125/300）。与NPSD组相比，PSD组BDNF rs2030324 TT及CT基因型比例较高（〖XC小五号.EPS;P〗=6.946、5.034，P=0.008、0.025），而CC基因型比例较低（〖XC小五号.EPS;P〗=29.114，P<0.001），T等位基因分布频率高于C等位基因频率（〖XC小五号.EPS;P〗=13.336，P<0.001）。与NPSD组相比，PSD组在年龄、经济状况、梗死部位、梗死面积、抑郁症家族史、NIHSS评分、mRS评分上差异有统计学意义（〖XC小五号.EPS;P〗=7.849、9.138、10.835、14.378、18.182、8.336、13.173，P=0.005、0.003、0.001、<0.001、<0.001、0.015、<0.001）。年龄≥70岁（OR=1.637，95%CI:1.028～2.879）、经济状况较差（≤2000元/月）（OR=2.344，95%CI:1.203～4.866）、梗死部位为脑干延髓基底核（OR=1.659，95%CI:1.113～3.106）、大梗死（OR=2.317，95%CI:1.047～4.590）、伴抑郁症家族史（OR=2.554，95%CI:1.277～4.956）、NIHSS评分≥14分（OR=2.418，95%CI:1.007～4.679）、mRS评分≥3分（OR=1.878，95%CI:1.217～2.539）及BDNF rs2030324 CT（OR=1.429，95%CI:1.067～2.036）及TT（OR=1.314，95%CI:0.911～1.822）基因型是PSD发生的独立危险因素。结论 年龄、经济状况、梗死部位、梗死面积、抑郁症家族史、NIHSS评分、mRS评分是PSD发生的危险因素，BDNF基因单核苷酸多态性与PSD有关，有望成为早期诊断、预防PSD的标志物。

Risk factors and BDNF gene polymorphism in elderly patients with post-stroke depression in northern Henan province

To study the risk factors of post stroke depression(PSD)and the relationship between the risk factorsand brain－derived neurotrophic factor(BDNF)gene polymorphism.Methods The single nucleotide polymorphism of BDNFrs2030324 in the plasma of 300 elderly stroke patients in our hospital was detected by the method of polymerase chain reaction(PCＲ)－high resolution melting(HＲM)，and the difference of BDNF rs2030324 single nucleotide polymorphism between PSDgroup and non PSD group(NPSD)was compared，and the risk factors of PSD in patients were analyzed by single factor andmulti factor Logistic regression.Ｒesults The incidence of PSD was 41.7%(125/300).Compared with NPSD group，theproportion of BDNF rs2030324 TT and CT genotype in PSD group was higher(χ2=6.946，5.034，P=0.008，0.025)，whilethe proportion of CC genotype was lower(χ2=29.114，P＜0.001)，and the distribution frequency of T allele was higher thanthat of C allele(χ2=13.336，P＜0.001).Compared with NPSD group，PSD group had significant differences in age，economic status，infarct location，infarct area，family history of depression，NIHSS score and mＲS score(χ2=7.849，9.138，10.835，14.378，18.182，8.336，13.173，P=0.005，0.003，0.001，＜0.001，＜0.001，0.015，＜0.001).Age≥70years old(OＲ=1.637，95%CI:1.028－2.879)，poor economic status(≤2000 yuan/month)(OＲ=2.344，95%CI:1.203－4.866)，infarct location:brainstem bulbar nucleus(OＲ=1.659，95%CI:1.113－3.106)，large infarct(OＲ=2.317，95%CI:1.047－4.590)，family history with depression(OＲ=2.554，95%CI:1.277－4.956)，NIHSS score≥14points(OＲ=2.418，95%CI:1.007－4.679)，mＲSscore≥3 points(OＲ=1.878，95%CI:1.217－2.539)，BDNFrs2030324 CT(OＲ=1.429，95%CI:1.067－2.036)and TT(OＲ=1.314，95%CI:0.911－1.822)genotypes wereindependent risk factors for PSD.Conclusion Age，economic status，infarct location，infarct area，family history ofdepression，NIHSS score and mＲS score are risk factors for PSD.BDNF gene single nucleotide polymorphism is related toPSD，and it is expected to be a marker for early diagnosis and prevention of PSD.