高血压脑出血患者术后不同程度抑郁风险因素模型构建及验证

目的构建和验证高血压脑出血（HICH）患者术后不同程度抑郁风险因素的模型。 方法纳入济南市中心医院神经外科自2017年7月至2020年3月收治的200例HICH术后患者，分为术后抑郁组（89例）和非抑郁组（111例），对患者相关因素进行单因素分析；根据卒中后抑郁诊断标准将术后抑郁组分为轻度组和中重度组，进行Logistic回归分析，构建中重度抑郁风险预测模型并进行验证，用RStudio软件构造其列线图。 结果200例HICH患者的抑郁发生率为44.5%，其中轻度抑郁发生率为59.6%（53例），中重度抑郁发生率为40.4%（36例）。单因素分析显示：抑郁组与非抑郁组患者的性别、性格、家庭收入、出血程度、瘫痪等级、血清脑源性神经营养因子（BDNF）水平、血清同型半胱氨酸（Hcy）水平、血浆核因子E2相关因子（Nrf2）水平具有统计学意义（P<0.05）；轻度与中重度抑郁患者的家庭收入、出血程度、瘫痪等级、Hcy水平、Nrf2水平、BDNF水平是具有统计学意义（P<0.05）。纳入多因素Logistic回归分析显示，出血程度、瘫痪等级、Hcy水平、Nrf2水平、BDNF水平是影响HICH术后不同程度抑郁的独立危险因素（P<0.05）。构建的中重度抑郁风险预测模型灵敏度为89.6%，特异度为84.6%，AUC（95%CI）为0.794（0.694~0.831），且验证结果与构建结果相同。 结论HICH术后不同程度抑郁的主要风险因素为出血程度、瘫痪等级、Hcy水平、Nrf2水平、BDNF水平。研究构建的风险预测模型可成为其术后中重度抑郁发生的风险预测工具。

Construction and validation of risk factor models for different degrees of depression in patients with hypertensive intracerebral hemorrhage after surgery

ObjectiveTo construct and validate models of risk factors for depression in patients with hypertensive intracerebral hemorrhage (HICH) after surgery. MethodsThe study included the case data of 200 patients with HICH who were admitted to our hospital from July 2017 to March 2020. They were divided into postoperative depression group (n=89) and non-depression group (n=111), a univariate analysis was performed on patients. According to the post stroke depression diagnostic criteria, the postoperative depression group was divided into two groups: mild and moderate-severe. Logistic regression analysis was performed on the two groups, a moderate to severe depression risk prediction model was constructed and verified, and the nomogram was constructed with RStudio software. ResultsThe incidence of depression in 200 patients with HICH was 44.5%, of which the incidence of mild depression was 59.6%, and the incidence of moderate to severe depression was 40.4%. A univariate analysis of the depression group and the non-depression group showed that, the gender, personality, family income, degree of bleeding, level of paralysis, brain-derived neurotrophic factor (BDNF) level, homocysteine (Hcy) level, nuclear factor erythroid-2 related factor 2 (Nrf2) level of the two groups were statistically significant (P<0.05). Univariate analysis of mild and moderate-severe depression showed that family income, bleeding degree, paralysis level, Hcy level, Nrf2 level, and BDNF level were statistically significant (P<0.05). The inclusion of multivariate Logistic regression analysis showed that the degree of bleeding, the level of paralysis, the level of Hcy, the level of Nrf2, and the level of BDNF were independent risk factors for different degrees of depression after HICH (P<0.05). The sensitivity of the constructed moderate to severe depression risk prediction model was 89.6%, the specificity was 84.6%, and the AUC (95%CI) was 0.794 (0.694-0.831), and the verification results were the same as the constructed results. ConclusionThe main risk factors for different degrees of depression after HICH are the degree of bleeding, the level of paralysis, the level of Hcy, the level of Nrf2, and the level of BDNF. The risk prediction model constructed by the research can become a risk prediction tool for the occurrence of moderate to severe depression after surgery.