Correlation of Circadian Rhythms and Improvement of Depressive Symptoms in Acute Ischemic Stroke Patients

Yue Ding, Shengnan Chen, Qian Sun, Fei Han, Rui Chen, Jie Li
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Abstract

Objectives: To investigate the correlation between evening melatonin timing secretion, dim light melatonin onset (DLMO), and post-stroke depression (PSD) in acute ischemic stroke patients and their influence on the improvement of depressive symptoms.

Materials and methods: 120 patients with a recent magnetic resonance imaging confirmed stroke were included. Salivary melatonin samples were collected at 5 time points within 1 week after hospitalization (7 p.m.-11 p.m., 1 sample per hour). The circadian phase was defined by calculating DLMO secretion. Post-stroke depressive symptoms were evaluated by the 17-item Hamilton Rating Scale for Depression (HRSD) both on day 7 of hospitalization and 3 months after stroke. Patients were divided into PSD and non-PSD groups based on whether the acute phase HRSD score was ≥8. Similarly, patients were divided into the improved depressive symptoms (IDS) and no improvement in depressive symptoms (non-IDS) groups based on whether the HRSD score at 3 months was lower than at baseline. Neurological recovery at 3 months was assessed using the modified Rankin Scale (mRS).

Results: The difference in DLMO between PSD and non-PSD patients was not statistically significant (p =0.173). In the non-IDS group, there was a significant decrease in melatonin secretion at 10 p.m. (p =0.012), and DLMO was significantly later than in the IDS group (p =0.017). Logistic regression analysis showed that DLMO (OR 1.91, 95%CI:1.13-3.23, p = 0.016) was an independent risk factor for persistent no improvement in depressive symptoms, which was associated with a markedly worse prognosis (p <.001).

Conclusion: Our findings suggest possible interventions for the very early identification of non-IDS patients.

昼夜节律与急性缺血性脑卒中患者抑郁症状改善的相关性
研究目的研究急性缺血性脑卒中(AIS)患者晚间褪黑激素定时分泌、暗光褪黑激素起效(DLMO)与卒中后抑郁(PSD)之间的相关性及其对抑郁症状改善的影响。在住院后一周内的 5 个时间点收集唾液褪黑激素样本(晚上 7 点至 11 点,每小时 1 个样本)。通过计算 DLMO 的分泌量来确定昼夜节律阶段。卒中后抑郁症状由 17 个项目组成的汉密尔顿抑郁量表(HRSD)进行评估,分别在住院第 7 天和卒中后 3 个月进行。根据急性期 HRSD 评分是否≥8 分,将患者分为 PSD 组和非 PSD 组。同样,根据 3 个月时 HRSD 评分是否低于基线,将患者分为抑郁症状改善组(IDS)和抑郁症状无改善组(non-IDS)。3个月后的神经功能恢复情况采用改良Rankin量表(mRS)进行评估:PSD患者和非PSD患者的DLMO差异无统计学意义(P =0.173)。在非IDS组中,褪黑激素分泌在晚上10点明显减少(p =0.012),DLMO明显晚于IDS组(p =0.017)。逻辑回归分析表明,DLMO(OR 1.91,95%CI:1.13-3.23,p = 0.016)是抑郁症状持续无改善的独立风险因素,而抑郁症状持续无改善与预后明显较差有关(p 结论:我们的研究结果表明,可以对极度抑郁患者采取干预措施:我们的研究结果为早期识别非 IDS 患者提供了可能的干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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