血清PLR、NLR、SII与脑卒中急性期抑郁症状严重程度的关联研究

Association of Serum PLR, NLR, and SII with Depressive Symptom Severity in Patients with Acute Stroke

摘要: 目的：探讨急性期脑卒中患者的血小板/淋巴细胞比值(Platelet-to-lymphocyte ratio, PLR)、中性粒细胞/淋巴细胞比值(Neutrophil-to-lymphocyte ratio, NLR)及全身免疫炎症指数(Systemic immune-inflammation index, SII)与抑郁症状严重程度的关系，为卒中后抑郁(Post-stroke depression, PSD)的早期识别提供依据。方法：本研究为前瞻性队列研究，纳入2024年10月至2025年4月住院的急性卒中患者(共650例)，通过筛选最终纳入140例急性脑梗死和自发性脑出血患者。研究对象均能完成汉密尔顿抑郁量表-24 (Hamilton Depression Rating Scale-24, HAMD-24)评估。在入院7天内，测定血常规指标并计算PLR、NLR和SII。通过单因素和多因素回归分析各炎症指标与HAMD总分的关联，采用HC3稳健标准误和对数转换进行敏感性分析。结果：共纳入140例患者，急性脑梗死89例，自发性脑出血51例。入院NIHSS评分中位数为3.00，提示研究人群为轻中度卒中患者。PLR、SII、NLR及年龄与HAMD总分显著正相关(P < 0.05)。多因素分析显示，PLR (β = 0.017, P < 0.001)和SII (β = 0.002, P = 0.002)与HAMD总分独立正相关，NLR (β = 0.241, P = 0.021)正相关，但稳健性较差。筛查阶段有64例因严重交流障碍、50例因继发性脑出血、32例因活动性感染或严重慢性炎症性疾病未纳入，另有364例拒绝或无法完成量表评估。结论：在急性期脑卒中患者中，PLR和SII与抑郁症状严重程度密切相关，可能成为辅助评估抑郁症状的潜在炎症指标，NLR的相关性需进一步验证。

Abstract: Objective: To investigate the relationship between platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) with the severity of depressive symptoms in acute stroke patients, providing a basis for early identification of post-stroke depression (PSD). Methods: This is a prospective cohort study conducted among acute stroke patients hospitalized from October 2024 to April 2025. A total of 650 patients were screened, and 140 eligible patients (89 with acute ischemic stroke and 51 with spontaneous intracerebral hemorrhage) were included. All participants completed the Hamilton Depression Rating Scale-24 (HAMD-24) assessment within 7 days of hospitalization. Blood routine tests were performed, and PLR, NLR, and SII were calculated. Univariate and multivariate regression analyses were used to examine the association between inflammatory markers and HAMD total score, with robust standard errors (HC3) and logarithmic transformation for sensitivity analysis. Results: A total of 140 patients were included, consisting of 89 with acute ischemic stroke and 51 with spontaneous intracerebral hemorrhage. The median NIHSS score on admission was 3.00, indicating that the study population consisted mainly of patients with mild to moderate stroke. PLR, SII, NLR, and age were significantly positively correlated with HAMD total score (all P < 0.05). Multivariate analysis revealed that PLR (β = 0.017, P < 0.001) and SII (β = 0.002, P = 0.002) were independently positively correlated with HAMD total score, while NLR (β = 0.241, P = 0.021) showed a positive correlation but with less stability. During screening, 64 patients were excluded due to severe communication disorders, 50 due to secondary intracerebral hemorrhage, and 32 due to active infections or severe chronic inflammatory diseases. Additionally, 364 patients refused or were unable to complete the scale assessment. Conclusion: In acute stroke patients, PLR and SII are closely related to the severity of depressive symptoms and may serve as potential inflammatory markers for assessing the burden of depressive symptoms. The relationship with NLR needs further validation.