2024 年第 7 期 第 0 卷

血清神经递质及损伤相关标志物与急性缺血性脑卒中患者睡眠障碍的关系

The relationship between serum neurotransmitters and injury-related markers and sleep disorders in patients with acute ischemic stroke

作者：米唤金刘斌邓春颖马原源王雅楠任伯毛文静

英文作者：Mi Huanjin Liu Bin Deng Chunying Ma Yuanyuan Wang Yanan Ren Bo Mao Wenjing

单位：华北理工大学附属医院神经内一科，唐山063000

英文单位：First Department of Neurology North China University of Science and Technology Affiliated Hospital Tangshan 063000 China

关键词：急性缺血性脑卒中；睡眠障碍；神经递质；神经损伤标志物

英文关键词：Acuteischemicstroke;Sleepdisorders;Neurotransmitters;Neurologicalinjurymarkers

• 摘要：

• 目的 探讨血清神经递质及损伤相关标志物5-羟色胺(5-HT)、去甲肾上腺素（NE）、神经元特异性烯醇化酶（NSE）、神经丝重链蛋白（NfH）、S100β蛋白水平与急性缺血性脑卒中患者睡眠障碍的相关性。方法 选取2022年11月至2023年10月华北理工大学附属医院神经内科住院的急性缺血性脑卒中患者358例，入院后3 d内完成匹兹堡睡眠质量指数量表（PSQI）评估，根据PSQI评分标准及结果将患者分为睡眠障碍组(276例)和非睡眠障碍组(82例)，再将睡眠障碍组进一步分为轻度睡眠障碍组(147例)、中度睡眠障碍组(96例)和重度睡眠障碍组(33例)。比较各组患者血清5-HT、NE、NSE、NfH、S100β蛋白水平。采用Logistic回归方法分析急性缺血性脑卒中后睡眠障碍的危险因素。采用Spearman相关性方法分析血清5-HT、NE、NSE、NfH、S100β蛋白与急性缺血性脑卒中患者睡眠障碍严重程度的相关性。结果 睡眠障碍组血清5-HT、NE水平均低于非睡眠障碍组［（248±90）ng/L比（422±48）ng/L、（147±50）ng/L比（270±46）ng/L］，NSE、NfH、S100β蛋白水平均高于非睡眠障碍组［（9.2±3.0）μg/L比（5.2±1.6）μg/L、（85±24）ng/L比（51±12）ng/L、（798±174）ng/L比（480±98）ng/L］，差异均有统计学意义（均P＜0.001）。Logistic回归分析结果显示，5-HT、NE、NSE、NfH、S100β蛋白是急性缺血性脑卒中后睡眠障碍的独立影响因素(均P＜0.05)，其中，5-HT、NE是保护因素，NSE、NfH、S100β蛋白是危险因素。Spearman相关性分析结果显示，急性缺血性脑卒中患者睡眠障碍严重程度与5-HT、NE水平呈负相关(r=-0.902、-0.942，均P＜0.001)，与NSE、NfH、S100β蛋白水平呈正相关(r=0.774、0.775、0.878，均P＜0.001)。结论 血清5-HT、NE、NSE、NfH、S100β蛋白与急性缺血性脑卒中患者睡眠障碍及其严重程度相关，患者睡眠障碍严重程度与血清5-HT、NE呈负相关，与血清NSE、NfH、S100β蛋白呈正相关。

• Objective To investigate the relationship between the levels of serum neurotransmitters, 5- hydroxytryptamine (5-HT), norepinephrine (NE), neuron-specific enolase (NSE), neurofilament heavy chain protein (NfH), S100β protein and sleep disorders in patients with acute ischemic stroke. Methods A total of 358 patients with acute ischemic stroke hospitalized in the Department of Neurology, North China University of Science and Technology Affiliated Hospital from November 2022 to October 2023 were selected. The Pittsburgh Sleep Quality Index (PSQI) scale was completed within 3 days after admission to evaluate the sleep condition of patients. According to PSQI score and results, the patients were divided into sleep disorder group (276 cases) and non-sleep disorder group (82 cases). The sleep disorder group was further divided into mild sleep disorder group (147 cases), moderate sleep disorder group (96 cases) and severe sleep disorder group (33 cases). The serum levels of 5-HT, NE, NSE, NfH and S100β were compared among the groups. Logistic regression method was used to analyze the risk factors of sleep disorders after acute ischemic stroke. Spearman correlation method was used to analyze the correlation between serum 5-HT, NE, NSE, NfH, S100β protein and the severity of sleep disorder in patients with acute ischemic stroke. Results  The serum levels of 5-HT and NE in sleep disorder group were lower than those in non-sleep disorder group［(248±90)ng/L vs (422±48)ng/L, (147±50)ng/L vs (270±46)ng/L］, and the levels of NSE, NfH and S100β protein in the sleep disorder group were higher than those in the non-sleep disorder group ［(9.2±3.0)μg/L vs (5.2±1.6)μg/L, (85±24)ng/L vs (51±12)ng/L, (798±174)ng/L vs (480±98)ng/L］ (all P＜0.001). Logistic regression analysis showed that 5-HT, NE, NSE, NfH and S100β protein were independent risk factors for sleep disorders after acute ischemic stroke (all P＜0.05). Among them, 5-HT and NE were protective factors, and NSE, NfH and S100β protein were risk factors. Spearman correlation analysis showed that the severity of sleep disorders was negatively correlated with the levels of 5-HT and NE in patients with acute ischemic stroke (r=-0.902, -0.942, both P＜0.001), and positively correlated with the levels of NSE, NfH and S100β (r=0.774, 0.775, 0.878, all P＜0.001). Conclusion  sThe serum levels of 5-HT, NE, NSE, NfH and S100β protein were correlated with sleep disorders and their severity in patients with acute ischemic stroke. The severity of sleep disorders was negatively correlated with serum levels of 5-HT and NE, and positively correlated with serum levels of NSE, NfH and S100β protein.