뇌졸중후 우울증에서 호모시스테인의 역할

Abstract

Background : The risk of depression after stroke is influenced by various factors such as age, severity of disability, the location of the brain lesion, etc. We examined whether plasma homocysteine and MTHFR genotypes are associated with depression after stroke.

Methods : 173 patients with cerebral infarction whose Barthel’s index improved over 90 points were included. Beck Depression Inventory (BDI) was used to evaluate depression, and the patients were divided into two: depression (DG) and non-depression (NDG) groups according to their BDI score (cut off=21). We then analyzed factors, including plasma homocysteine and MTHFR genotype.

Results : The DG was 49 patients (28.3%) and the NDG were 124 patients (71.7%). The genotype distribution consisted of 22.4%(CC), 57.2%(CT), 20.4%(TT) in DG and 27.4%(CC), 55.5%(CT), 16.1%(TT) in NDG, the frequency of which was not different from that in DG. Age, sex, lesion location (left/right/bilateral, anterior/posterior/lenticulostriatal/ multiple), an interval from the stroke onset to the evaluation, the presence of diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, and family history were not different between the two groups. The plasma homocysteine level was significantly higher in DG (14.70 μmol/L) than NDG (11.51 μmol/L) (OR 1.094;95% CI 1.013-1.180) after controlling of the factors described above.

Conclusions : Our results suggest that homocysteine may play a role in the pathogenesis of post-stroke depression and support a vascular depression theory. Early identification of this risk factor may lead to effective therapeutic intervention.