To investigate the effect of apolipoprotein E (APOE) gene polymorphisms on post-stroke depression (PSD) after acute ischemic stroke.

A total of 180 patients with acute ischemic stroke admitted to the Department of Neurology of Luoyang Central Hospital from January 1 to December 1, 2024 were continuously included. Routine hematological examinations were conducted within 24 h of admission, and the National Institutes of Health stroke scale (NIHSS) score was used to assess the degree of neurological deficits in stroke patients, while the modified Rankin scale (mRS) score was used to assess the degree of disability in stroke patients. The Hamilton depression scale (HAMD) was used to assess the depression status of patients at 2, 3 weeks, and 1 month after the onset of stroke. Patients were divided into PSD group and non PSD (NPSD) group based on whether PSD was present. Real-time fluorescence quantitative PCR was used to detect APOE gene polymorphisms in the 2 groups, and baseline clinical data, laboratory tests, APOE genotype distribution, and allele frequency were compared between the 2 groups. Multiple Logistic regression was used to analyze the influencing factors of PSD.

There were 62 patients in the PSD group and 118 patients in the NPSD group. There was no statistically significant difference in the general clinical data between the two groups (P>0.05). The serum total cholesterol (CHOL) and homocysteine (HCY) levels of patients in PSD group were higher than those in NPSD group, and the folic acid levels were lower than those in NPSD group, and the differences were statistically significant (P<0.05). The distribution frequency of the ε3ε4 and ε4ε4 genotypes in PSD group patients was higher than that in NPSD group, the frequency of the ε2 allele was lower than that in NPSD group, and the frequency of the ε4 allele was higher than that in NPSD group, the differences were statistically significant (P<0.05). The HAMD scores of patients carrying the ε4 allele were higher than those of patients without the ε4 allele in the PSD group, and the difference was statistically significant (P<0.05). All patients carrying the ε4 allele had higher NIHSS and mRS scores than those without the allele, and the differences were statistically significant (P<0.05). Multiple Logistic regression analysis showed that serum CHOL and HCY levels, and the ε4 allele, were independent risk factors for the development of PSD (P<0.05).

The polymorphism of APOE gene is closely related to PSD, and the ε4 allele is an independent risk factor influencing the development of PSD. Elevated serum CHOL and HCY levels may increase the risk of developing PSD.