摘要
目的探讨血清胱抑素C(CysC)与老年缺血性脑卒中后认知功能障碍(PSCI)的相关性,分析CysC对PSCI的预测价值。方法收集2017-06—2019-06连云港市东方医院神经内科病房老年(>65岁)缺血性脑卒中患者,入院时分别记录(性别、年龄、受教育年限、既往史、血压、血脂、肾功能等)一般资料,入院治疗14 d后分别检测血清CysC水平,评定美国国立卫生研究院卒中量表(NIHSS)评分、简易智能状态检查量表(MMSE)评分及蒙特利尔认知评估量表(MoCA)评分。治疗14 d后MMSE评分及MoCA评分筛查出PSCI患者90例为PSCI组,同时筛查出非认知功能障碍患者90例为非PSCI组。对2组患者入院时一般资料及入院治疗14 d后CysC水平、MMSE评分进行单因素分析,并对血清CysC的相关因素进行分析;从中选择有差异的变量为自变量,并进行多重共线性的诊断,排除可能有共线性问题的自变量,纳入Logistic回归模型进行PSCI患病风险的分析。绘制血清CysC预测老年PSCI的ROC曲线,判定CysC对PSCI的预测价值。结果单因素分析显示2组患者的糖尿病患病率、高血压患病率、收缩压、舒张压、HbA1C、NIHSS、CysC、MMSE评分及MoCA评分差异有统计学意义(P<0.001)。Pearson相关分析显示血清CysC水平与收缩压(r=0.233,P=0.002)呈正相关,与MMSE评分(r=-0.456,P<0.001)及MoCA评分(r=-0.403,P<0.001)均呈负相关。多因素Logistic回归分析显示高血压(OR=2.186,95%CI 1.129~4.230,P=0.020)和CysC(<0.88:OR=1,P<0.001;0.88~1.08:OR=3.852,95%CI 1.689~8.789,P=0.001;>1.08:OR=8.310,95%CI 3.674~18.797,P<0.001)是老年缺血性脑卒中后认知障碍的相关危险因素。ROC曲线下AUC:0.773,P<0.0001,95%CI 0.705~0.832,最佳诊断界值为0.91 mg/L(敏感度83.33%,特异性60.00%,Youden指数0.433)。结论血清CysC与老年缺血性PSCI的严重程度存在相关性,是其发生发展的相关危险因素,并有一定预测价值。
Objective To examine the relevance of serum Cystatin C(CysC)to the post-stroke cognitive impairment(PSCI),and to explore the predictive value of serum CysC on PSCI in elder ischemic stroke patients.Methods Elder ischemic stroke patients(>65 years old)who were admitted to the Nerve Ward of Lianyungang Municipal Oriental Hospital from June 2017 to June 2019 were consecutively enrolled in this study.General patient information was recorded on admission:sex,age,education years,past-history,blood pressure,blood lipids,renal function.Serum CysC levels,the National Institute of Health stroke scale(NIHSS)score,the mini-mental state examination(MMSE)score,the Montreal cognitive assessment(MoCA)score were determined at 14 days after admission.According to the MMSE and MoCA scores,the patients were divided into PSCI group and non-PSCI group.The general information at admission,MMSE score and serum CysC level at 14 days after admission were analyzed by single factor analysis between the two groups.The related factors of serum CysC were analyzed,and the variable with difference was selected as independent variable to perform multicollinearity diagnosis.Independent variables that may have collinearity problems were excluded,and the risk of PSCI was analyzed by logistic regression model.Receiver operating characteristic(ROC)curve was drawn to determine the predictive value of CysC to PSCI.Results Single factor analysis of clinical data:there is significant difference(P<0.001)between two groups in rates of diabetes and hypertension,systolic blood pressure,diastolic blood pressure,HbA1 C,NIHSS score,MMSE score,MoCA score and CysC levels.By Pearson analysis,serum CysC level was positively correlated with systolic blood pressure(r=0.233,P=0.002),and negatively correlated with MMSE score(r=-0.456,P<0.001)and MoCA score(r=-0.403,P<0.001).By Multivariate Logistic regression analysis,hypertension(OR=2.186,95%CI 1.129-4.230,P=0.020)and CysC(<0.88:OR=1,P<0.001;0.88-1.08:OR=3.852,95%CI 1.689-8.789,P=0.001;>1.08:OR=8.310,95%CI 3.674-18.797
作者
赵平
孔令胜
洪波
季晓宇
任孝林
韩学聃
徐玲
刘丽艳
ZHAO Ping;KONG Lingsheng;HONG Bo;JI Xiaoyu;REN Xiaolin;HAN Xuedan;XU Ling;LIU Liyan(Lianyungang Dongfang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222042,China)
出处
《中国实用神经疾病杂志》
2020年第20期1766-1772,共7页
Chinese Journal of Practical Nervous Diseases
基金
连云港市青年科技项目(编号:201729)。
