血清β_(2)-微球蛋白和胱抑素C水平监测对缺血性脑卒中后患者发生认知损害的预测价值研究

Predictive Value Analysis of Serumβ_(2)-microglobulin Combined with Cystatin C in Cognitive Dysfunction after Ischemic Stroke

目的探讨血清β_(2)-微球蛋白(β_(2)-MG)联合胱抑素C(Cys-C)对缺血性脑卒中(IS)后发生认知损害的预测价值。方法选择2020年1月至2021年12月就诊的96例IS患者为研究对象,根据患者受教育年限和Mo CA评分将患者分为脑卒中后认知正常(PSNCI)组和脑卒中后认知损害(PSCI)组。采用LASSO回归模型、10倍交叉验证法获得IS患者发生认知损害的最佳风险预测因子子集,采用Logistic回归分析IS患者发生认知损害的独立危险因素,采用平滑曲线拟合分析血清β_(2)-MG、Cys-C与认知损害的曲线关系,构建列线图预测模型并评价其预测效能。结果PSNCI组与PSCI组的年龄、受教育年限、入院时NIHSS评分、hs-CRP、Hcy、β_(2)-MG及Cys-C比较,差异均有统计学意义(均P<0.05)。年龄、hs-CRP、β_(2)-MG、Cys-C为IS患者发生认知损害的独立危险因素(均P<0.05),受教育年限为IS患者发生认知损害的独立保护因素(P<0.05)。β_(2)-MG、Cys-C与认知损害的发生呈线性正相关关系,当β_(2)-MG≥2.96mg·L^(-1)时,β_(2)-MG每增加0.2 mg·L^(-1),IS患者发生认知损害的风险增加17%(P<0.05);当Cys-C≥1.72 mg·L^(-1)时,Cys-C每增加0.2 mg·L^(-1),IS患者发生认知损害的风险增加14%(P<0.05)。依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性。结论IS患者血清β_(2)-MG和Cys-C水平异常变化与认知损害的发生密切相关,是IS患者发生认知损害的独立影响因素,血清β_(2)-MG和Cys-C的监测对认知损害的早期预测具有较高的应用价值。

Aim To investigate the predictive value of serumβ_(2)-microglobulin(β_(2)-MG)combined with cystatin C(Cys-C)on cognitive dysfunction after ischemic stroke(IS).Methods A total of 96 IS patients admitted to the department of neurology of our hospital from January 2020 to December 2021 were selected as the research subjects,according to their education level and MoCA score,the patients were divided into a post stroke noncognitive impairment(PSNCI)group and a poststroke cognitive impairment(PSCI)group.The LASSO regression model and 10-fold cross-validation method were carried out to obtain the best subset of risk predictors for cognitive impairment in IS patients.Logistic regression was used to analyze the independent risk factors for cognitive impairment in IS patients,and the smooth curve fitting was used to analyze the curve relationship between serumβ_(2)-MG and Cys-C and cognitive impairment.The prediction model was constructed and was evaluated its prediction efficiency.Results There were significant differences between the PSNCI group and the PSCI group in age,years of education,NIHSS score at admission,HS-CRP,Hcy,β_(2)-MG and Cys-C(P<0.05).Age,hs-CRP,β_(2)-MG and Cys-C were independent risk factors for cognitive impairment in IS patients(P<0.05),while the education levels were independent protective factors for cognitive impairment in IS patients(P<0.05).Whenβ_(2)-MG≥2.96 mg·L^(-1),each 0.2 mg·L^(-1)increase ofβ_(2)-MG increased the risk of cognitive impairment in IS patients by 17%(P<0.05),when Cys-C≥1.72 mg·L^(-1),each 0.2 mg·L^(-1)increase of Cys-C increased the risk of cognitive impairment in IS patients by 14%(P<0.05).The prediction model based on independent factors has high differentiation,accuracy and clinical applicability.Conclusion The abnormal changes of serumβ_(2)-MG and Cys-C in IS patients are closely related to the occurrence of cognitive dysfunction,which is an independent influencing factor for the occurrence of cognitive dysfunction in IS patients.β_(2)-MG combined with Cys-C has high application value in the early prediction of cognitive dysfunction.