血清胱抑素-C水平与认识功能减退的相关性研究

Relationship between Cerum cystatin-C and cognitive function

目的探讨血清胱抑素C水平与认知功能减退发生风险的相关性。方法纳入有效随访受试者共503例,包括328例男性,175例女性,平均年龄67(67±26.7)岁,随访期2.5年。在随访期内对血清胱抑素C水平、认知功能进行重复测量。在调整了其他可能混杂因素的影响后,分析血清胱抑素C水平与认知功能减退发生风险的相关性。结果不同血清胱素水平组年龄、高血压、糖尿病、中风史和吸烟状况分布差异具有统计学意义(P<0.05),提示高龄、高血压、糖尿病、中风和当前吸烟者可能伴随着更高的血清胱抑素浓度。经混合线性模型处理后,仍然可以发现简明精神状态量表(MMSE)及蒙特利尔智力测试表(MoCA)值的变化趋势与血清胱抑素水平的相关性(P<0.01及P<0.001)。通过2年的随访,不同胱抑素C浓度组的认知功能减退发生率不同。通过多因素回归分析显示,基于MMSE判定的认知功能减退风险比值比(OR)分别为1.26和1.88,经过协变因素校正后的比值比分别为1.48和1.93;基于Mo-CA判定的认知功能减退风险比值比(OR)分别为1.34和1.84,经过协变因素校正后的比值比分别为1.36和1.78。另外,胱抑素C浓度<1.25 mg/L组或者≥1.25 mg/L组,肾功能不全均是认知功能减退的影响因素。结论高血清胱抑素C与中老年人群的认知功能减退发生风险密切相关,且这种联系独立于肾功能水平影响之外。

Objective To determine the relevance of serum cystatin C levels and cognitive decline.Methods 503 cases of eligible subjects were included.Follow-up duration was 2.5 years.In the follow-up period,serum cystatin C levels and cognitive status were detected repeatedly.After adjusting for potential confounding factors,the relativity between serum cystatin C levels and cognitive decline was analyzed.Results Significant deferent distribution of risk factors such as age,hypertension,diabetes,stroke,smoking history were found among groups with various serum cystatin C levels（P0.05）,which suggested that aged,hypertension,diabetes,stroke and current smokers may be accompanied by higher concentration of serum cystatin C levels.After had processed by mixed linear model,correlation between values of MMSE/ MoCA and serum cystatin C levels were still obsevered（P0.01/P0.001）.After 2 years follow-up,cognitive decline in varing degree occurred.Multivariate regression analysis showed that MMSE-based odds ratio（OR） of cognitive decline was 1.26 and 1.88,respectively,and the odds ratios were 1.48 and 1.93 after adjustment for covariants;MoCA-based odds ratio（OR） of cognitive decline was 1.34 and 1.84 respectively,and the odds ratios were 1.36 and 1.78 after adjustment for covariants.In addition,renal dysfunction was risk factor of cognitive decline in all groups（cystatin C1.25 mg/Lor≥1.25 mg / L）.Conclusion High serum cystatin C level is closely correlated with occurrence of cognitive decline and the effect is independent of renal function.