血管性认知功能障碍患者测定可溶性CD40配体、同型半胱氨酸和内皮素-1临床意义

Clinical significance of soluble CD40 ligand,homocysteine,endothelin-1 in patients with vascular cognitive impairment

目的观察血管性认知功能障碍(VCI)患者血清可溶性CD40配体(sCD40L)、同型半胱氨酸(Hcy)和内皮素1(ET-1)的临床意义。方法选取2011年6月至2012年8月在我院连续住院的脑梗死患者279例,依据脑卒中后6个月的认知评定结果分为血管性痴呆(VD)组75例,血管性非痴呆认知障碍(VCIND)组123例和认知正常组(对照组)81例。观察各组血清sCD40L,ET-1、Hcy水平和简易精神状态评价量表(MMSE)评分的变化,及其与VCI严重程度的关系。结果 VD组和VCIND组的MMSE评分比对照组明显降低(P<0.01);sCD40L,ET-1和Hcy水平较对照组明显增高(P<0.01),MMSE评分(19.58±2.67)分、(25.94±1.68)分vs(28.46±1.56)分,sCD40L(7.45±2.24)μg/L、(5.98±1.94)μg/L vs(3.46±0.76)μg/L,ET-1(88.35±3.64)ng/L、(81.65±4.35)ng/L vs(65.24±5.64)ng/L,Hcy(25.67±4.25)mmol/L、(18.54±3.24)mmol/L vs(10.25±2.68)mmol/L;而VD组的增高水平较VCIND组更为明显(P<0.01)。MMSE评分、sCD40L、ET-1和Hcy水平随着VCI严重程度的增高而增高(P<0.05或<0.01)。结论 sCD40L,ET-1和Hcy参与了VCI疾病的发生、发展过程,血浆sCD40L、ET-1和Hcy水平与VCI严重程度呈正相关,可以作为VCI疾病严重程度的重要指标。

Objective To observe the clinical significance of soluble CD40 ligand（sCD40L）,homocysteine（Hcy）,endothelin-1（ET-1）in patients with vascular cognitive impairment（VCI）.Methods A total of 279 patients with cerebral infarction who got treatment in the hospital from June 2011 to August 2012,were divided into three groups：vascular dementia（VD）group（75cases）,vascular cognitive impairment no dementa（VCIND）group（123cases）and cognitively normal group（control group,81cases）according to the scores of cognitive assessment after 6months′stroke.The levels of serum sCD40L,ET-1,Hcy and MMSE score were observed in all groups and their relation to the severity of VCI was evaluated.Results MMSE score in VD group and VCIND group was significantly lower,（19.58±2.67）marks,（25.94±1.68）marks vs（28.46±1.56）marks（P 0.01）,but sCD40L,ET-1 and Hcy levels were significantly higher in VD group and VCIND group compared with those of control group（P 0.01）,（7.45±2.24）μg/L,（5.98±1.94）μg/L vs（3.46±0.76）μg/L;（88.35±3.64）ng/L,（81.65±4.35）ng/L vs（65.24±5.64）ng/L;（25.67±4.25）mmol/L,（18.54±3.24）mmol/L vs（10.25±2.68）mmol/L,while the increasing levels of VD group were more obvious significantly compared with VCIND group（P 0.01）.The levels of MMSE score,sCD40L,ET-1and Hcy increased as the severity of VCI increased（P 0.05or0.01）.Conclusion The sCD40L,ET-1and Hcy were involved in the occurrence and development of VCI,there are positive correlation among sCD40L,ET-1,Hcy and severity of VCI,they can be used as important indicators of the severity in VCI.