急性脑卒中后并发血管性认知障碍患者的血清半胱氨酸蛋白酶抑制剂C水平变化

Changes of serum cystatin C levels in patients with vascular cognitive impairment after acute stroke

目的 探讨急性脑卒中后并发血管性认知障碍（VCI）患者的血清半胱氨酸蛋白酶抑制剂（Cys）C水平的变化及其临床意义,为VCI患者的早期诊断及治疗提供依据.方法 选择2012年12月至2013年12月东营市人民医院神经内科和神经外科收治的120例急性脑卒中患者为研究对象,纳入研究组,按脑卒中后是否并发VCI将其分为VCI亚组（n=60）和非VCI亚组（n=60）;并选择同期于本院门诊体检的年龄≥50岁、无认知功能减退主诉的60例受试者纳入对照组.采用《简易精神状态评价量表》（MMSE）系统评价VCI亚组患者认知功能,并根据MMSE评分结果评价其VCI严重程度.采用全自动生化分析仪免疫比浊法检测研究组与对照组血清Cys C水平,并进行比较,同时对VCI亚组患者血清Cys C水平与VCI严重程度之间的关系进行统计学分析.本研究遵循的程序符合东营市人民医院人体试验委员会所制定的伦理学标准,得到该伦理会批准,分组征得受试对象本人的知情同意,并与之签订临床研究知情同意书.结果 VCI亚组、非VCI亚组及对照组3组受试者性别构成、年龄、受教育年限、原发性高血压、糖尿病等社会人口学资料比较,差异均无统计学意义（P＞0.05）.VCI亚组患者血清Cys C水平为（1.68±0.46） mg/L,高于非VCI亚组[（0.88±0.42） mg/L]和对照组[（0.83±0.32） mg/L],且3者比较,差异有统计学意义（F=12.99,P＜0.05）.VCI亚组患者中,VCI不同严重程度患者血清Cys C水平比较,差异有统计学意义（F=7.98,P＜0.05）.其中,MMSE评分≤13分的重度VCI患者为19例,其血清Cys C水平最高,为（1.92±0.36） mg/L;MMSE评分为≥14～20分的中度VCI患者为23例,其血清Cys C水平为（1.33±0.41） mg/L;MMSE评分为≥21～24分的轻度VCI患者为18例,其血清Cys C水平最低,为（1.09±0.28） mg/L.3者比较,差异有统计意义（F=7.98,P＜0.05）.VCI亚组患者血清Cys C水平越高,其VCI程度越严重.VCI亚组患者Cys C水平与MMSE评分的Spearmen相关系数的双变量相关分析结果示,MMSE评分与VCI患者血清CysC水平呈负相关关系（r=-0.421,P=0.039）.结论 急性脑卒中患者血清Cys C水平与其VCI的发生、发展有关.血清Cys C水平可作为急性脑卒中患者VCI早期诊断的外周血生物学标志物之一,为VCI的早期诊断与治疗提供生物学依据.

Objective To explore changes and clinical significances of serum cystatin （Cys） C levels in patients with vascular cognitive impairment （VCI） after acute stroke,in order to provide evidence for early diagnosis and treatment of patients with VCI.Methods From December 2012 to December 2013,a total of 120 cases of acute stroke patients who were treated in Department of Neurology and Neurosurgery,Dongying People＆#39;s Hospital were included in this study,as study group.According to whether the patients complicated VCI or not after stroke,study group were divided into VCI subgroup （n=60） and non-VCI subgroup （n=60）.And at the same period,a total of 60 cases of elderly health examination who were over 50 years old and without complaints of cognitive dysfunction were included in control group （n =60）.Systematic evaluations of VCI patients＆#39; cognitive function were evaluated by mini-mental state examination （MMSE） scale,and severity of VCI was divided according to results of MMSE score.Levels of serum Cys C in three group were detected with immunoturbidimetry by automatic biochemical analyzer,and relationship between serum Cys C levels and VCI severity was analyzed.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Dongying People＇s Hospital.Informed consent was obtained from all participants.Results There were no significant differences in gender,age,years of education,high blood pressure,diabetes and other socio-demographic data among VCI subgroup,non-VCI subgroup and control group （P〉0.05）.Level of serum Cys C in VCI subgroup was （1.68±0.46）mg/L,which was higher than （0.88±0.42） mg/L of non-VCI subgroup and （0.83±0.32） mg/L of control group,and difference among three group was statistically significant （F=12.99,P〈0.05）.In VCI subgroup,there was statistical difference of levels of serum Cys C in patients with different VCI degrees （F=7.98,P〈0.05）.There were 19 cases of severe VCI patients with MMSE score ≤13 whose serum levels of Cys C were （1.92±0.36） mg/L.There were 23 cases of moderate VCI patients with MMSE score of ≥14-20 whose serum levels of Cys C were （1.33±0.41） mg/L.There were 18 cases of mild VCI patients with MMSE score of ≥21-24 whose levels of Cys C were （1.09 ± 0.28） mg/L.There was statistical difference among above three groups （F=7.98,P〈0.05）.The higher levels of serum Cys C in VCI patients after acute stroke were,the more serious the degree of their VCI.The results of bivariate Spearmen correlation coefficient analysis showed that there was a negative correlation between levels of Cys C and MMSE scores in VCI patients （r=-0.421,P=0.039）.Conclusions Levels of Cys C in VCI patients after acute stroke were related to their development of VCI.Levels of serum Cys C could be one of biomarkers in peripheral blood as an early diagnosis of VCI,to provide biological evidence for early diagnosis and treatment of VCI.