糖尿病患者颈动脉支架植入后认知功能与S-100B蛋白水平探讨

Investigation of cognitive function and serum S- 100 B protein level in diabetic patients after receiving carotid artery stent implantation

目的探讨严重颈动脉狭窄伴糖尿病和不伴糖尿病患者经颈动脉支架成形术(CAS)治疗后认知功能改善是否存在差异,认知功能改善与血清S-100 B蛋白水平的关系。方法随机将128例重度颈内动脉狭窄患者纳入本研究,分为伴糖尿病组(n=52)和不伴糖尿病组(n=76),两组患者术前临床一般情况及认知功能情况无显著差异。对患者CAS术前及术后3个月血清S-100 B蛋白水平及简易智能精神状态检查量表(MMSE)、Montreal认知评估量表(Mo CA)、Alzheimer评定量表认知分表(ADASCog)、画钟测验(CDT)等评分数据进行分析比较。结果不伴糖尿病组CAS术后血清S-100 B蛋白水平(0.10±0.04)ng/ml较术前(0.11±0.04)ng/ml明显降低(P=0.000),术后3个月认知功能相关MMSE(24.8±2.2对25.2±2.1)、Mo CA(25.6±2.0对26.1±1.9)、ADAS-Cog(6.5±1.3对6.1±1.3)、CDT(3.3±0.7对3.5±0.7)评分均较术前有明显改善(P<0.01);伴糖尿病组CAS术后血清S-100 B蛋白水平及MMSE、Mo CA、ADAS-Cog、CDT评分较术前无明显变化(P=0.159)。血清S-100 B蛋白下降水平与MMSE(r=0.38,P<0.01)、Mo CA(r=0.39,P<0.01)评分增加和ADAS-Cog(r=0.19,P<0.05)评分递减呈正相关。结论CAS术后颈动脉狭窄伴认知功能障碍患者认知功能恢复存在个体差异,认知功能改善程度与血清S-100 B蛋白水平降低相关。颈动脉狭窄伴糖尿病患者认知功能障碍无明显改善,且S-100 B蛋白水平无明显变化。伴和不伴糖尿病患者认知功能障碍的机制可能不同,单纯改善缺血情况不能改善伴糖尿病患者认知功能障碍。

Objective To clarify whether there is any difference in the improvement of cognition function between diabetic patients and non-diabetic patients after receiving percutaneous carotid artery stenting （CAS） for severe carotid artery stenosis, and to investigate the relationship between the improvement of cognition function and serum S-100 B protein level. Methods A total of 128 consecutive patients with severe internal carotid artery stenosis were randomly collected for this study. The patients were divided into diabetic group （n=-52） and non-diabetic group （n=76）. No significant differences in preoperative clinical conditions and cognition function existed between the two groups. The serum S-100 B protein levels, and the scores of mini mental state examination （MMSE）, Montreat cognitive assessment scale （MoCA）, Alzheimer assessment scale cognitive table （ADAS-Cog） as well as clock drawing test （CDT） were determined before and 3 months after CAS, and the results were compared between the two groups. Results In non-diabetic group, the postoperative serum S-100 B protein level was （0.10±0.04） ng/ml, which was significantly lower than the preoperative level of （0.1 ±O.04） ng/ml （P=0.000）. Three months after CAS, significant improvements in MMSE （24.8±2.2 vs 25.2±2.1, P=-0.003）, MoCA （25.6±2.0 vs 26.1±1.9, P=O.O00）, ADAS-Cog （6.5±1.3 vs 6.1±1.3, P=0.000） and CDT （3.3±0.7 vs 3.5±0.7 ,P =0.034） were achieved. In diabetic group, after CAS the serum S-100 B protein level, MMSE, MoCA, ADAS-Cog and CDT scores showed no significant changes when compared with the preoperative data （P=0.159）. The reduction degree of S-100 B protein bore a parallel relationship with the increasing of MMSE （r=0.38, P〈0.0I） and MoCA （r=0.39, P〈0.01） scores, as well as with the decreasing of ADAS-Cog （r=0.19, P〈0.05） scores. Conclusion The recovery of cognitive function in patients with carotid stenosis complicated by cognitive impairment after CAS has individual differences; the improvement degree of cognitive function is correlated with the reduction of serum S-100 B protein level. In diabetic patients with carotid stenosis, the cognitive impairment is not significantly improved after CAS, and the serum S-100 B protein level shows no obvious changes. The mechanisms of cognitive impairment may be different in diabetic and non-diabetic patients, as simply improving ischemia can not improve cognitive dysfunction in diabetic patients.