急性腔隙性脑梗死患者血清胱抑素C与认知功能的相关性研究

The study on the relationship between the levels of serum CysC and cognitive function in patients with acute cerebral lacunar infarction

目的探讨急性腔隙性脑梗死患者血清胱抑素C(cystatin C,CysC)水平与认知功能的相关性。方法123例住院治疗的小血管病变所致急性腔隙性脑梗死患者根据CysC水平被分为低、中、高三组(各组均为n=41例)。根据认知功能评测分为认知功能正常组(n=64),血管性轻度认知功能障碍(vascular mild cognitive impairment,VaMCI)组(n=36)及血管性痴呆(vascular dementia,VaD)组(n=23)。比较组间血清CysC、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清肌酐(serum creatinine,Scr)、血脂、空腹血糖、糖化血红蛋白A1C、血压、美国国立卫生研究院卒中量表(NIHSS)评分、简易精神状态量表(MMSE)、阿尔兹海默病评定量表认知分量表(ADAS-cog)、汉密尔顿抑郁量表(HAMD)得分的差异。采用Logistic回归方法分析CysC与认知功能障碍的相关性。结果高水平血清CysC组较中、低水平血清CysC组的MMSE得分更低(21.98±6.08 vs.25.02±4.69 vs.25.10±3.95),ADAS-cog得分更高(17.73±14.23 vs.12.51±10.39 vs.10.67±7.53),差异有统计学意义(P<0.05)。随着血清CysC升高,SCr逐渐升高,e GFR逐渐减低(P<0.05)。CysC(0.93±0.21 vs.1.10±0.45 vs.1.34±0.58)、MMSE、ADAS-cog在认知正常组、VaMCI组和VaD三组间两两比较差异均具有统计学意义(P<0.05),认知损害越重,CysC越高。多元Logistic回归分析显示CysC的回归系数为7.06(P<0.05)。结论血清CysC升高是小血管病变所致急性腔隙性脑梗死患者认知功能障碍的危险因素之一,且与认知障碍的严重程度相关。

Objective To investigate the relationship between the level of serum cystatin C （CysC） and cognitive function in patients with acute cerebral lacunar infarction caused by small vessel disease . Methods One hundred twen- ty-three patients with acute cerebral lacunar infarction were divided into 3 groups according to serum cystatin C level. Patients were further divided into normal group （n=64）, vascular mild cognitive impairment （VaMCI） group（n=36）, and vascular dementia（VaD） group （n=23）. The Cyst, estimated glomerular filtration rate （eGFR）, serum creatinine （Scr）, TC, TG, HDL, LDL, fast glucose, HbA1C, NIHSS, MMSE, ADAS-cog score were compared between the 3 groups. Muhivari- able logistic regression analysis was used to examine the association of serum CysC with cognitive function. Results Sub- jects with higher CysC levels tended to have lower MMSE score（21.98±6.08 vs. 25.02±4.69 vs. 25.10±3.95 ）and higher ADAS-cog score （17.73± 14.23 vs. 12.51± 10.39 vs. 10.67±7.53 ）. The higher CysC was, the higher SCr and lower eGFR were. Subjects with severer cognition impairment tended to have higher CysC （0.93±0.21 vs. 1.10±0.45 vs. 1.34±0.58）. Multivariable logistic regression showed the regression coefficient was 7.06（P〈0.05 ）. Conclusion Elevated Serum CysC is one of the risk factors of cognitive dysfunction and associated with the severity in patients with small vessel disease-re- lated acute lacunar cerebral infarction.