血清胆红素和纤维蛋白原浓度与血管性认知损害非痴呆的相关性

Relationship between serum bilirubin and fibrinogen levels and non-dementia with vascular cognitive impairment

目的探究血管性认知损害非痴呆(vascular cognitive impairment with no dementia,VCIND)患者血清胆红素和血浆纤维蛋白原(fibrinogen,FIB)浓度与认知功能的关系。方法测定82例VCIND组和70例对照组血浆纤维蛋白原和血清胆红素的浓度;采用简易精神状态检查量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)对入组者行神经心理学评价;比较两组间胆红素和纤维蛋白原浓度及认知功能变化情况;用Logistic回归法分析VCIND的影响因素。结果 VCIND组患者的血清胆红素浓度较对照组降低,而血浆FIB浓度较对照组明显升高;VCIND组MMSE评分(25.40±2.33)和MoCA评分(22.40±2.08)较对照组(28.44±1.11、27.44±1.04)偏低,差别均有统计学意义(t=-8.368,P=0.000;t=-10.644,P=0.000);血清胆红素水平与MMSE评分和MoCA评分总得分(r=0.271,P=0.042;r=0.341,P=0.009)及其子项目中的视空间与执行功能、注意力、延迟回忆等评分均呈正相关(r=0.322,P=0.024;r=0.232,P=0.034;r=0.307,P=0.005),血浆FIB水平与MMSE评分和MoCA总评分(r=-0.538,P=0.001;r=-0.464,P=0.007)及其子项目中的视空间与执行功能、注意力、延迟回忆、抽象思维等评分均呈负相关(r=-0.321,P=0.013;r=-0.305,P=0.016;r=-0.376,P=0.003;r=-0.295,P=0.017);Logistic回归分析显示:在调整多种因素后,高龄和高纤维蛋白原水平与认知功能为负性相关关系(β=0.115,P=0.001;β=2.818,P=0.000),高教育程度和总胆红素水平与与认知功能为正性相关关系(β=-0.281,P=0.000;β=-0.101,P=0.035)。结论 VCIND患者血清胆红素浓度下降,与认知功能呈正相关;血浆FIB升高,与认知功能呈负相关。较高年龄及纤维蛋白原水平是VCIND的危险因素,而较高的受教育程度及总胆红素水平是保护性因素。

Objective To investigate the relationship between serum bilirubin and plasma fibrinogen （FIB）concentrations and cognitive function in patients with vascular cognitive impairment with no dementia （VCIND）.Methods The levels of plasma fibrinogen and serum bilirubin in 82 patients with VCIND and 70 patients with controlwere measured; the mini-mental state examination （MMSE） and Montreal Cognitive Assessment （MoCA） et al. performedneuropsychological evaluations on the participants; compared bilirubin and fibrinogen concentrations and cognitivefunction changes between the two groups; and analyzed the influencing factors of VCIND using Logistic regressionanalysis. Results the plasma FIB concentration was significantly higher in patients with VCIND than in the controlgroup; the VCIND group had a MMSE score （25.40±2.33） anda MoCA score （22.40±2.08） which were significantly lower compared with the control group （28.44±1.11）. 27.44±1.04） （t=-8.368, P=0.000; t=-10.644, P=0.000）; Theserum bilirubin levels and the total scores of MMSE scores and MoCA scores（r=0.271, P=0.042; r=0.341, P=0.009）and their visual and spatial performance functions, attention, and delayed recall scores were all Positively correlated（r=0.322, P=0.024; r=0.232, P=0.034; r=0.307, P=0.005）. plasma FIB levels and MMSE scores, and MoCA totalscore （r=-0.538, P=0.001; r=-0.464, P=0.007） and its subprojects hada negative correlation with visual space andperformance, attention, delayed recall, and abstract thinking （r=-0.321, P=0.013; r=-0.305, P=0.016; r=-0.376, P=0.003; r=-0.295, P= 0.017）; Logistic regression analysis showed that after adjustment for multiple factors, there wasanegative correlation between old age and high fibrinogen levels and cognitive function （r=0.115, P=0.001; r=2.818,P=0.000）, high educational level and that there wasa positive correlation between total bilirubin levels and cognitivefunction （r=-0.281, P=0.000; r=-0.101, P=0.035）. Conclusion The serum bilirubin concentration in patients withVCIND is decreased, which is positively correlated with cognitive function. The increase of plasma FIB is negativelycorrelated with cognitive function. Higher age and fibrinogen levels are risk factors for VCIND, and higher levels ofeducation and total bilirubin are protective factors.