血清脂联素水平与缺血性卒中后认知损害的相关性

Correlation between serum adiponectin levels and post-stroke cognitive impairment

目的探讨血清脂联素水平与缺血性卒中后认识损害(post-stroke cognitive impairment, PSCI)的相关性。方法连续纳入2018年1月至2018年12月期间在广州医科大学附属脑科医院、东莞市常平医院及江苏省第二中医院神经内科住院的急性缺血性卒中患者,采用放射免疫法测定血清脂联素浓度。卒中发病后1个月采用蒙特利尔认知功能量表(Montreal Cognitive Assessment, MoCA)进行认知功能评估,MoCA总分<22分定义为PSCI。采用单变量分析比较组间基线资料差异,同时采用多变量logistic回归分析确定血清脂联素水平和PSCI的相关性。结果共纳入257例急性缺血性卒中患者,年龄(66.5±9.9)岁,男性139例(54.1%),91例(35.4%)出现PSCI。PSCI组年龄[(68.2±8.1)岁对(65.6±10.8)岁;t=2.007,P=0.046]、高半胱氨酸[(16.0±6.2)μmol/L对(14.5±4.5)μmol/L;t=2.208,P=0.028]及高敏C反应蛋白[7.0(3.3~9.9)mg/L对4.7(2.2~9.6)mg/L;Z=2.346,P=0.019]以及高血压(64.8%对50.6%;χ2=4.824,P=0.028)、糖尿病(33.0%对21.1%;χ2=4.392,P=0.036)、脑白质疏松(47.2%对32.5%;χ2=5.422,P=0.020)和弥散加权成像-阿尔伯塔卒中项目早期CT评分0~7分(59.3%对41.4%;χ2=6.942,P=0.008)患者的构成比均显著高于非PSCI组,而脂联素水平显著低于非PSCI组[5.4(3.5~8.4)mg/L对7.0(5.3~9.3)mg/L;Z=3.624,P=0.001]。多变量logistic回归分析显示,校正混杂因素后,血清脂联素水平较低是PSCI的独立危险因素(第1四分位数组对第4四分位数组:优势比2.152,95%可信区间1.119~5.039;P=0.047)。结论低血清脂联素水平可能是缺血性卒中患者PSCI的独立危险因素。

Objective To investigate the correlation between serum adiponectin levels and post-stroke cognitive impairment (PSCI). Methods From January 2018 to December 2018, consecutive patients with ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Dongguan Changping Hospital, and Jiangsu Provincial Second Chinese Medicine Hospital were enrolled. Serum adiponectin concentration was detected by radioimmunoassay. The cognitive function assessment was performed 1 month after the onset of stroke using the Montreal Cognitive Assessment (MoCA). The total score of MoCA <22 was defined as PSCI. Univariate analysis was used to compare the baseline data between groups, and multivariate logistic regression analysis was used to determine the association between serum adiponectin levels and PSCI. Results A total of 257 patients with acute ischemic stroke were enrolled, with age 66.5±9.9 years, 139 (54.1%) males, and 91 (35.4%) with PSCI. Age (68.2±8.1 years vs. 65.6±10.8 years;t=2.007, P=0.046), homocysteine (16.0±6.2 μmol/L vs. 14.5±4.5 μmol/L;t=2.208, P=0.028), and high-sensitivity C-reactive protein (7.0 [3.3-9.9] mg/L vs. 4.7 [2.2-9.6] mg/L;Z=2.346, P=0.019) as well as the proportion of hypertension (64.8% vs. 50.6%;χ2=4.824, P=0.028), diabetes (33.0% vs. 21.1%;χ2=4.392, P=0.036), leukoaraiosis (47.2% vs. 32.5%;χ2=5.422, P=0.020) and diffusion weighting imaging-Alberta Stroke Project early CT score 0-7 (59.3% vs. 41.4%;χ2=6.942, P=0.008) in the PSCI group was significantly higher than that of the non-PSCI group, while the adiponectin level was significantly lower than that of the non-PSCI group (5.4 [3.5-8.4] mg/L vs. 7.0 [5.3-9.3] mg/L;Z=3.624, P=0.001). Multivariate logistic regression analysis showed that after adjusting for the confounding factors, the lower serum adiponectin level was an independent risk factors for PSCI (the 1st quartile group vs. the 4th quartile group: odds ratio 2.152, 95% confidence interval 1.119-5.039;P=0.047). Conclusions Low serum adiponectin level might be an independent risk factor for PSCI in patients with ischemic stroke.