缺血性脑小血管病患者一氧化氮、内皮素-1和尿酸与血管性认知障碍的相关性

ASSOCIATION OF NITRIC OXIDE,ENDOTHELIN-1 AND URIC ACID WITH VASCULAR COGNITIVE IMPAIRMENT IN PATIENTS WITH ISCHEMIC CEREBRAL SMALL VESSEL DISEASES

目的探讨缺血性脑小血管病患者一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)和尿酸(uric acid,UA)与血管性认知障碍的相关性。方法选取2017年1月-2017年12月于华北理工大学附属医院神经内科住院治疗的300例缺血性脑小血管病患者作为研究对象,选取同期门诊健康体检者60例作为对照组。采用简易精神状况检查表(mini mental state examination,MMSE)评定认知功能。根据MMSE评分结果将缺血性脑小血管病患者分为认知正常组(106例)和认知障碍组(194例),其中认知障碍组进一步分为轻度认知障碍组(102例)、中度认知障碍组(59例)和重度认知障碍组(33例)。NO及ET-1均采用双抗体夹心法测定,血尿酸用尿酸酶法测定,比较分析各项结果。结果(1)与对照组比较,认知正常组、认知障碍组NO水平降低,ET-1、UA水平升高,差异均有统计学意义(均P<0.05);与认知功能正常组比较,认知障碍组的NO水平降低,ET-1、UA水平升高,差异均有统计学意义(均P<0.05)。(2)多因素Logistic回归显示,血清NO水平、血清ET-1水平和血清UA水平与缺血性脑小血管病患者发生认知功能障碍独立相关,其中,血清ET-1、UA水平为危险因素,血清NO水平为保护性因素。(3)与轻度认知障碍组比较,中度认知障碍组、重度认知障碍组,ET-1、UA水平增高,NO水平水平降低,差异均有统计学意义(均P<0.05);与中度认知障碍组比较,重度认知障碍组ET-1、UA水平增高,NO水平降低,差异均有统计学意义(均P<0.05)。结论缺血性脑小血管病患者血清NO、ET-1、UA与血管性认知障碍及认知障碍程度密切相关,其中NO为保护性因素,ET-1、UA为危险因素,可能参与了认知障碍的发生、发展过程。

Objective To explore the correlation between nitric oxide(NO),endothelin-1(ET-1)and Uric acid(UA)and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases(CSVD).Methods Three hundred patients with ischemic cerebral small vessel diseases who were admitted to Department of Neurology,Affiliated Hospital of North China University of Science and Technology from January 2017 to December 2017 were selected as the research object,and 60 healthy outpatients in the same period were selected as the control group.According to the results of MMSE,patients with ischemic cerebral small vessel diseases were divided into cognitive normal group(106 cases)and cognitive impairment group(194 cases).The cognitive impairment group was further divided into mild cognitive impairment group(102 cases),moderate cognitive impairment group(59 cases)and severe cognitive impairment group(33 cases).NO andET-1 were determined by double antibody sandwich method,and UA was determined by uricacid enzyme method.The results were compared and analyzed.Results①Compared with the control group,the levels of NO,ET-1 and UA in normal group and cognitive impairment group,the level of NO decreased significantly,and the levels of ET-1 and UA increased significantly,the differences were statistically significant(all P<0.05).Compared with the cognitive normal group,the level of NO decreased significantly,and the levels of ET-1 and UA increased significantly in cognitive impairment group,the differences were statistically significant(all P<0.05).②Multivariate analysis showed that the serum NO level were independent protective factors of vascular cognitive impairment in patients with ischemic CSVD,while the serum ET-1 and UA levels were independent risk factors.③Compared with mild cognitive impairment group,the levels of ET-1 and UA in moderate cognitive impairment group and severe cognitive impairment group increased significantly(all P<0.05),and the level of NO in moderate cognitive impairment group and severe cognitive impairment group decreased significantly(P<0.05).Compared with the moderate cognitive impairment group,the levels of ET-1 and UA in the severe cognitive impairment group increased significantly(all P<0.05),while the level of NO decreased significantly(P<0.05).Conclusion Serum NO,ET-1 and UA levels are closely related to the vascular cognitive impairment and the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases.NO is the protective factor,and ET-1 and UA are risk factors,which may be involved in the occurrence and development of cognitive impairment.