血清β-淀粉样蛋白42水平与脑小血管病患者认知损害的相关性

Correlation between serum β-amyloid 42 level and cognitive impairment in patients with cerebral small vessel disease

目的探讨血清β-淀粉样蛋白(amyloidβ,Aβ)42水平与脑小血管病(cerebral small vascular disease,CSVD)患者认知损害的相关性。方法回顾性连续纳入2016年9月至2019年9月期间在济宁医学院附属医院住院的CSVD患者,采用蒙特利尔认知评估量表中文版、临床痴呆评定量表以及流行病学研究中心抑郁量表进行神经心理学评估。根据轻度认知障碍诊断标准分为认知损害组和认知功能正常组。采用多变量logistic回归分析确定CSVD患者出现认知损害的独立危险因素。应用受试者工作特征(receiver operator characteristic,ROC)曲线评估血清Aβ42水平对认知损害的预测价值。结果共纳入171例CSVD患者,血清Aβ42为(2.14±0.56)μg/L。81例(47.4%)存在认知损害,90例(52.6%)认知功能正常。单变量分析显示,认知损害组年龄、吸烟、高血压、糖尿病、既往卒中或短暂性脑缺血发作史、血压、空腹血糖以及血清Aβ42与认知正常组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,在校正年龄、吸烟、糖尿病、血压以及既往卒中或短暂性脑缺血发作史后,血清Aβ42[优势比(odds ratio,OR)2.974,95%可信区间(confidence interval,CI)1.632~6.348;P=0.009]、高血压(OR 2.063,95%CI 1.340~5.438;P=0.021)和空腹血糖(OR 1.598,95%CI 1.167~4.156;P=0.030)是CSVD患者出现认知损害的独立危险因素。ROC曲线分析显示,血清Aβ42预测CSVD患者认知损害的曲线下面积为0.700(95%CI 0.619~0.782;P<0.001)。最佳截断值为2.39μg/L,其预测敏感性和特异性分别为56.8%和80.0%。结论血清Aβ42与CSVD患者认知损害独立相关,可用于CSVD患者认知损害的预测。

Objective To investigate the correlation between serum β-amyloid (Aβ) 42 level and cognitive impairment in patients with cerebral small vascular disease (CSVD).Methods Consecutive patients with CSVD admitted to the Affiliated Hospital of Jining Medical University from September 2016 to September 2019 were enrolled retrospectively. Montreal Cognitive Assessment (Chinese edition), Clinical Dementia Rating and Center for Epidemiologic Studies-Depression scale were used for neuropsychological evaluations. According to the diagnostic criteria of mild cognitive impairment, they were divided into cognitive impairment group and normal cognitive function group. Multivariate logistic regression analysis was used to identify the independent risk factors for cognitive impairment in patients with CSVD. Receiver operator characteristic (ROC) curve was used to evaluate the predictive value of serum Aβ42 level for cognitive impairment.Results A total of 171 patients with CSVD were enrolled. The serum Aβ42 was 2.14±0.56 μg/L. Eight-one patients (47.4%) had cognitive impairment, and 90 (52.6%) had normal cognitive function. Univariate analysis showed that there were significant differences in age, smoking, hypertension, diabetes, history of previous stroke or transient ischemic attack, blood pressure, fasting blood glucose and serum Aβ42 between the cognitive impairment group and the normal cognitive function group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for age, smoking, diabetes, blood pressure and history of previous stroke or transient ischemic attack, serum Aβ42 (odd ratio [OR] 2.974, 95% confidence interval [CI] 1.632-6.348;P=0.009), hypertension (OR 2.063, 95% CI 1.340-5.438;P=0.021) and fasting blood glucose (OR, 1.598, 95% CI 1.167-4.156;P=0.030) were the independent risk factors for cognitive impairment in patients with CSVD. ROC curve analysis showed that the area under the curve of serum Aβ42 was 0.700 (95% CI 0.619-0.782;P<0.001). The optimal cut-off value was 2.39 μg/L, and the sensitivity and specificity were 56.8% and 80.0%, respectively.Conclusions Aβ42 is independently correlated with cognitive impairment in patients with CSVD, and can be used to predict cognitive impairment in patients with CSVD.