NF-H在无症状颈动脉狭窄患者血清中的表达与认知功能的关系

Relationship between NF-H expression and cognitive function in the serum of patients with asymptomatic carotid artery stenting

目的:探讨无症状颈动脉狭窄患者颈动脉支架术前及术后血清神经丝蛋白重链(NF-H)表达与患者认知功能的关系。方法:入选2018年5月—2019年8月于四川省人民医院神经内科住院的40例伴有轻度认知功能损害的无症状颈动脉狭窄患者作为实验组,对照组为40例健康人群。用酶联免疫吸附试验(ELISA)法测定实验组CAS术前、术后3月血清NF-H水平以及对照组血清NF-H水平。分别在CAS术前1周、术后3个月用简易智力状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)评价患者认知功能。比较术前、术后3月血清NF-H表达差异及患者术前及术后3个月认知功能变化。结果:实验组术前患者血清NF-H水平高于对照组(P<0.01),实验组术前MMSE评分为(26.08±1.59)分低于对照组MMSE评分(27.93±2.95)分(P<0.05),实验组术前MoCA评分明显低于对照组:(24.48±1.89)分个月vs.(27.97±1.21)分(P<0.01);与术前实验组相比,术后3个月实验组血清NF-H水平显著下降(P<0.01),这与实验组CAS术后3个月的后认知功能改善相符,实验组认知功能术前术后比较:MMSE(26.08±1.59)分vs.(27.48±1.95)分,P<0.05、MoCA(24.48±1.89)分vs.(26.83±.49)分,P<0.05;Pearson相关性分析得出,患者血清NF-H水平与患者MMSE评分及MoCA评分均呈负相关(P<0.01)。结论:无症状颈动脉狭窄患者存在不同程度的脑损伤及认知功能障碍,颈动脉支架术可有效改善颈动脉狭窄相关的认知功能损害,脑损伤标志物NF-H可能成为早期识别认知功能损害及监测颈动脉支架术后患者认知功能改变的生物学标志物。

Objective:To investigate the relationship between serum neurofilament protein heavy chain(NF-H)expression and cognitive function in patients with asymptomatic carotid artery stenosis before and after carotid artery stenting(CAS).Methods:From May 2018 to August 2019,40 patients with asymptomatic carotid stenosis and mild cognitive impairment were admitted to the Department of Neurology of Sichuan Provincial People's Hospital as experimental group,and the control group was 40 health people.Blood samples in the operated patients were collected at three different points:24 hours prior to CAS,3 months after CAS in experimental group.Blood samples in control group were also collected.The serum concentrations of the NF-H were measured by ELISA.The cognitive function of the patients was evaluated by the mini-mental state examination(MMSE)and Montreal Cognitive Assessment(MoCA)before and 3 months after CAS.Compare the difference of serum NF-H expression level and the changes of cognitive function before and 3 months after operation.Results:Serum NF-H level of the patients in the experimental group was higher than that in the control group,with statistical difference(P<0.01).The preoperative MMSE score in the experimental group was(26.08±1.59),which was lower than that in the control group(27.93±2.95),and the difference was statistically significant(P<0.05).The preoperative MoCA score of the experimental group was significantly lower than that of the control group(24.48±1.89)vs.(27.97±1.21),and the difference was statistically significant,(P<0.01).Serum NF-H level decreased significantly(P<0.01)in 3 months after operation compared with that before operation,and this is consistent with the improvement of cognitive function after 3 months--preoperative and postoperative comparison:MMSE(26.08±1.59)vs(27.48±1.95),P<0.05;MoCA(24.48±1.89)vs.(26.83±.49),P<0.05。Pearson correlation analysis showed that the serum NF-H level was negatively correlated with MMSE score and MoCA score(P<0.05).Conclusion:The patient with asymptomatic carotid artery stenosis have different degrees of brain injury and cognitive dysfunction.CAS can effectively improve the cognitive impairment associated with carotid stenosis,and the brain injury marker NF-H may be a biomarker for early recognition of cognitive impairment and may be used to monitor the cognitive function changes in patients after CAS.