血清胰岛素样生长因子-1水平与脑梗死患者认知功能的相关性研究

Study on the correlation between serum insulin-like growth factor-1 level and cognitive function in patients with cerebral infarction

目的探讨血清胰岛素样生长因子-1(insulin like growth factor-1,IGF-1)水平与脑梗死患者认知功能之间的相关性,以及影响认知障碍的其他危险因素。方法选择苏州大学附属第三医院神经内科2019-11—2020-08收治的脑梗死患者186例,对所有患者进行蒙特利尔认知评估量表(MoCA)评估,根据得分结果分为脑梗死伴认知障碍组(95例)与脑梗死不伴认知障碍组(91例)。收集符合入组标准患者的临床资料,于苏州大学附属第三医院化验室统一测定甘油三酯、总胆固醇、低密度脂蛋白、空腹血糖、糖化血红蛋白(HbA1c)、空腹胰岛素、C肽、抗人胰岛素抗体、血清IGF-1等指标。结果脑梗死伴认知障碍组与脑梗死不伴认知障碍组相比,年龄、受教育程度、糖尿病史、既往卒中史、此次卒中病灶、空腹血糖、糖化血红蛋白、胰岛素、抗人胰岛素抗体、血清IGF-1水平差异有统计学意义(P<0.05)。脑梗死患者MoCA评分与年龄、糖尿病史、既往卒中史、此次卒中病灶、空腹血糖、糖化血红蛋白、胰岛素及抗人胰岛素抗体呈负相关(r值分别为0.401、0.433、0.147、0.305、0.237、0.354、0.236、0.252,P<0.05),与受教育年限及血清IGF-1水平呈正相关(r值分别为0.146、0.631,P<0.05)。多元线性Logistic回归分析显示血清IGF-1水平差异有统计学意义(OR=1.058,95%CI 1.03~1.083,P<0.05)。结论糖尿病会加重脑梗死患者的认知障碍。受教育程度、年龄、血糖控制水平、脑梗死的数量和病灶的数量是认知障碍的危险因素。血清IGF-1水平降低是脑梗死患者认知能力下降的独立危险因素之一。

Objective To investigate the correlation between serum insulin like growth factor-1(IGF-1)levels and cognitive function in patients with cerebral infarction,and other risk factors affecting cognitive impairment.Methods Totally 186 patients with cerebral infarction were selected from the Department of Neurology of the Third Affiliated Hospital of Soochow University from November 2019 to August 2020.All patients were subjected to the Montreal cognitive assessment scale(MoCA),and the patients were divided into cerebral infarction with cognitive impairment group based on the score results(95 cases)and cerebral infarction without cognitive impairment group(91 cases).Clinical general data of selected patients,and uniformly measure blood pressure,blood lipids,fasting blood glucose,glycosylated hemoglobin(HbA1c),fasting insulin,C peptide,anti-human insulin antibody,se⁃rum IGF-1,etc.were collected.Results Compared with the cerebral infarction with cognitive impairment group and the cerebral in⁃farction without cognitive impairment group,the difference in age,education level,history of diabetes,history of previous stroke,fo⁃cus of this stroke,fasting blood glucose,HbA1c,insulin,anti-human insulin antibody and serum IGF-1 levels was statistically sig⁃nificant(P<0.05).The MoCA scores in all patients were negatively correlated with age(r=0.401,P<0.05),history of previous stroke(r=0.305,P<0.05),history of previous diabetes(r=0.433,P<0.05),fasting blood glucose(r=0.237,P<0.05),HbA1c(r=0.354,P<0.05),fasting insulin(r=0.236,P<0.05),anti-human insulin antibodies(r=0.252,P<0.05),and posi⁃tively correlated with years of education(r=0.146,P<0.05)and IGF-1 levels(r=0.631,P<0.05).Multiple linear Logistic regres sion analysis showed that the serum IGF-1 level was statistically significant(OR=1.058,95%confience interval 1.03-1.083;P<0.05).Conclusion Diabetes can aggravate the cognitive impairment in patients with cerebral infarction.Education level,age,blood sugar control,the number of cerebral infarctions and the number of lesions are risk factors for cognitive impairment.Decreased serum IGF-1 level is one of the independent risk factors for cognitive decline in patients with cerebral infarction.