缺血性小动脉卒中后认知障碍与血糖、血清神经元特异性烯醇化酶、脑源性神经营养因子水平相关性分析

Correlation between cognitive impairment and blood glucose,serum neuron specific enolase and brain-derived neurotrophic factor levels after ischemic small-artery stroke

目的探讨缺血性小动脉卒中后认知障碍与血糖、血清神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)水平的相关性。方法选择晋城市人民医院2018年1月至2019年12月收治的缺血性小动脉卒中患者160例为观察对象,并以是否并发认知障碍为依据分为观察组(有认知障碍,68例)与对照组(无认知障碍,92例)。比较两组一般资料及血糖、NSE、BDNF水平,并应用多因素logistic回归分析缺血性小动脉卒中后认知障碍与各因素的相关性。结果两组患者性别、年龄、病程、体质量指数(BMI)、高血压病史、高血脂病史、2型糖尿病病史、吸烟史、饮酒史比较,差异均无统计学意义(均P>0.05);观察组美国国立卫生研究院卒中量表(NIHSS)评分[(18.86±4.08)分]高于对照组[(14.27±2.66)分],简易智力状态检查量表(MMSE)评分[(21.45±3.03)分]低于对照组[(24.28±3.32)分],差异均有统计学意义(t=6.664、4.452,均P<0.05)。两组糖基化血红蛋白、空腹血糖、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇水平比较,差异均无统计学意义(均P>0.05);两组氧化低密度脂蛋白(ox-LDL)、NSE、BDNF水平差异显著,其中,观察组ox-LDL、NSE水平[(44.8±7.6)mmol/L、(26.5±9.5)ng/mL]均明显高于对照组[(35.9±4.7)mmol/L、(11.6±6.9)ng/mL],BDNF水平[(5.1±1.8)ng/mL]明显低于对照组[(6.3±2.4)ng/mL],差异均有统计学意义(t=7.04、8.973、2.828,均P<0.05)。多因素logistic回归分析结果显示:ox-LDL、NSE水平以及NIHSS评分为缺血性小动脉卒中后认知障碍独立危险因素(均P<0.05),BDNF、MMSE评分为其独立保护因素(均P<0.05)。结论缺血性小动脉卒中后认知障碍与NIHSS评分、MMSE评分、ox-LDL、NSE、BDNF存在相关性,ox-LDL、NSE水平以及NIHSS评分为其独立危险因素,BDNF、MMSE评分为独立保护因素。

Objective To investigate the correlation between cognitive impairment and blood glucose,serum neuron specific enolase(NSE)and brain-derived neurotrophic factor(BDNF)levels after ischemic small-artery stroke.Methods A total of 160 patients with ischemic small-artery stroke who received treatment in Jincheng People's Hospital from January 2018 to December 2019 were included in this study.They were divided into an observation group(with cognitive impairment,n=68)and a control group(without cognitive impairment,n=92)according to whether they had cognitive impairment.General data,blood glucose,NSE and BDNF levels were compared between the two groups.Multivariate logistic regression analysis was used to analyze the correlation between cognitive impairment and each factor after ischemic small-artery stroke.Results There were no significant differences in gender,age,course of disease,body mass index,history of hypertension,hyperlipidemia,history of type 2 diabetes mellitus,history of smoking,and history of drinking between the two groups(all P>0.05).The National Institute Health of Stroke Scale(NIHSS)score in the observation group was significantly higher than that in the control group[(18.86±4.08)points vs.(14.27±2.66)points,t=6.664,P<0.05],and the Mini-Mental State Examination(MMSE)score in the observation group was significantly lower than that in the control group[(21.45±3.03)points vs.(24.28±3.32)points,t=4.452,P<0.05].There were no significant differences in glycosylated hemoglobin,fasting blood glucose,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),triglyceride(TG)and total cholesterol levels between the two groups(all P>0.05).There were significant differences in oxidized low-density lipoprotein(ox-LDL),NSE and BDNF levels between the two groups.The ox-LDL[(44.8±7.6)mmol/L]and NSE[(26.5±9.5)ng/mL]levels in the observation group were significantly higher than those in the control group[(35.9±4.7)mmol/L,(11.6±6.9)ng/mL,t=7.04,8.973,both P<0.05].BDNF level in the observation group was significantly lower than that in the control group[(5.1±1.8)ng/mL vs.(6.3±2.4)ng/mL,t=2.828,P<0.05].Multivariate logistic regression analysis showed that ox-LDL and NSE levels and NIHSS score were independent risk factors of cognitive impairment after ischemic small-artery stroke(all P<0.05),and BDNF level and MMSE score were independent protective factors(all P<0.05).Conclusion Cognitive impairment was correlated with NIHSS score,MMSE score,ox-LDL,NSE and BDNF levels in patients with ischemic small-artery stroke.ox-LDL and NSE levels as well as NIHSS score were independent risk factors and BDNF level and MMSE score were independent protective factors of ischemic small-artery stroke.