血清维生素B_(12)水平与急性腔隙性脑梗死患者短期预后的相关性分析

Correlation analysis of vitamin B_(12)level and short-term prognosis in patients with acute lacunar cerebral infarction

目的探讨维生素B_(12)水平与急性腔隙性脑梗死患者短期预后的相关性。方法选取2020年6月-2021年2月在重庆市某医院治疗的56例急性腔隙性脑梗死患者为研究对象,并进行回顾性队列研究。以维生素B_(12)水平中位数(血清维生素B_(12)水平中位数为227 pg/mL)为分界点,将所有患者平均分为2组:高维生素B_(12)组(维生素B_(12)水平229~1047 pg/mL)和低维生素B_(12)组(维生素B_(12)水平81~227 pg/mL),每组28例。将2组患者年龄、性别、慢病情况(高血压病、糖尿病)、吸烟史、改良Rankin量表(mRS)评分(评估患者预后,预后不良定义为mRS>2分)、相关检查指标等进行单因素分析。将单因素分析中P<0.30的因素进行二元Logistic回归分析。结果2组患者在年龄、性别构成、是否患高血压、是否患糖尿病、Fazekas评分等一般资料比较,差异无统计学意义(P>0.05)。高维生素B_(12)组患者中出院时mRS>2分所占比例低于低维生素B_(12)组,差异有统计学意义(P<0.05)。二元Logistic回归分析结果提示,低维生素B_(12)水平是腔隙性脑梗死患者预后不良的独立危险因素(OR=7.668;95%CI:1.201~48.974;P=0.031)。结论低血清维生素B_(12)水平是急性腔隙性脑梗死不良预后的独立危险因素,原因可能是低维生素B_(12)导致了梗死部位以外的亚临床的脑白质结构异常,进而导致脑网络代偿功能失调。因此,为急性腔隙性脑梗死患者补充维生素B_(12)有可能改善患者结局。然而这需要后期加大研究的样本量,并进行脑网络研究以证实。

Objective To investigate the correlation between vitamin B_(12)levels and short-term prognosis of patients with acute lacunar cerebral infarction.Methods Fifty-six patients with acute lacunar cerebral infarction treated in a hospital in Chongqing from June 2020 to February 2021 were selected and studied in a retrospective cohort study.Using the median vitamin B_(12)level(median serum vitamin B_(12)of 227 pg/mL)as the cut-off point,all patients were equally divided into 2 groups:the high vitamin B_(12)group(vitamin B_(12)level 229-1047 pg/mL)and the low vitamin B_(12)group(vitamin B_(12)level 81-227 pg/mL),with 28 cases in each group.The age,gender,chronic disease status(hypertension,diabetes mellitus),smoking history,modified Rankin Scale(mRS)score(to assess patient prognosis;poor prognosis was defined as mRS>2),and relevant examination indexes were analyzed univariately in the 2 groups.Factors with P<0.30 in the univariate analysis were subjected to binary logistic regression analysis.Results There was no statistically significant difference between the 2 groups when comparing general information such as age,gender composition,whether they had hypertension,whether they had diabetes mellitus,and Fazekas score(P>0.05).The proportion of patients with mRS>2 at discharge was lower in the high vitamin B_(12)group than in the low vitamin B_(12)group,and the difference was statistically significant(P<0.05).The results of binary logistic regression analysis suggested that low vitamin B_(12)level was an independent risk factor for poor prognosis in patients with lacunar cerebral infarction(OR=7.668;95%CI:1.201-48.974;P=0.031).Conclusion Low serum vitamin B_(12)level is an independent risk factor for poor prognosis in acute lacunar cerebral infarction,probably because hypovitaminosis B_(12)leads to subclinical abnormalities in cerebral white matter structures beyond the infarct site,which in turn leads to dysregulation of brain network compensation.Therefore,vitamin B_(12)supplementation for patients with acute lacunar cerebral infarction has the potential to improve patient outcomes.However,this needs to be confirmed by increasing the sample size of the study and doing brain network studies at a later stage.