血清超氧化物歧化酶介导的发病前体育运动对缺血性脑卒中患者认知功能改善作用的队列研究

A cohort study on the effect of pre-onset physical exercise mediated by serum superoxide dismutase on improving the cognitive function of patients with ischemic stroke

目的探讨发病前体育运动对首次缺血性脑卒中患者认知功能短期预后的影响,以及血清超氧化物歧化酶(superoxide dismutase,SOD)的中介作用。方法选取2018年7月1日―2019年11月30日蚌埠医学院第一附属医院神经内科缺血性脑卒中首次发病患者512人进行短期随访研究,通过问卷调查患者发病前体育运动相关变量,使用改良版蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表进行认知功能测量和随访评估。采用Logistic回归分析模型分析体育运动对患者认知功能短期预后的影响,采用自助抽样法(bootstrap method)分析血清SOD的中介作用。结果与不参加运动组相比,运动年限≥1年、每周运动天数≥3 d、每天运动次数≥1次、运动持续时间30~<60 min的缺血性脑卒中患者在出院后3个月、6个月和12个月的MoCA量表得分较高。从运动年限和运动持续时间观察,随访3个月、6个月、12个月,发病前体育运动对认知功能康复的效应不断降低,且3个月和6个月时血清SOD效应修饰作用较强。血清SOD在发病前体育运动促进缺血性脑卒中患者认知功能短期预后的中介作用明显,均在10%左右。结论发病前体育运动是缺血性脑卒中患者出院后认知功能恢复的保护因素,其机制与血清SOD存在相关性。

Objective To explore the impact of pre-ischemic stroke physical exercise on the short-term prognosis of cognitive function in patients with first ischemic stroke and the mediating role of serum SOD on this effect.Methods In this study,512 patients who were first-onset diagnosed with ischemic stroke in the department of neurology of the first affiliated hospital of Bengbu Medical College were selected for a short-term cohort study from July 1,2018 to November 30,2019.A questionnaire was used to investigate the physical activity-related variables before the onset of the disease,and the modified montreal cognitive assessment(MoCA)scale was used for cognitive function measurement and follow-up evaluation.Logistic regression analysis model was adopted to analyze the effect of physical exercise on the short-term prognosis of cognitive function.The bootstrap method was used to analyze the mediation role of serum SOD.Results Compared with the non-exercise group,the patients who exercised≥3 d a week,exercised at least once a day,and exercised 30~<60 min per day for more than 1 year had higher MoCA scale scores at 3,6,and 12 months after discharge.The effect of physical exercise on cognitive function rehabilitation decreased continuously after follow-up for 3 months,6 months,and 12 months,and the modification effect of serum SOD was evident at 3 months and 6 months.The mediation effect of serum SOD in promoting the short-term prognosis of cognitive function of ischemic stroke patients by physical exercise was significant,with a mediation effect of about 10%.Conclusion Pre-ischemic stroke regular physical exercise is a protective factor for the recovery of cognitive function after discharge from ischemic stroke,and its mechanism is correlated with serum SOD.