血清GFAP、Hcy与Fazekas评分对脑小血管病患者认知障碍的预测价值

Predictive value of serum GFAP,Hcy and Fazekas scores on cognitive impairment in patients with cerebral small vascular disease

目的探讨血清胶质纤维酸性蛋白(GFAP)、同型半胱氨酸(Hcy)与Fazekas评分对脑小血管病(CSVD)患者认知障碍的预测价值。方法选取海南医学院第二附属医院2019年1月至2020年6月收治的129例CSVD患者,根据蒙特利尔认知量表(MoCA)分为认知障碍组和认知正常组。收集患者性别、年龄、基础病史、血脂、血清GFAP、Hcy及Fazekas评分等资料,分析血清GFAP、Hcy水平、Fazekas评分与MoCA评分相关性及其对CSVD患者认知障碍的预测价值。结果129例CSVD患者院后半年内出现认知功能障碍56例,发生率为43.41%;其中轻度障碍16例,中度障碍33例,重度障碍7例。认知障碍组患者血清GFAP、Hcy水平、Fazekas评分均明显高于认知正常组(P<0.05)。随着认知障碍病情的加重,CSVD患者血清GFAP、Hcy水平呈明显增高趋势(P<0.05);重度认知障碍患者Fazekas评分高于轻度认知障碍患者(P<0.05)。血清GFAP、Hcy水平、Fazekas评分与MoCA评分呈显著负相关(P<0.05)。血清GFAP、Hcy水平、Fazekas评分预测CSVD患者认知障碍的ROC曲线下面积为0.888、0.886、0.883,最佳临界值分别为6.26μg·mL^(-1)、15.30μmol·L^(-1)、2.5分。结论血清GFAP、Hcy水平及Fazekas评分与CSVD患者认知状况密切相关,可作为早期预测认知障碍的参考指标。

Objective To investigate the predictive value of serum glial fibrillary acidic protein(GFAP),homocysteine(Hcy)and Fazekas score on cognitive impairment in patients with cerebral small vascular disease(CSVD).Methods A total of 129 patients with CSVD admitted to our hospital from January 2019 to June 2020 were selected and divided into cognitive impairment group and cognitive normal group according to Montreal Cognition Scale(MOCA).The data including gender,age,basic medical history,blood lipid,serum GFAP,Hcy and Fazekas scores were collected.The correlation between GFAP,Hcy,Fazekas score and MOCA score were analyzed and the predictive values of those indexes on cognitive impairment in patients with CSVD were analyzed.Results56 cases(43.41%)of 129 CSVD patients developed cognitive impairment in the second half of the hospital.There were 16 cases with mild disorder,33 cases with moderate disorder and 7 cases with severe disorder.The serum GFAP,Hcy levels and Fazekas score in cognitive impairment group were significantly higher than those in cognitive normal group(P<0.05).With the aggravation of cognitive impairment,the levels of GFAP,Hcy in patients with CSVD were significantly increased(P<0.05).The Fazekas scores of patients with severe cognitive impairment were higher than those of patients with mild cognitive impairment(P<0.05).The levels of serum GFAP,Hcy and Fazekas score were significantly negatively correlated with MOCA score(P<0.05).The area under the ROC curve for predicting cognitive impairment in patients with CSVD was 0.888,0.886 and 0.883,and the optimal cut-off values were6.26μg·mL^(-1),15.30μmol·L^(-1) and 2.5 points,respectively.Conclusion The levels of GFAP,Hcy and Fazekas score are closely related to the cognitive status of patients with CSVD,which can be used as a reference index for early prediction of cognitive impairment.