脑小血管病患者血清VEGF水平与脑白质高信号、认知功能障碍的相关性研究

Correlation between serum VEGF level and white matter hyperintensity and cognitive dysfunction in patients with cerebral small vessel disease

目的探讨脑小血管病(cerebral small vascular disease,CSVD)患者血清血管内皮生长因子(vascular endothelial growth factor,VEGF)水平与脑白质高信号和非痴呆型认知功能障碍的相关性。方法纳入2019年4月至2020年12月连续就诊于新乡医学院第一附属医院神经内科的106例CSVD患者为研究对象,依据简易智能评估量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)及日常生活活动能力量表(activity of daily living scale,ADL)将其分为非痴呆型血管性认知功能障碍(vascular cognitive impairment no dementia,VCIND)组(VCIND组,n=47)和无认知功能障碍(no vascular cognitive impairment,N-VCI组,n=59),采用酶联免疫吸附法检测两组患者血清VEGF水平,比较两组患者的基线资料、血清VEGF水平、MoCA评分及Fazekas评分,并分析血清VEGF水平与脑白质高信号、认知功能的相关性。采用SPSS 19.0软件进行数据处理,统计方法采用t检验、卡方检验、非参数检验、Logistic回归分析、Pearson相关分析和Spearman相关分析。结果两组患者血清VEGF水平[(464.18±114.58)pg/mL,(414.17±45.80)pg/mL,F=22.880]、MoCA评分[(13.07±6.48)分,(20.17±4.06)分,F=17.920]、Fazekas评分[4(3,5)分,3(1,3)分,Z=-4.189]均差异有统计学意义(均P<0.05)。VEGF水平(β=0.008,OR=1.008,95%CI=1.001~1.015,P<0.05)是CSVD患者认知功能的影响因素。VEGF水平与MoCA量表总分、注意力与计算力、定向力呈负相关(r=-0.345,-0.373,-0.445,均P<0.05),并且与Fazekas评分总分、脑室旁及深部白质Fazekas评分呈正相关(r=0.392,0.495,0.302,均P<0.05)。脑室旁和深部白质的白质高信号等级与VCIND存在线性趋势(均P<0.05)。结论在CSVD患者中血清VEGF水平与认知功能、脑白质高信号具有相关性,VEGF水平升高可能是反映认知功能障碍的因素。此外随着脑白质高信号等级的增加,CSVD患VCIND的风险升高。

Objective To investigate the relationship between serum vascular endothelial growth factor(VEGF)levels and white matter high signal and non-dementia vascular cognitive dysfunction in patients with cerebral small vascular disease(CSVD).Methods Total 106 patients with CSVD who were admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical College from April 2019 to December 2020 were enrolled.They were divided into vascular cognitive impairment no dementia group(VCIND group,n=47)and no vascular cognitive impairment group(N-VCI group,n=59)according to mini-mental assessment scale(MMSE),Montreal cognitive assessment(MoCA)scale and activity of daily living scale(ADL).Serum VEGF levels were detected by enzyme-linked immunosorbent assay(ELISA).The baseline data,serum VEGF levels,MoCA score and Fazekas score were compared between the two groups.The correlation between serum VEGF level and white matter high signal and cognitive function was analyzed.SPSS 19.0 software was used for data processing.The statistical methods were t-test,Chi square test,nonparametric test,Logistic regression analysis,Pearson correlation analysis and Spearman correlation analysis.Results There were significant differences in serum VEGF level((464.18±114.58)pg/mL,(414.17±45.80)pg/mL,F=22.880),MoCA score((13.07±6.48),(20.17±4.06),F=17.920)and Fazekas score(4(3,5),3(1,3),Z=-4.189)between the two groups(all P<0.05).The level of VEGF(β=0.008,OR=1.008,95%CI=1.001-1.015,P<0.05)was the influencing factor of cognitive function in patients with CSVD.The level of VEGF was negatively correlated with the total score of MoCA,attention and calculation power,and orientation ability(r=-0.345,-0.373,-0.445,all P<0.05)and it was positively correlated with the total Fazekas score and the Fazekas score of paraventricular and deep white matter(r=0.392,0.495,0.302,all P<0.05).There was a linear trend between the high signal grade of paraventricular and deep white matter and VCIND(both P<0.05).Conclusion Serum VEGF level is correlated with cognitive function and white matter hyperintensity in patients with CSVD.The increase of VEGF level may be a factor reflecting cognitive dysfunction.In addition,with the increase of white matter hyperintensity level,the risk of VCIND in CSVD is increased.