血清VCAM-1、PECAM-1水平与急性脑梗死患者并发卒中后认知功能障碍的相关性研究

Correlation between serum levels of VCAM-1,PECAM-1and post-stroke cognitive impairment in patients with acute cerebral infarction

目的 探讨血清血管细胞黏附分子-1(VCAM-1)、血小板内皮细胞黏附分子-1(PECAM-1)水平与急性脑梗死(ACI)患者并发卒中后认知功能障碍(PSCI)的相关性,并评估其诊断效能。方法 选择2020年1月至2021年7月三亚中心医院神经内科收治的200例ACI患者作为研究对象,并根据简明精神状态量表(MMSE)评分将其分为认知功能正常组(MMSE评分大于或等于27分,n=121)和并发PSCI组(MMSE评分小于27分,n=79)。收集两组患者的一般资料,并在接受治疗前行血清VCAM-1、PECAM-1水平检测和MMSE认知功能测评。采用单因素分析、Pearson相关分析和多因素Logistic回归分析探讨血清VCAM-1、PECAM-1水平与ACI患者并发PSCI的关系;绘制受试者工作特征(ROC)曲线,采用曲线下面积(AUC)评价VCAM-1、PECAM-1诊断ACI患者并发PSCI的效能。结果PSCI组年龄、伴糖尿病比例、美国国立卫生研究院卒中量表(NIHSS)评分以及血清VCAM-1、PECAM-1水平明显高于认知功能正常组(P<0.05)。Pearson相关分析结果显示,血清VCAM-1、PECAM-1水平分别与MMSE评分呈负相关(r=-0.590,P<0.001;r=-0.713,P<0.001)。多因素Logistic回归分析结果显示,年龄(OR=1.094,95%CI:1.033-1.157,P=0.002)、NIHSS评分(OR=1.247,95%CI:1.002-1.551,P=0.048)、VCAM-1(OR=2.359,95%CI:1.327-4.194,P=0.003)及PECAM-1(OR=1.253,95%CI:1.111-1.414,P<0.001)是ACI患者是否并发PSCI的独立影响因素。血清VCAM-1、PECAM-1诊断ACI患者并发PSCI的AUC分别为0.832、0.821,灵敏度分别为84.81%、91.14%,特异度分别为72.73%、62.81%。结论 ACI并发PSCI患者血清VCAM-1、PECAM-1表达异常升高,且二者对PSCI具有较高诊断价值,可作为临床诊疗PSCI的重要依据。

Objective To explore the correlation between serum levels of vascular cell adhesion molecule-1(VCAM-1),platelet endothelial cell adhesion molecule-1(PECAM-1)and concurrent post-stroke cognitive impairment(PSCI)in patients with acute cerebral infarction(ACI),and to evaluate their diagnostic power.Methods A total of 200patients with ACI admitted to the department of neurology of Sanya Central Hospital from January 2020to July 2021were selected as the research object,and according to Mini mental state examination scale(MMSE)score,patients were divided into the normal cognitive function group(MMSE score≥27points,n=171)and the PSCI group(MMSE score<27points,n=79).The general data of the two groups were collected,and the serum levels of serum VCAM-1,PECAM-1were detected and MMSE cognitive function assessment were performed in both groups before receiving treatment.Pearson correlation analysis and multivariate logistic regression analysis were used to explore the relationship between the serum levels of VCAM-1,PECAM-1and concurrent PSCI in patients with ACI.The receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC)was used to evaluate the diagnostic effectiveness of VCAM-1and PECAM-1for concurrent PSCI in patients with ACI.Results The age,proportion of diabetes mellitus,National Institutes of Health Stroke Scale(NIHSS)score and the serum levels of VCAM-1and PECAM-1in the PSCI group were significantly higher than those of the normal cognitive function group(P<0.05).The results of Pearson correlation analysis showed that the serum levels of VCAM-1and PECAM-1were negatively correlated with MMSE score(r=-0.590,P<0.001;r=-0.713,P<0.001).The results of multivariate logistic regression analysis showed that age(OR=1.094,95%CI:1.033-1.157,P=0.002),NIHSS score(OR=1.247,95%CI:1.002-1.551,P=0.048),VCAM-1(OR=2.359,95%CI:1.327-4.194,P=0.003)and PECAM-1(OR=1.253,95%CI:1.111-1.414,P<0.001)were independent influencing factors for concurrent PSCI in patients with ACI.The AUC of VCAM-1and PECAM-1in diagnosing concurrent PSCI in patients with ACI was 0.832and 0.821,the sensitivity was 84.81% and 91.14%,and the specificity was 72.73% and 62.81%,respectively.Conclusion The serum expressions of VCAM-1and PECAM-1in patients with ACI with concurrent PSCI are abnormally increased,and the diagnostic value for PSCI of both is also high,which can be used as an important basis for clinical diagnosis and treatment of PSCI.