摘要
目的 分析缺血性脑小血管病(CSVD)患者脂蛋白a[Lp(a)]、血管性血友病因子(vWF)、细胞间黏附因子-1(ICAM-1)与血管性认知障碍的关系。方法 回顾性分析河北省沧州中西医结合医院2019年1月至12月收治的110例缺血性脑小血管病患者的临床资料。根据简易智能状态量表(MMSE)与韦氏成人智力量表(WAIS)评分结果将患者分为认知障碍组(CSVD-1组,59例;MMSE≤26分,WAIS≤69分)与认知正常组(CSVD-2组,51例;MMSE>26分,WAIS>69分)。另选取同时期50名健康体检者作为对照组。采用免疫比浊法检测Lp(a)水平,采用酶联免疫荧光法检测vWF和ICAM-1,分析三者与CSVD认知障碍的关系。采用SPSS 25.0统计软件进行数据分析。根据数据类型,多组间比较采用方差分析,进一步两两比较采用LSD-t检验。应用logistic回归分析CSVD患者认知障碍的危险因素。应用受试者工作特征(ROC)曲线评估Lp(a)和ICAM-1水平对CSVD患者的预测价值。结果 与对照组比较,CSVD-1与CSVD-2组总胆固醇(TC)、Lp(a)、vWF、ICAM-1水平均明显升高,高密度脂蛋白胆固醇(HDL-C)水平明显下降,差异均有统计学意义(均P<0.05)。与CSVD-2组比较,CSVD-1组TC、Lp(a)、ICAM-1水平明显升高,HDL-C水平明显下降,差异均有统计学意义(均P<0.05);而vWF水平比较差异无统计学意义(P>0.05)。二元logistic回归分析显示,Lp(a)(OR=1.872,95%CI 1.406~2.492,P=0.008)和ICAM-1(OR=1.115,95%CI 1.031~1.206,P=0.002)是CSVD患者发生认知障碍的独立危险因素。当Lp(a)、ICAM-1预测CSVD危险因素切点值分别为30.89 mg/dl和300.25μg/L时,二者联合检测的预测价值最高(ROC曲线下面积=0.930,P=0.000)。结论 Lp(a)和ICAM-1与血管性认知障碍紧密相关,且二者联合检测对CSVD患者的预测价值更高。
Objective To analyze the relationships of lipoprotein a[Lp(a)],von willebrand factor(vWF)and intercellular adhesion molecule-1(ICAM-1)with the severity of vascular cognitive impairment in patients with ischemic cerebral small vessel disease(CSVD).Methods A retrospective analysis was performed on 110 patients with ischemic CSVD admitted to our hospital from January to December 2019.According to their mini-mental state examination(MMSE)and Wechsler adult intelligence scale(WAIS)scores,they were divided into cognitive impairment group(CSVD-1 group,n=59;MMSE≤26 points,WAIS≤69 points)and normal cognitive group(CSVD-2 group,n=51;MMSE>26 points,WAIS>69 points).Another 50 healthy subjects taking physical examination during the same period served as the control group.Lp(a)level was detected by immunoturbidimetry,and the levels of vWF and ICAM-1 were detected by enzyme-linked immunofluorescence assay.The relationship of the 3 indicators and cognitive impairment in ischemic CSVD patients was analyzed.SPSS statistics 25.0 was used for statistical analysis.According to data types,ANOVA was used for inter-group comparison,and LSD-t test was used for further pairwise comparison.Logistic regression was used to analyze the risk factors of cognitive impairment in CSVD patients.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive values of Lp(a)and ICAM-1 levels in the CSVD patients.Results Compared with the control group,the levels of TC,Lp(a),vWF and ICAM-1 were significantly increased,and the level of high-density lipoprotein cholesterol(HDL-C)was significantly decreased in the CSVD-1 and CSVD-2 groups(P<0.05).Compared with the CSVD-2 group,the levels of TC,Lp(a)and ICAM-1 were significantly increased,and the level of HDL-C was significantly decreased in the CSVD-1 group(P<0.05).However,the difference in the vWF level was not significant(P>0.05).Binary logistic regression analysis showed that Lp(a)(OR=1.872,95%CI 1.406-2.492;P=0.008)and ICAM-1(OR=1.115,95%CI 1.031-1.206;P=0.002)were independent risk factors for cognitive impairment in CSVD patients.When the cut-point values of Lp(a)and ICAM-1 for predicting CSVD risk factors were 30.89 mg/dl and 300.25μg/L,respectively,the combined detection of the 2 indicators had the highest predictive value(area under the ROC curve=0.930,P=0.000).Conclusion Lp(a)and ICAM-1 are closely associated with vascular cognitive impairment,and their combined detection has higher predictive value in patients with CSVD.
作者
王雯
窦荣花
邱志新
许晓冬
景海芳
王雪静
王爱卿
WANG Wen;DOU Rong-Hua;QIU Zhi-Xin;XU Xiao-Dong;JING Hai-Fang;WANG Xue-Jing;WANG Ai-Qing(Second Department of Encephalopathy,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061001,Hebei Province,China)
出处
《中华老年多器官疾病杂志》
2022年第7期506-510,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
河北省卫生计生委课题(20171192)。
关键词
脑缺血
血管性认知障碍
脂蛋白A
血管性血友病因子
细胞间黏附因子-1
cerebral ischemia
vascular cognitive impairment
lipoprotein a
von Willebrand factor
intercellular adhesion factor-1