存在糖调节受损的缺血性脑小血管病患者血清脂蛋白相关磷脂酶A2与血管性认知障碍的相关性

Relationship between serum lipoprotein-associated phospholipase A2 and vascular cognitive impairment in patients with ischemic cerebrovascular disease with impaired glucose regulation

目的探讨存在糖调节受损(IGR)的缺血性脑小血管病患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)与血管性认知障碍的相关性。方法选取2019年9月至2021年2月在华北理工大学附属医院神经内科住院治疗的缺血性脑小血管病患者349例(其中259例存在IGR)。采用简易智力状态检查量表将患者分为认知正常组(139例)和认知障碍组(210例),认知障碍患者进一步分为轻度认知障碍组(100例)、中度认知障碍组(56例)和重度认知障碍组(54例)。采用双抗体夹心法检测血清Lp-PLA2水平。比较不同认知功能组患者一般资料及生化指标,分析Lp-PLA2与存在IGR的缺血性脑小血管病患者血管性认知障碍及障碍程度的相关性。结果 认知障碍组年龄、体重指数、IGR比例、三酰甘油、Lp-PLA2水平大于/高于认知正常组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,Lp-PLA2为存在IGR的缺血性脑小血管病患者血管性认知障碍的危险因素(比值比=1.002,95%置信区间:1.000~1.003,P=0.008)。中、重度认知障碍组的Lp-PLA2水平高于轻度认知障碍组[(131±33)、(155±38)μg/L比(124±33)μg/L],重度认知障碍组高于中度认知障碍组,差异均有统计学意义(均P<0.05)。Lp-PLA2预测存在IGR的缺血性脑小血管病患者血管性认知障碍的受试者工作特征曲线下面积为0.571,95%置信区间:0.511~0.632,差异有统计学意义(P=0.024)。结论存在IGR的缺血性脑小血管病患者血清Lp-PLA2水平与血管性认知障碍及认知障碍程度有关,对该类患者认知障碍的预防及早期诊断具有重要意义。

Objective To investigate the correlation between serum lipoprotein-associated phospholipase A2(Lp-PLA2) and vascular cognitive impairment in patients with ischemic cerebrovascular disease with impaired glucose regulation(IGR). Methods Totally 349 patients with ischemic cerebrovascular disease admitted to Department of Neurology, North China University of Science and Technology Affiliated Hospital from September 2019 to February 2021 were selected(259 of them had IGR). The patients were divided into normal cognitive group(139 cases) and cognitive impairment group(210 cases) through mini mental state examination, and patients with cognitive impairment were further divided into mild cognitive impairment group(100 cases), moderate cognitive impairment group(56 cases) and severe cognitive impairment group(54 cases). The level of serum Lp-PLA2 was detected by double antibody sandwich method. The general data and biochemical indexes of patients in different cognitive function groups were compared. The relationship between Lp-PLA2 and vascular cognitive impairment and degree of impairment in patients with ischemic cerebrovascular disease and IGR was analyzed. Results The age, body mass index, ratio of IGR, triglyceride and Lp-PLA2 levels in the cognitive impairment group were higher than those in the cognitive normal group(all P<0.05). Multivariate Logistic regression analysis showed that Lp-PLA2 was a risk factor for cognitive impairment in patients with ischemic cerebrovascular disease and IGR(odds ratio=1.002, 95% confidence interval: 1.000-1.003, P=0.008). The level of Lp-PLA2 in moderate and severe cognitive impairment group was higher than that in mild cognitive impairment group[(131±33),(155±38)μg/L vs(124±33)μg/L], and the level in severe cognitive impairment group was higher than that in moderate cognitive impairment group(all P<0.05). The area under the receiver operating characteristic curve for Lp-PLA2 predicting vascular cognitive impairment in patients with ischemic cerebrovascular disease and IGR was 0.571, 95% confidence interval: 0.511-0.632(P=0.024). Conclusions Serum Lp-PLA2 in patients with ischemic cerebrovascular disease with IGR is related to vascular cognitive impairment and the degree of cognitive impairment, which is of great significance for the prevention and early diagnosis of cognitive impairment in these patients.