血清Hcy HbA1c及APN与急性脑梗死患者认知功能障碍的相关性分析

Correlation of Serum Hcy,HbA1c and APN with Cognitive Impairment in Patients with Acute Cerebral Infarction

目的:分析血清同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)与血清脂联素(APN)与急性脑梗死(ACI)患者认知功能障碍的相关性。方法:选取2018年7月至2022年2月我院收治的ACI患者102例作为研究对象,根据简易精神状况量表(MMSE)将上述患者分为认知正常组(n=57例,MMSE评分≥27分)和认知障碍组(n=45例,MMSE评分<27分);比较两组患者一般资料,测定患者Hcy、HbA1c及APN等实验室指标,分析ACI患者认知功能障碍的危险因素,依据MMSE将认知障碍患者分为轻度组17例,中度组15例和重度组13例。比较不同分组患者上述血清指标的变化,分析其与认知功能障碍及严重程度的相关性。结果:认知正常组和认知障碍组患者病程、受教育年限、性别、饮酒史和脑梗死的部位、甘油三酯(TG)、总胆固醇(TC)水平比较均无明显统计学意义(P>0.05);认知障碍组年龄高于认知正常组,高血压、冠心病、糖尿病患者比例高于认知正常组,认知障碍组低密度脂蛋白(LDL-C)、Hcy、HbAlc均高于认知正常组,差异均有统计学意义(P<0.05)。高血压(OR=1.442,95%CI:1.131~1.839)、冠心病(OR=1.342,95%CI:1.069~1.684)和糖尿病(OR=1.493,95%CI:1.027~2.171)以及Hcy(OR=1.525,95%CI:1.053~2.209)、HbAlc水平升高(OR=1.650,95%CI:1.100~2.476)是ACI患者出现认知功能障碍的危险因素,APN水平升高(OR=0.659,95%CI:0.458~0.949)是ACI患者认知障碍的保护因素(P<0.05)。中度组Hcy、HbAlc水平高于轻度组,APN低于轻度组(P<0.05);重度组Hcy、HbAlc水平均高于轻、中度组,APN均低于轻、中度组,上述差异有统计学意义(P<0.05);Hcy、HbAlc与MMSE评分均呈负相关(r=-0.569,-0.451,P<0.05),APN与MMSE评分呈正相关(r=0.447,P<0.05)。结论:Hcy、HbAlc水平升高是ACI患者认知功能障碍的危险因素,高APN是ACI患者认知障碍的保护因素,Hcy、HbAlc水平随着认知障碍程度加剧而升高,与认知功能评分呈负相关,APN随着认知障碍加重而降低,与认知功能评分呈正相关,上述指标有助于指导评估ACI患者认知功能障碍的进展。

Objective:To analyze the correlation between serum homocysteine(Hcy),glycosylated hemoglobin(HbA1c)and serum adiponectin(APN)and cognitive impairment in patients with acute cerebral infarction(ACI).Methods:102 patients with acute cerebral infarction treated in the hospital between July 2018 and February 2022 were selected as observation subjects,and the above patients were divided into normal cognition group(n=57,MMSE score≥27 points)and cognitive impairment group(n=45,MMSE score<27 points)according to the Mini-Mental State Scale(MMSE).The general data of the two groups of patients were compared,and the laboratory indicators such as Hcy,HbA1c and APN were measured.The risk factors of cognitive impairment in patients with ACI were analyzed.According to MMSE,the patients with cognitive impairment were classified into mild group(17 cases),moderate group(15 cases)and severe group(13 cases).The changes in the above serum indicators in different groups of patients were compared,and their correlation with cognitive impairment and severity was analyzed.Results:There were no statistically significant differences in the course of disease,years of education,gender,drinking history,location of cerebral infarction,triglyceride(TG)and total cholesterol(TC)between normal cognition group and cognitive impairment group(P>0.05).The age in cognitive impairment group was older than that in normal cognition group,and the proportions of patients with hypertension,coronary heart disease and diabetes mellitus were higher than those in normal cognition group,and the levels of low-density lipoprotein cholesterol(LDL-C),Hcy and HbAlc were higher compared to normal cognition group(P<0.05).Hypertension(OR=1.442,95%CI:1.131~1.839),coronary heart disease(OR=1.342,95%CI:1.069~1.684),diabetes mellitus(OR=1.493,95%CI:1.027~2.171)and elevated levels of Hcy(OR=1.525,95%CI:1.053~2.209)and HbAlc(OR=1.650,95%CI:1.100~2.476)were risk factors for cognitive impairment in patients with ACI,and elevated APN level(OR=0.659,95%CI:0.458~0.949)was a protective factor for cognitive impairment in patients with ACI(P<0.05).The levels of Hcy and HbAlc in moderate group were higher than those in mild group while the APN was lower than that in mild group(P<0.05).The levels of Hcy and HbAlc were higher in severe group than those in mild and moderate groups while the APN was lower than that in mild and moderate groups(P<0.05).Hcy and HbAlc were negatively correlated with MMSE score(r=-0.569,-0.451,P<0.05),and APN was positively correlated with MMSE score(r=0.447,P<0.05).Conclusion:Elevated levels of Hcy and HbAlc are risk factors for cognitive impairment in patients with ACI,and high APN is a protective factor for cognitive impairment.The levels of Hcy and HbAlc are increased with the aggravation of cognitive impairment and are negatively correlated with cognitive function score,while APN is decreased with the aggravation of cognitive impairment and is positively correlated with cognitive function score.These indicators are helpful to guide the evaluation of cognitive impairment in patients with ACI.