Fibulin-5、VEGF联合Livin在预测脑卒中后认知障碍中的价值

Value of Fibulin-5 and VEGF combined with Livin in predicting cognitive impairment after stroke

目的探讨衰老关键蛋白抗原-5(Fibulin-5)、血管内皮生长因子(VEGF)联合抗凋亡因子(Livin)预测脑卒中后认知障碍(PSCI)的价值。方法选取2020年1月至2021年11月该院收治的54例脑卒中患者,根据脑卒中后6个月内是否发生PSCI分为PSCI组(30例)、无PSCI组(24例),比较两组基线资料[年龄、体质量指数、性别、美国国立卫生研究院卒中量表(NIHSS)评分、脑卒中类型、教育层次、合并疾病、治疗方法、脑白质病变、脑萎缩],就诊时、2周后、4周后Fibulin-5、VEGF、Livin水平,采用Pearson相关、多元线性回归分析血清Fibulin-5、VEGF、Livin水平与简易智力状态检查量表(MMSE)评分的关系,受试者工作特征(ROC)曲线分析Fibulin-5、VEGF、Livin预测PSCI的价值。结果PSCI组脑白质病变、脑萎缩患者多于无PSCI组(P<0.05);PSCI组2周后、4周后Fibulin-5水平高于无PSCI组,VEGF、Livin水平低于无PSCI组(P<0.05);血清Fibulin-5与MMSE评分呈负相关,血清VEGF、Livin与MMSE评分呈正相关(均P<0.05);校正了脑白质病变、脑萎缩后,4周后血清Fibulin-5、VEGF、Livin仍是MMSE评分的影响因素(P<0.05);4周后血清Fibulin-5、VEGF、Livin预测PSCI的曲线下面积(AUC)分别为0.739、0.846、0.826,三者联合的AUC为0.931。结论Fibulin-5、VEGF、Livin均与PSCI相关,并与患者认知损害程度有关,联合检测可作为预测PSCI的有效方案,为临床早期筛查PSCI高危人群、早期干预提供决策支持。

Objective To investigate the value of aging key protein antigen-5(Fibulin-5),vascular endothelial growth factor(VEGF)combined with anti-apoptotic factor(Livin)in predicting post-stroke cognitive impairment(PSCI).Methods A total of 54 stroke patients from January 2020 to November 2021 were selected and divided into PSCI group(30 cases)and non-PSCI group(24 cases)according to whether PSCI occurred within 6 months after stroke.Baseline data[age,body mass index,gender,National Institutes of Health Stroke Scale(NIHSS)score,stroke type,education level,comorbidities,treatment methods,white matter lesions,cerebral atrophy],Fibulin-5,VEGF,Livin at presentation,in 2 weeks,4 weeks between two group were compared.Pearson and multiple linear regression were used to analyze the relationship between serum Fibulin-5,VEGF,Livin and MMSE scores,and receiver operating characteristic(ROC)curve was used to analyze the value of Fibulin-5,VEGF,Livin in predicting PSCI.Results The patients with white matter lesions and brain atrophy in the PSCI group were more than those in the non-PSCI group(P<0.05).Fibulin-5 levels in the PSCI group were higher than those in the non-PSCI group in 2 weeks and 4 weeks,and VEGF and Livin levels were lower than those in the non-PSCI group(P<0.05).Serum Fibulin-5 was negatively correlated with MMSE score,and serum VEGF and Livin were positively correlated with MMSE score(P<0.05).After adjusting for white matter lesions and brain atrophy,serum Fibulin 5,VEGF,and Livin remained the influencing factors for MMSE scores after 4 weeks(P<0.05).The area under the curve(AUC)of serum Fibulin-5,VEGF,and Livin after 4 weeks for predicting PSCI were 0.739,0.846,and 0.826,and the AUC of combined detection was 0.931.Conclusion Fibulin-5,VEGF and Livin are all related to PSCI and the degree of cognitive impairment of patients.Combined detection could be used as an effective scheme to predict PSCI,and provide decision support for early clinical screening of high-risk groups of PSCI and early intervention.