血清Ghrelin、Obestatin、Hcy水平与老年缺血性脑卒中后并发认知功能障碍的相关性

Correlation between the levels of Ghrelin,Obestatin,Hcy in serum and cognitive dysfunction after elderly ischemic stroke

目的分析血清胃饥饿素(Ghrelin)、肥胖抑制素(Obestatin)、同型半胱氨酸(Hcy)水平与老年缺血性脑卒中后并发认知功能障碍的相关性。方法选取2019年9月至2022年2月邯郸市中心医院收治的120例老年缺血性脑卒中后并发认知功能障碍患者作为观察组,110例老年缺血性脑卒中后无认知功能障碍患者作为对照A组,100例体检健康者作为对照B组。酶联免疫吸附试验测定血清Ghrelin、Obestatin、Hcy水平;使用简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)对观察组进行评分,根据MMSE评分将观察组分为轻度组(50例)、中度组(30例)、重度组(40例);分析观察组血清Ghrelin、Obestatin、Hcy水平与MMSE、MoCA评分的相关性,老年缺血性脑卒中患者发生认知功能障碍的影响因素,血清Ghrelin、Obestatin、Hcy水平对老年缺血性脑卒中患者发生认知功能障碍的诊断价值。结果观察组、对照A组、对照B组血清Ghrelin水平依次升高(P<0.05),Obestatin、Hcy水平依次降低(P<0.05);轻度组、中度组、重度组血清Ghrelin水平、MMSE、MoCA评分依次降低(P<0.05),重度组血清Obestatin、Hcy水平高于轻度组(P<0.05);老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin水平与MMSE、MoCA评分均呈正相关(P<0.05),血清Obestatin、Hcy水平与MMSE、MoCA评分均呈负相关(P<0.05);血清Ghrelin水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的保护因素,Obestatin、Hcy水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的独立危险因素(P<0.05);血清Ghrelin、Obestatin、Hcy三者联合诊断老年缺血性脑卒中患者发生认知功能障碍的曲线下面积(AUC)为0.904,明显高于血清Ghrelin、Obestatin、Hcy水平单独诊断的AUC(P<0.05)。结论老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin呈低水平,Obestatin、Hcy呈高水平,及时检测三者水平可能对评估患者认知功能障碍发生及病情严重程度具有重要意义。

Objective To analyze the correlation between the levels of Ghrelin,Obestatin,homocysteine(Hcy)in serum and the cognitive dysfunction after elderly ischemic stroke.Methods A total of 120 elderly patients with ischemic stroke and cognitive dysfunction in Handan Central Hospital from September 2019 to February 2022 were selected as the observation group,and 110 elderly patients without cognitive dysfunction after ischemic stroke were served as the control A group,and 100 healthy persons were served as control group B.The levels of Ghrelin,Obestatin and Hcy in serum were determined by enzyme-linked immunosorbent assay.Mini-mental state examination(MMSE)and montreal cognitive assessment(MoCA)were used to score the observation group.According to MMSE score,the observation group was divided into mild group(50 cases),moderate group(30 cases)and severe group(40 cases).The correlation of serum Ghrelin,Obestatin and Hcy levels with MMSE and MOCA scores in the observation group,the influencing factors of cognitive dysfunction in elderly patients with ischemic stroke,and the diagnostic value of serum Ghrelin,Obestatin and Hcy levels for cognitive dysfunction in elderly patients with ischemic stroke were analyzed.Results The levels of serum Ghrelin in observation group,control A group and control B group increased in turn,and Obestatin,Hcy levels decreased in turn(P<0.05).The levels of serum Ghrelin,MMSE and MOCA scores in mild group,moderate group and severe group decreased in turn,and the levels of serum Obestatin and Hcy in severe group were significantly higher than those in mild group(P<0.05).Serum Ghrelin level was positively correlated with MMSE and MOCA scores,while serum Obestatin and Hcy levels were negatively correlated with MMSE and MOCA scores in elderly patients with cognitive dysfunction after ischemic stroke(P<0.05).The increased level of Ghrelin was a protective factor affecting cognitive dysfunction in elderly patients with ischemic stroke,and the decreased levels of Obestatin and Hcy were independent risk factors that affect cognitive dysfunction in elderly patients with ischemic stroke(P<0.05).The area under curve(AUC)of combined detection of Ghrelin,Obestatin and Hcy for diagnosing cognitive dysfunction in elderly patients with ischemic stroke was 0.904,which was significantly higher than that of single detection of serum Ghrelin,Obestatin and Hcy(P<0.05).Conclusion In elderly patients with cognitive dysfunction after ischemic stroke,the level of Ghrelin is low,the levels of Obestatin and Hcy are high.Timely detection of the three levels may be of great significance to assess the occurrence and severity of cognitive dysfunction.