反应性充血指数、血管生成素样蛋白2与脑梗死患者认知功能和复发的关系

The relationship between reactive hyperemia index,angiopoietin-like protein 2 and cognitive function and recurrence in patients with cerebral infarction

目的探讨反应性充血指数(RHI)、血管生成素样蛋白2(Angptl-2)与脑梗死患者认知功能和复发的关系。方法前瞻性选取120例首发脑梗死患者为研究组,并以同期健康体检者100人为对照组。检测比较两组的RHI和血清Angptl-2水平。采用蒙特利尔认知评估量表(MoCA)对研究组患者认知功能障碍进行评价,以MoCA得分<26分为认知功能障碍标准,统计研究组认知功能障碍发生率。研究组患者均随访观察至少1年时间,统计患者随访1年复发率,比较复发和未复发患者的基线RHI、血清Angptl-2水平和MoCA得分。Pearson线性相关法分析研究组RHI和血清Angptl-2水平与其MoCA得分的关系,Logistic分析研究组基线RHI、血清Angptl-2水平和MoCA得分对其复发发生情况的影响,ROC曲线分析RHI、血清Angptl-2水平单独和联合检测在其复发早期评估中的应用效能。结果与对照组比较,研究组RHI较低而血清Angptl-2水平较高(均P<0.05)。研究组认知功能障碍发生率和脑梗死复发率分别为75.83%(91/120)和26.67%(32/120)。研究组认知功能障碍患者的RHI低于无认知功能障碍患者,而血清Angptl-2水平高于无认知功能障碍患者(均P<0.05)。Pearson线性分析结果显示,研究组RHI与MoCA得分呈正相关(P<0.05),而血清Angptl-2水平与MoCA得分呈负相关(P<0.05)。研究组复发患者的RHI与MoCA得分明显低于未复发患者,而血清Angptl-2水平明显高于未复发患者(均P<0.05)。Logistic分析结果显示,研究组基线RHI、血清Angptl-2水平和MoCA得分均可明显影响复发发生情况(均P<0.05)。ROC曲线分析结果显示,RHI、血清Angptl-2水平联合检测在脑梗死复发早期评估中具有较高的敏感度和准确性。结论脑梗死患者RHI较低而血清Angptl-2水平较高且与认知功能和复发情况均密切相关,可辅助评估其认知功能;可能作为复发早期评估参考指标。

Objective To investigate the relationship between reactive hyperemia index(RHI),angiopoietinlike protein 2(Angptl-2)and cognitive function and recurrence in patients with cerebral infarction.Methods One hundred and twenty patients with first-episode cerebral infarction were prospectively selected as the study group,and 100 healthy subjects in the same period were selected as the control group.The RHI and serum Angptl-2 levels of the two groups were tested and compared.The Montreal cognitive assessment scale(MoCA)was used to evaluate the cognitive dysfunction of the patients in the study group,and the MoCA score<26 was the standard of cognitive dysfunction,and the incidence of cognitive dysfunction in the study group was counted.Patients in the study group were followed up for at least 1 year,and the recurrence rate of the patients was counted for 1 year.The baseline RHI,serum Angptl-2 levels and MoCA scores of relapsed and non-relapsed patients were compared.The relationship between the RHI and serum Angptl-2 levels and their MoCA scores in the study group was analyzed by Pearson’s linear correlation method.The influence of baseline RHI,serum Angptl-2 levels and MoCA scores of the study group on the occurrence of recurrence were analyzed by Logistic method.And efficacy of RHI,serum Angptl-2 levels alone and combined detection in the early evaluation of recurrence was analyzed by ROC curve.Results Compared with the control group,the study group had lower RHI and higher serum Angptl-2 levels(all P<0.05).The incidence rate of cognitive dysfunction and the recurrencein of cerebral infarction in the study group were 75.83%(91/120)and 26.67%(32/120),respectively.The RHI of patients with cognitive dysfunction in the study group were lower than those of patients without cognitive dysfunction,while the serum Angptl-2 level was higher than that of patients without cognitive dysfunction(all P<0.05).Pearson linear analysis showed that the RHI of the study group was positively correlated with MoCA score(P<0.05),while the serum Angptl-2 level was negatively correlated with MoCA score(P<0.05).The RHI and MoCA scores of relapsed patients in the study group were lower than those of non-relapsed patients,while the serum Angptl-2 level was higher than that of non-relapsed patients(all P<0.05).Logistic analysis results showed that the baseline RHI,serum Angptl-2 level and MoCA score of the study group could significantly affect the occurrence of recurrence(all P<0.05).ROC curve analysis results show that the combined detection of RHI and serum Angptl-2 levels in the early assessment of cerebral infarction recurrence could achieve high sensitivity and accuracy.Conclusions Patients with cerebral infarction have lower RHI and higher serum Angptl-2 levels,which are closely related to cognitive function and recurrence.It can assist in the evaluation of their cognitive function and may be used as a reference index for early evaluation of their recurrence.