糖调节异常的缺血性脑小血管病患者细胞间黏附分子水平与认知障碍的相关性研究

Correlation of ICAM-1 and VCAM-1 levels with cognitive impairment in ischemic CSVD patients with impaired glucose regulation

目的探讨糖调节受损(IGR)的缺血性脑小血管病(ICSVD)患者血管细胞黏附分子1(VCAM-1)、细胞间黏附分子1(ICAM-1)与血管性认知功能障碍(VCI)的相关性。方法回顾性分析华北理工大学附属医院2020年9月至2022年3月收治的血糖异常但未确诊糖尿病的ICSVD患者455例,根据蒙特利尔认知评估量表(MoCA)评分结果将其分为认知正常组(238例)和认知障碍组(217例),认知障碍组进一步分为轻度组(97例)、中度组(68例)和重度组(52例),行口服葡萄糖耐量试验评定患者IGR情况,采用双抗体夹心法测定血清ICAM-1、VCAM-1水平。结果认知障碍组IGR、血清ICAM-1、VCAM-1水平显著高于认知正常组(P<0.05,P<0.01)。logistic回归分析显示,IGR、血清ICAM-1及VCAM-1水平与ICSVD患者认知障碍独立相关(OR=1.544,95%CI:1.042~2.286,P=0.030;OR=1.239,95%CI:1.037~1.481,P=0.018;OR=1.271,95%CI:1.064~1.517,P=0.008)。与轻度组比较,中度组及重度组血清ICAM-1、VCAM-1水平明显上升;与中度组比较,重度组血清ICAM-1、VCAM-1水平显著升高,差异有统计学意义(P<0.05)。Spearman相关性分析显示,ICSVD患者认知障碍严重程度与IGR严重程度、血清VCAM-1、ICAM-1水平呈正相关(r=0.279,P=0.002;r=0.242,P=0.009;r=0.217,P=0.019)。结论血清ICAM-1、VCAM-1水平与伴IGR的缺血性CSVD患者血管性认知障碍及严重程度有关,且IGR可能与伴血清ICAM-1、VCAM-1升高的ICSVD患者认知障碍及其严重程度之间存在双向影响。

Objective To explore the correlation of ICAM-1 and VCAM-1 levels with vascular cognitive impairment(VCI)in ischemic cerebral small vessel disease(ICSVD)patients with impaired glucose regulation(IGR).Methods A retrospective study was conducted on 455 ICSVD patients with abnormal blood glucose but not diagnosed with diabetes hospitalized in the Affiliated Hospital of North China University of Science and Technology from September 2020 to March 2022.According to the results of MoCA,they were divided into normal cognitive group(238 cases)and cognitive impairment group(217 cases).The cognitive impairment group was further divided into mild(97 cases),moderate(68 cases)and severe cognitive impairment(52 cases)subgroups.Oral glucose tolerance test was used to determine the IGR status.Serum ICAM-1 and VCAM-1 levels were measured by double antibody sandwich assay.Results The IGR,serum ICAM-1 and VCAM-1 levels were significantly higher in the cognitive impairment group than the normal cognitive group(P<0.05,P0.01).Multivariate logistic regression analysis showed that IGR and serum ICAM-1 and VCAM-1 levels were independently correlated with cognitive impairment in ICSVD patients(OR=1.544,95%CI:1.042-2.286,P=0.030;OR=1.239,95%CI:1.037-1.481,P=0.018;OR=1.271,95%CI:1.064-1.517,P=0.008).The severe cognitive impair-ment subgroup had the highest serum ICAM-1 and VCAM-1 levels,and followed by the moderate subgroup and then the mild subgroup(P<0.05).Spearman correlation analysis showed that the severity of cognitive impairment was positively correlated with the severity of IGR,serum VCAM-1 and ICAM-1 levels in ICSVD patients(r=0.279,P=0.002;r=0.242,P=0.009;r=0.217,P=0.019).Conclusion Serum ICAM-1 and VCAM-1 levels are associated with vascular cognitive impairment and its severity in ICSVD patients with IGR,and IGR may show bidirectional effects on cognitive impairment and its severity in ICSVD patients with elevated serum ICAM-1 and VCAM-1 levels.