脑小血管病患者血清SIRT1水平与脑白质病变及认知障碍的相关性分析

Correlation analysis of serum SIRT1 level and white matter hyperintensities and cognitive impairment in CSVD patients

目的研究脑小血管病(CSVD)患者血清沉默信息调节因子1(SIRT1)水平与脑白质病变严重程度及认知障碍的相关性。方法选择CSVD患者209例,ELISA法检测入院次日血清SIRT1水平。使用Fazekas量表对入组患者脑白质病变进行评分,并评估CSVD患者的腔隙性梗死、脑微出血和血管周围间隙增大。为评估SIRT1和CSVD疾病进展之间的关系,对CSVD的每个影像学标志物的负荷进行评分,并根据Fazekas量表评分将脑白质病变分为轻度无症状WMH组与中重度WMH组。分析入组患者血清SIRT1表达水平与不同程度的脑白质病变是否相关,以及血清SIRT1表达水平与患者认知功能之间的相关性。结果在多变量logistic回归分析中,校正了其他混杂因素后,SIRT1仍然是中重度WMH(OR=1.25,95%CI=1.034~1.512,P=0.021)的独立预测因素,血清SIRT1表达水平与腔隙性脑梗死(OR=0.979,95%CI=0.817~1.173,P=0.819),脑微出血(OR=0.996,95%CI=0.860~1.153,P=0.958)和中重度EPVS(OR=1.147,95%CI=0.956~1.377,P=0.141)无显著相关。此外,SIRT1与Fazekas评分(r=0.262,P=0.001)、EPVS负荷(r=0.237,P=0.001)呈正剂量依赖性显著相关。结论血清SIRT1水平与CSVD患者WMH严重程度呈剂量依赖关系,并与脑小血管病患者认知功能改变密切相关。这些发现为今后研究CSVD发生发展的病理生理学提供了线索。

Objective To study the correlation between the level of serum silent information regulator 1(SIRT1)and the severity of white matter lesions and cognitive impairment in cerebral small vessel disease(CSVD)patients.Methods Totally 209 CSVD patients were selected.The serum SIRT1 level was detected by ELISA on the next day after admission,we used Fazekas score to assess white matter hyperintensities.We also evaluated lacunar infarction,cerebral microhemorrhage and perivascular space enlargement in patients with CSVD.In order to evaluate the relationship between SIRT1 and the progression of CSVD,we scored the load of each imaging marker of CSVD.According to the Fazekas scale score,the white matter lesions were divided into mild-asymptomatic WMH group and moderate-severe WMH group.We analyzed whether the expression level of SIRT1 in serum of the enrolled patients was related to different degrees of white matter lesions,and analyzed the correlation between the expression level of SIRT1 in serum and the cognitive function of the patients.Results In multivariate Logistic regression analysis,after adjusting for other confounding factors,SIRT1 was still an indepen⁃dent predictor of moderate-severe WMH(OR=1.25,95%CI=1.034-1.512,P=0.021).The expression level of se⁃rum SIRT1 was not significantly correlated with lacunar infarction(OR=0.979,95%CI=0.817-1.173,P=0.819),cerebral microhemorrhage(OR=0.996,95%CI=0.860-1.153,P=0.958)and moderate-severe EPVS(OR=1.147,95%CI=0.956-1.377,P=0.141).In addition,SIRT1 was significantly correlated with Fazekas score(r=0.262,P=0.001)and EPVS load(r=0.237,P=0.001)in a positive dose-dependent manner.Conclusion The level of serum SIRT1 is dose-dependent on the severity of WMH in CSVD patients,and is closely related to the changes of cog⁃nitive function in patients with CSVD.These findings provide clues to the pathophysiology of the occurrence and development of CSVD in the future.