联合脑小血管病影像学总负担评分与血液炎症、代谢指标预测认知障碍的风险

Predicting the Risk of Cognitive Impairment by Combining Total Imaging Burden Score of Ce⁃rebral Small Vessel Disease with Blood Inflammation and Metabolic Indicators

目的:探讨影像学总负担评分及炎性、代谢指标与脑小血管病(CSVD)认知障碍的相关性并建立早期预测模型。方法:选取2020年9月至2022年5月于山西医科大学第五临床医学院神经内科就诊的CSVD患者170例进行回顾性研究。根据蒙特利尔认知评估量表(MoCA)评分将患者分为无认知障碍组60例和认知障碍组110例,随机选取其中的140例作为训练集,30例作为验证集。对训练集的2组患者的一般资料、CSVD总负担评分、炎性指标[脂蛋白磷脂酶A2(Lp-PLA2)、白细胞介素6(IL-6)]及代谢指标[同型半胱氨酸(Hcy)、胱抑素C(CysC)]进行组间比较,对差异因素进行Logistic多因素回归分析,选取其中的独立危险因素,构建列线图,建立预测模型,并评价模型效能。结果:认知障碍组患者的CSVD总负担评分及血清Lp-PLA2、IL-6、Hcy、CysC表达水平高于无认知障碍组(P<0.05);将5项指标进行多因素Logistic回归分析显示CSVD总负担评分、血清Lp-PLA2、Hcy水平升高是CSVD患者发生认知障碍的独立危险因素;绘制CSVD总负担评分、血清Lp-PLA2、Hcy及3项指标联合诊断CSVD患者继发认知障碍的ROC曲线,其曲线下面积值分别为0.775、0.795、0.877、0.929;通过构建CSVD总负担评分、血清Lp-PLA2、Hcy指标的列线图,绘制预测模型与单独使用CSVD总负担评分诊断验证集CSVD患者继发认知障碍的ROC曲线进行效能评价,其曲线下面积值分别为0.935、0.905。结论:联合影像学总负担评分与血液炎症、代谢指标预测CSVD认知障碍风险要优于单独的影像学评估,对CSVD患者认知损伤的早期诊断具有一定的提示作用。

Objective:To investigate the correlation of total imaging burden score and inflammatory and metabolic indexes with cognitive impairment in cerebral small vessel disease(CSVD),and establish an early prediction model.Methods:A retrospective study was performed on 170 CSVD patients who visited the Department of Neurology,Fifth Clinical School of Medicine,Shanxi Medical University from September 2020 to May 2022.According to their Montreal Cognitive Assessment(MoCA)scale scores,the patients were divided into the no cognitive impairment group(n=0)and cognitive impairment group(n=110).Then,140 patients were randomly selected as the training set and 30 as the validation set.General data,CSVD total burden score,inflammatory indicators[lipoprotein phospholipase A2(Lp-PLA2),interleukin 6(IL-6)]and metabolic indicators[homocysteine(Hcy)and cystatin C(CysC)]of the two groups in the training set were compared.Logistic multivariate regression analysis was performed on the difference factors,independent risk factors were selected,nomograms were constructed,predictive model were established,and model performance was evaluated.Results:The CSVD total burden score and the expression levels of serum Lp-PLA2,IL-6,Hcy,and CysC in the cognitive impairment group were higher than those in the non-cognitive impairment group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the increasing of CSVD total burden score and serum Lp-PLA2 and Hcy levels were independent risk factors for cognitive impairment in patients with CSVD.These three items were used to draw the ROC curve for the diagnosis of secondary cognitive impairment in CSVD patients,and the area under the curve was 0.775,0.795,0.877,and 0.929.By constructing the nomogram of the CSVD total burden score and serum Lp-PLA2 and Hcy,the prediction was drawn.The ROC curves of the model and the CSVD total burden score alone to diagnose secondary cognitive impairment of CSVD patients in the validation set were evaluated,and the area under the ROC curve of the model and the CSVD total burden score alone was 0.935 and 0.905,respectively.Conclusion:The combined imaging total burden score and blood inflammatory and metabolic indicators are superior to imaging assessment alone in predicting the risk of cognitive impairment in CSVD,and they provide certain clues for the early diagnosis of cognitive impairment in patients with CSVD.