老年脑梗死后认知功能障碍患者血清骨钙素、G蛋白耦联雌激素受体30水平变化及其与预后的相关性研究

Changes in serum osteocalcin and G protein-coupled estrogen receptor 30 levels in elderly patients with cognitive dysfunction after cerebral infarction and their correlation with prognosis

目的研究老年脑梗死后认知功能障碍患者血清骨钙素、G蛋白耦联雌激素受体30(GPER 30)水平变化及其与预后的相关性,为评估患者预后提供参考。方法选取2021年1月至2022年10月平顶山市第二人民医院收治的115例老年脑梗死患者为研究对象,于脑梗死后第3天采用蒙特利尔认知评估量表(MoCA)评估患者的认知功能,根据有无认知功能障碍分为障碍组(54例,MOCA评分≤26分)和无障碍组(61例,MOCA评分>26分),比较两组患者的一般资料及血清骨钙素、GPER 30水平,同时比较不同认知障碍程度患者及障碍组中预后良好组和预后不良组患者的骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量,采用多因素Logistic回归分析老年脑梗死后认知功能障碍的影响因素,采用Spearman分析障碍组血清骨钙素、GPER 30水平与认知障碍程度及预后的相关性。结果两组患者的年龄、神经功能缺损(NIHSS)评分、骨钙素、GPER 30蛋白相对灰度值、GPER30 mRNA相对表达量比较,差异均有统计学意义(P<0.05);经Logistic回归分析结果显示,年龄、NIHSS评分、骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量均是老年脑梗死患者认知功能障碍发生的影响因素(P<0.05);不同认知障碍程度患者的骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量比较,轻度>中度>重度,差异均有统计学意义(P<0.05);经Spearman分析结果显示,血清骨钙素、GPER 30蛋白相对灰度值、GPER 30mRNA相对表达量与老年脑梗死后认知障碍程度呈正相关(r=0.784、0.715、0.673;P<0.05);障碍组预后良好患者血清骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量水平明显高于预后不良组,差异均有统计学意义(P<0.05);经Spearman分析结果显示,血清骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量与老年脑梗死后认知障碍预后呈负相关(r=-0.675、-0.663、-0.584;P<0.05)。结论骨钙素、GPER 30蛋白相对灰度值、GPER 30 mRNA相对表达量是老年脑梗死患者认知功能障碍发生的影响因素,其水平变化与认知障碍严重程度及预后均存在相关性。

Objective To study the changes of serum osteocalcin and G protein-coupled estrogen receptor 30(GPER 30)levels in elderly patients with cognitive dysfunction after cerebral infarction and their correlation with prognosis,in order to provide a reference for assessing patients'prognosis.Methods A total of 115 patients with cerebral infarction admitted to Pingdingshan Second People's Hospital from January 2021 to October 2022 were selected for the study.The cognitive function of the patients was assessed using the Montreal Cognitive Assessment Scale(MoCA)on the third day after cerebral infarction.According to the occurrence of cognitive dysfunction,the patients were divided into the impaired group(54 patients with MoCA score≤26)and the unimpaired group(61 patients with MOCA score>26).The general data,serum osteocalcin,and GPER 30 levels were compared between the two groups,and the osteocalcin,relative grey value of GPER 30 protein,and the relative expression of GPER 30 mRNA were compared among patients with different degrees of cognitive impairment and between the good prognosis and poor prognosis groups in the impaired group.Multi-factor logistic regression analysis was used to analyze the influencing factors of cognitive dysfunction in elderly patients with cerebral infarction.Spearman's analysis was applied to determine the correlation of serum osteocalcin and GPER 30 levels with the degree of cognitive impairment and prognosis in the impaired group.Results There were statis tically significant differences in age,neurological deficit(NIHSS)score,osteocalcin,relative gray value of GPER 30 protein,and relative expression of GPER 30 mRNA between the impaired group and unimpaired group(P<0.05).Logistic regression analysis showed that age,NIHSS score,osteocalcin,relative gray value of GPER 30 protein,and relative expression of GPER 30 mRNA were all factors influencing the occurrence of cognitive dysfunction in elderly patients with cerebral infarction,and the differences were statistically significant(P<0.05).The osteocalcin,protein relative gray value of GPER 30,and relative expression of GPER 30 mRNA showed statistically significant differences among patients with different degrees of cognitive dysfunction(P<0.05):mild>moderate>severe.Spearman analysis showed that serum osteocalcin,relative gray value of GPER 30 protein,and relative expression of GPER 30 mRNA were positively correlated with the degree of cognitive impairment after cerebral infarction in the elderly(r=0.784,0.715,0.673;P<0.05).Serum osteocalcin,relative gray value of GPER 30 protein,and relative expression of GPER 30 mRNA in patients with good prognosis in the impaired group were significantly higher than those in patients with poor prognosis(P<0.05).Spearman analysis showed that serum osteocalcin,relative gray value of GPER 30 protein,and relative expression of GPER 30 mRNA were negatively correlated with the prognosis of cognitive impairment after cerebral infarction in the elderly(r=-0.675,-0.663,-0.584;P<0.05).Conclusion Osteocalcin,the relative gray value of GPER 30 protein,and the relative expression of GPER 30 mRNA are influential factors in the occurrence of cognitive impairment in elderly patients with cerebral infarction,and their changes correlate with the severity of cognitive impairment and prognosis.