同型半胱氨酸 组织因子途径抑制物血栓调节蛋白与缺血性脑小血管病患者血管性认知障碍的关系

Relationship between Hcy, TFPI, TM, and vascular cognitive impairment in patients with ischemic cerebrovascular disease

目的探讨同型半胱氨酸(Hcy)、组织因子途径抑制物(TFPI)、血栓调节蛋白(TM)与缺血性脑小血管病患者血管性认知障碍的关系。方法选择2021年10月至2022年10月河南省安阳市第二人民医院神经内科收治的160例缺血性脑小血管病患者作为研究对象,按照简易智能状态检查量表(MMSE)将患者分为认知障碍组(105例)和认知正常组(55例),根据MMSE评分的不同将认知障碍组患者分为轻度组(57例)、中度组(32例)、重度组(16例)。收集所有研究对象基线资料,并检测所有研究对象各项实验室检查指标及Hcy、TFPI、TM水平。对比健康对照组研究对象、认知正常组患者以及认知障碍患者基线资料、实验室检查指标,采用多因素Logsistic回归分析筛选缺血性脑小血管病患者血管性认知障碍的危险因素,比较轻度、中度、重度认知障碍患者Hcy、TFPI、TM水平,分析Hcy、TFPI、TM与缺血性脑小血管病患者血管性认知障碍的关系。结果认知正常组和认知障碍组患者吸烟史、高血压病占比、空腹血糖(FBG)、总胆固醇(TC)、Hcy、TM水平均比健康对照组高,TFPI水平比健康对照组低,且认知障碍组患者吸烟史占比、FBG、TC、Hcy、TM水平均比认知正常组高,TFPI水平比认知正常组低(P均<0.05);缺血性脑小血管病患者血管性认知障碍的危险因素为FBG、Hcy、TM、TFPI(OR=1.517、1.507、1.749、1.679,P均<0.05);中、重度认知障碍组患者Hcy、TM水平均比轻度认知障碍组高,而TFPI水平比轻度认知障碍组低,且重度认知障碍组患者Hcy、TM水平比中度认知障碍组高,TFPI水平比中度认知障碍组低(P均<0.05);Hcy、TM与缺血性脑小血管病患者MMSE评分、MoCA各项评分均呈负相关,而TFPI与缺血性脑小血管病患者MMSE评分、蒙特利尔认知评估量表(MoCA)各项评分均呈正相关(P均<0.05)。结论Hcy、TM水平上升、TFPI水平下降与缺血性脑小血管病出现血管性认知障碍之间有密切联系,对上述指标进行检测可对缺血性脑小血管病患者是否发生血管性认知障碍进行判定,从而为临床治疗方案的制定提供参考依据。

Objective To explore the relationship between homocysteine(Hcy),tissue factor pathway inhibitors(TFPI),thrombomodulin(TM),and vascular cognitive impairment in patients with ischemic cerebrovascular disease.Methods A total of 160 patients with ischemic cerebrovascular disease admitted to the Neurology Department of Anyang Second People′s Hospital in Henan Province from October 2021 to October 2022 were selected as the research subjects.According to the Mini-Mental State Examination(MMSE),the patients were divided into cognitive impairment group(105 cases)and cognitive normal group(55 cases).According to the different MMSE scores,the cognitive impairment group patients could also be divided into mild group(57 cases),moderate group(32 cases),and severe group(16 cases).Baseline data were collected from all study subjects,and the biochemical indexes and Hcy,TFPI,and TM levels of all study subjects were tested.The baseline data and biochemical indicators of healthy control group research subjects,patients in the cognitively normal group,and patients with cognitive impairment were compared,and multivariate Logistic regression analysis was used to screen the risk factors of vascular cognitive impairment in patients with ischemic small vessel disease.Comparing the levels of Hcy,TFPI,and TM in patients with mild,moderate,and severe cognitive impairment,and analyzing the relationship between Hcy,TFPI,TM,and vascular cognitive impairment in patients with ischemic small vessel disease.Results The smoking history,proportion of hypertension,FBG,TC,Hcy,and TM levels of patients in the cognitively normal group and cognitive impairment group were higher than those in the healthy control group,while TFPI levels were lower than those in the healthy control group.Additionally,the proportion of smoking history,FBG,TC,Hcy,and TM levels of patients in the cognitive impairment group was higher than those in the cognitively normal group,and TFPI levels were lower than those in the cognitive normal group(all P<0.05).The risk factors for vascular cognitive impairment in patients with the ischemic cerebrovascular disease were FBG,Hcy,TM,and TFPI(OR=1.517,1.507,1.749,1.679,all P<0.05).The Hcy and TM levels in patients with moderate and severe cognitive impairment were higher than those in the mild cognitive impairment group,while TFPI levels were lower than those in the mild cognitive impairment group.Additionally,the Hcy and TM levels in patients with severe cognitive impairment were higher than those in the moderate cognitive impairment group,and TFPI levels were lower than those in the moderate cognitive impairment group(all P<0.05);Hcy and TM were negatively correlated with MMSE scores and MoCA scores in patients with ischemic cerebrovascular disease,while TFPI was positively correlated with MMSE scores and MoCA scores in patients with ischemic cerebrovascular disease(all P<0.05).Conclusion There is a close relationship between the increase of Hcy and TM levels,as well as the decrease of TFPI levels,and the occurrence of vascular cognitive impairment in ischemic cerebrovascular disease.The detection of the above indexes can determine whether patients with ischemic cerebrovascular disease have vascular cognitive impairment,which can provide a reference for the development of clinical treatment plans.