TT3、TT4、Hcy、Cys C预测脑小血管病认知损害的价值及意义

ROC analysis of the clinical significances of TT3,TT4,Hcy,and Cys C in predicting cognitive impairment of patients with cerebral small vessel disease

目的探讨总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、同型半胱氨酸(Hcy)、胱抑素C(Cys C)预测脑小血管病认知损害的价值及意义。方法选取2019年2月至2021年1月收治的脑小血管病患者129例,根据6个月内是否发生脑小血管病相关认知障碍(CSVD-VCI)分为障碍组(n=45)和无障碍组(n=84),比较2组基线资料、入院时、3个月后TT3、TT4、Hcy、Cys C、简易智力状态检查量表(MMSE)评分,应用Pearson及偏相关性分析TT3、Hcy、Cys C与MMSE评分关系,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析TT3、Hcy、Cys C及联合预测CSVD-VCI价值。结果障碍组高血压、脑白质高信号、静息性脑梗死、脑微出血患者占比高于无障碍组(P<0.05);障碍组入院时、3个月后TT3、MMSE评分低于无障碍组,Hcy、Cys C高于无障碍组(P<0.05);入院时、3个月后TT3与MMSE评分呈正相关,Hcy、Cys C与MMSE评分呈负相关(P<0.05);控制了高血压、脑白质高信号、静息性脑梗死、脑微出血后,入院时、3个月后TT3、Hcy、Cys C均与MMSE评分相关(P<0.05);3个月后各指标及联合的AUC大于入院时各指标及联合对应的AUC。结论TT3、Hcy、Cys C与CSVD患者认知损害的发生有关,联合检测可作为预测认知损害的有效方案,为临床防治CSVD-VCI提供参考。

Objective To investigate the value of total triiodothyronine(TT3),total thyroxine(TT4),homocysteine(Hcy)and cystatin C(Cys C)in predicting cognitive impairment in patients with cerebral small vessel disease(CSVD)and their clinical significances.Methods A total of 129 CSVD patients admitted to our hospital from February 2019 to January 2021 were selected.They were divided into impairment group(n=45)and non-impairment group(n=84)according to the occurrence of CSVD-related vascular cognitive impairment(CSVD-VCI)within 6 months.Baseline data,TT3,TT4,Hcy,and Cys C,and the Mini Mental State Examination Scale(MMSE)scores on admission and at 3 months of treatment were compared between groups.Pearson correlation and partial correlation analysis were performed to identify the correlation of TT3,Hcy and Cys C with MMSE scores.The receiver operating characteristic curve(ROC)was plotted and area under ROC(AUC)was calculated to analyze the detection of TT3,Hcy,Cys C and their combined detection in predicting CSVD-VCI.Results The proportion of patients with hypertension,white matter hyperintensity,resting cerebral infarction,and cerebral microhemorrhage in the impairment group was significantly higher than that of non-impairment group(P<0.05).TT3 and MMSE scores on admission and at 3 months of treatment were significantly lower in the impairment group than those of non-impairment group,while Hcy and Cys C were significantly higher(P<0.05).TT3 on admission and at 3 months of treatment was positively correlated with the MMSE score,and Hcy,and Cys C were negatively correlated it(P<0.05).After adjustment for hypertension,white matter hyperintensity,resting cerebral infarction,and cerebral microhemorrhage,TT3,Hcy,and Cys C on admission and at 3 months of treatment were all significantly correlated with the MMSE score(P<0.05).The AUC of single detection of TT3,Hcy and Cys C and their combined detection at 3 months of treatment was larger than that on admission.Conclusion TT3,Hcy,and Cys C are correlated with the occurrence of cognitive impairment in CSVD patients.A combined detection can be used as an effective plan for predicting cognitive impairment in CSVD patients,thus providing a reference for the clinical prevention and treatment of CSVD-VCI.