血清Hcy、BNP动态变化与颅内动脉瘤性蛛网膜下腔出血患者术后早期认知障碍的关系

Relationship Between the Dynamic Changes of Serum Hcy and BNP and Early Postoperative Cognitive Dysfunction in Patients with Intracranial Aneurysmal Subarachnoid Hemorrhage

目的研究血清同型半胱氨酸(Hcy)、脑钠肽(BNP)动态变化与颅内动脉瘤性蛛网膜下腔出血患者术后早期认知障碍的关系。方法选取河南科技大学第二附属医院2021年1月至2022年10月98例颅内动脉瘤性蛛网膜下腔出血患者进行研究。所有患者明确诊断及排除手术禁忌后,接受动脉瘤介入血管内栓塞术治疗。统计所有患者既往吸烟史、性别、既往手术史、年龄、发病至入院时间、体重、家族遗传史等一般资料,以及Hunt-Hess分级、手术时间、动脉瘤直径、动脉瘤部位等临床资料;于术前、术后1 d、术后3 d、术后5 d、术后7 d通过高效液相色谱仪测量患者血清Hcy水平,通过放射免疫法测量患者血清BNP水平;于术后14 d时,通过蒙特利尔认知评估量表(MoCA)评定患者认知功能,并根据MoCA评分将其分为认知正常组和认知障碍组。通过点二列相关性分析血清Hcy、BNP动态变化与颅内动脉瘤性蛛网膜下腔出血患者术后早期认知障碍的关系。结果术后14 d时,98例颅内动脉瘤性蛛网膜下腔出血患者中出现认知障碍56例,占比57.14%;认知障碍组动脉瘤直径大于认知正常组,差异有统计学意义(P<0.05);组间发病至入院时间、家族遗传史、Hunt-Hess分级、手术时间、年龄、性别等资料对比,差异无统计学意义(P>0.05);术前、术后1 d、术后3 d、术后5 d、术后7 d,两组患者血清Hcy、BNP水平呈下降趋势,且认知障碍组各个时点血清Hcy、BNP水平均高于认知正常组,差异有统计学意义(P<0.05);经点二列相关性分析,血清Hcy、BNP动态变化均与颅内动脉瘤性蛛网膜下腔出血患者术后早期认知障碍呈正相关(r>0,P<0.05)。结论血清Hcy、BNP动态变化与颅内动脉瘤性蛛网膜下腔出血患者术后早期认知障碍有关,血清Hcy、BNP水平越高,术后发生早期认知障碍可能性越大。

Objective To study the relationship between the dynamic changes of serum homocysteine(Hcy)and brain natriuretic peptide(BNP)and the early postoperative cognitive dysfunction in patients with intracranial aneurysmal subarachnoid hemorrhage.Methods A total of 98 patients with intracranial aneurysmal subarachnoid hemorrhage were selected from the Second Affiliated Hospital of Henan University of Science and Technology from January 2021 to October 2022.All patients received interventional endovascular embolization of aneurysms after clear diagnosis and exclusion of surgical contraindications.The general data of all patients,such as previous smoking history,gender,previous surgical history,age,time from onset to admission,weight,family genetic history,as well as Hunt-Hess grade,operation time,aneurysm diameter,aneurysm location and other clinical data were collected.The level of serum Hcy was measured by high performance liquid chromatography before operation,1 day,3 days,5 days and 7 days after operation,and the level of serum BNP was measured by radioimmunoassay.At the 14th day after operation,the cognitive function of patients was assessed by the Montreal cognitive assessment scale(MoCA),and they were divided into normal cognitive function group and cognitive dysfunction group according to the MoCA score.The relationship between the dynamic changes of serum Hcy and BNP and the early postoperative cognitive dysfunction in patients with intracranial aneurysmal subarachnoid hemorrhage was analyzed by point binary correlation.Results At 14 days after operation,56 of 98 patients with intracranial aneurysmal subarachnoid hemorrhage had cognitive impairment,accounting for 57.14%.The diameter of aneurysm in cognitive dysfunction group was larger than that in normal cognitive function group,with a statistical significant difference(P<0.05).There was no statistical significant difference between the two groups in terms of the time from onset to admission,family genetic history,Hunt-Hess grade,operation time,age and sex(P>0.05).The serum Hcy and BNP levels of patients in the two groups showed a downward trend before operation,1 day after operation,3 days after operation,5 days after operation and 7 days after operation,and the serum Hcy and BNP levels in the cognitive dysfunction group were higher than those in the normal cognitive function group at each time point,with a statistical significant difference(P<0.05).Point two column correlation analysis showed that the dynamic changes of serum Hcy and BNP were positively correlated with early postoperative cognitive dysfunction in patients with intracranial aneurysmal subarachnoid hemorrhage(r>0,P<0.05).Conclusion The dynamic changes of serum Hcy and BNP are related to the early postoperative cognitive dysfunction in patients with intracranial aneurysmal subarachnoid hemorrhage.The higher the serum Hcy and BNP levels,the greater the possibility of early postoperative cognitive dysfunction.