血清缺血修饰蛋白、钙调蛋白表达水平与脑小血管病患者神经功能受损的相关性分析

Correlation between serum ischemia modified albumin and calmodulin expression levels and neurological impairment in patients with cerebral small vessel disease

目的研究血清缺血修饰蛋白(ischemia modified albumin,IMA)、钙调蛋白(CaM)表达水平与脑小血管病(cerebral small vessel disease,CSVD)患者神经功能受损的相关性。方法回顾性分析2020年4月至2021年12月在聊城市第三人民医院住院治疗的CSVD患者的140例临床资料,在患者入院时,采用酶联免疫吸附法测定患者血清中CaM水平,采用白蛋白-钴结合实验测定患者血清中IMA水平,采用美国国立卫生院卒中量表(NIHSS)量表对患者的神经功能进行评价,参照国立神经病学与中风研究所(NINDS)评价患者短暂性脑缺血情况,评价患者尿失禁情况、步态障碍情况,采用蒙特利尔认知评估(MoCA)量表对患者的认知功能进行评价。分析CSVD患者血清IMA和CaM表达水平的影响因素,分析CSVD患者神经功能受损程度的影响因素及其与患者血清IMA和CaM表达水平的相关性。结果患者的性别、年龄、有无步态障碍、有无尿失禁等与患者血清IMA、CaM表达水平均无相关性(均P>0.05);认知功能障碍患者、头晕和眩晕患者、短暂性脑缺血患者的血清IMA表达水平[(38.5±5.3)×10^(3)U/L、(38.5±4.7)×10^(3)U/L、(39.0±4.4)×10^(3)U/L]、CaM表达水平[(190.4±34.5)μg/L、(191.2±26.7)μg/L、(199.7±24.8)μg/L]均显著高于认知功能正常患者、无头晕和眩晕患者、无短暂性脑缺血患者[(27.3±4.4)×10^(3)U/L、(21.0±3.8)×10^(3)U/L、(20.5±5.1)×10^(3)U/L、(180.6±29.6)μg/L、(179.5±28.6)μg/L、(168.6±32.4)μg/L](t=14.10、24.36、22.50,均P<0.05)。轻度、中度、重度神经功能受损患者的认知功能障碍(38/16/9)、头晕和眩晕(39/16/8)、短暂性脑出血(35/16/9)、NIHSS评分[(3.6±0.8)分、(7.5±0.9)分、(16.2±3.2)分]、CaM表达水平[(125.3±20.5)μg/L、(185.5±23.6)μg/L、(237.9±54.3)μg/L]、IMA表达水平[(21.2±3.5)×10^(3)U/L、(38.5±4.3)×10^(3) U/L、(74.9±5.4)×10^(3)U/L],组间差异均有统计学意义(t=32.87、11.28、12.42、34.59、151.73、147.84,均P<0.05)。多因素分析结果显示,认知功能障碍(OR=1.578,95%CI:1.043~2.386)、短暂性脑缺血(OR=2.396,95%CI:1.156~4.969)、头晕和眩晕(OR=1.906,95%CI:1.086~3.345)、NIHSS评分(OR=2.171,95%CI:1.162~4.056)、CaM水平(OR=2.022,95%CI:1.268~3.224)、IMA水平增加(OR=2.090,95%CI:1.313~3.325)均是患者神经功能受损加重的独立影响因素(均P<0.05)。患者血清IMA、CaM表达水平与神经功能受损程度呈明显的正相关(r=5.45、8.33,均P<0.05)。结论脑小血管病患者血清IMA、CaM表达水平的升高是神经功能受损的独立危险因素,其表达水平与神经功能受损程度呈正相关。

Objective To investigate the correlation between serum ischemia modified albumin(IMA)and calmodulin(CaM)expression levels and neurological impairment in patients with cerebral small vessel disease.Methods The clinical data of 140 patients with cerebral small vessel disease(CSVD)who received treatment at The Third People Hospital in Liaocheng between April 2020 and December 2021 were retrospectively analyzed.On admission,serum levels of CaM and IMA were measured using an enzyme-linked immunosorbent assay and an albumin-cobalt binding test.Patients'neurological function was evaluated using the National Institutes of Health Stroke Scale(NIHSS).Patients'transient cerebral ischemia,urinary incontinence,and gait disturbance were evaluated using the National Institute of Neurological Disorders and Stroke Scale.Patients'cognitive function was evaluated using the Montreal Cognitive Assessment scale.The influential factors of serum IMA and CaM expression levels in patients with CSVD were analyzed.The factors that affect the severity of neuological imairment in patients with CSVD and their correlation with serum IMA and CaM expression levels were analyzed.Results The gender,age,presence or absence of gait disorders,and presence or absence of urinary incontinence of patients were not correlated with serum IMA and CaM levels(all P>0.05).The serum levels of IMA[(38.5±5.3)×10^(3)U/L,(38.5±4.7)×10^(3)U/L,(39.0±4.4)×10^(3)U/L]and CaM[(190.4±34.5)μg/L,(191.2±26.7)μg/L,(199.7±24.8)μg/L]in patients with cognitive impairment,dizziness and vertigo,and transient cerebral ischemia were significantly higher than those in patients with normal cognitive function,patients without dizziness and vertigo,or patients without transient cerebral ischemia[(27.3±4.4)×10^(3)U/L,(21.0±3.8)×10^(3)U/L,(20.5±5.1)×10^(3)U/L,(180.6±29.6)μg/L,(179.5±28.6)μg/L,(168.6±32.4)μg/L,t=14.10,24.36,22.50,all P<0.05].There were significant differences in cognitive impairment(38/16/9),dizziness and vertigo(39/16/8),transient cerebral hemorrhage(35/16/9),NIHSS score[(3.6±0.8)points,(7.5±0.9)points,(16.2±3.2)points],CaM levels[(125.3±20.5)μg/L,(185.5±23.6)μg/L,(237.9±54.3)μg/L],and IMA levels[(21.2±3.5)]×10^(3)U/L,[(38.5±4.3)×10^(3)U/L,(74.9±5.4)×10^(3)U/L]among patients with mild,moderate,and severe neurological impairment(t=32.87,11.28,12.42,34.59,151.73,147.84,all P<0.05).The results of multivariate analysis indicated that cognitive impairment(OR=1.578,95%CI:1.043-2.386),transient cerebral ischemia(OR=2.396,95%CI:1.156-4.969),dizziness and vertigo(OR=1.906,95%CI:1.086-3.345),NIHSS score(OR=2.171,95%CI:1.162-4.056),CaM level(OR=2.022,95%CI:1.268-3.224),and increased IMA levels(OR=2.090,95%CI:1.313-3.325)were independent influential factors for worsened neurological impairment(all P<0.05).The serum levels of IMA and CaM in patients with CSVD were significantly positively correlated with the severity of neurological impairment(r=5.45,8.33,both P<0.05).Conclusion The elevated serum levels of IMA and CaM in patients with CSVD serve as independent risk factors for neurological impairment,and these levels are positively correlated with the severity of neurological impairment.