血管紧张素Ⅳ与急性脑梗死患者认知功能障碍及严重程度的相关性

Correlation of angiotensinⅣwith cognitive dysfunction and severity in patients with acute cerebral infarction

目的探究急性脑梗死(ACI)患者血清血管紧张素(Ang)、AngⅣ水平变化,并分析患者血清Ang、AngⅣ与认知功能障碍及严重程度的相关性。方法选取2020年1月至2023年1月江阴市人民医院神经内科收治的ACI患者280例,根据简易智能状态检查量表评分进行分组,将其分为认知正常组147例(≥27分)和认知障碍组133例(<27分);认知障碍组133例分为轻度组50例(21~26分),中度组44例(10~20分),重度组39例(<10分)。另外根据Pullicino公式计算梗死体积(V),将280例ACI患者分为以下3个亚组:V<5cm^(3)为轻度梗死组80例;V 5~10cm^(3)为中度梗死组130例;V>10cm^(3)为重度梗死组70例。分别比较不同组别血清Ang、AngⅣ水平。采用Pearson相关性分析Ang、AngⅣ与ACI患者认知功能障碍及严重程度的相关性。结果认知障碍组血清Ang、AngⅣ水平高于认知正常组(P<0.01)。轻度组、中度组、重度组血清Ang、AngⅣ水平比较差异有统计学意义(P<0.01);进一步两两比较,重度组、中度组血清Ang、AngⅣ水平高于轻度组(P<0.01);重度组血清Ang、AngⅣ水平高于中度组(P<0.01)。重度梗死组、中度梗死组、轻度梗死组血清Ang、AngⅣ水平比较,差异有统计学意义(P<0.01);进一步两两比较,重度梗死组、中度梗死组血清Ang、AngⅣ水平高于轻度梗死组(P<0.01);重度梗死组血清Ang、AngⅣ水平高于中度梗死组(P<0.01)。Pearson相关性分析显示,ACI患者血清Ang、AngⅣ水平与认知功能障碍呈正相关(r=0.764,P=0.000;r=0.792,P=0.000),血清Ang、AngⅣ水平与严重程度呈正相关(r=0.801,P=0.000;r=0.807,P=0.000)。多因素logistic回归分析结果显示,年龄、高血压、糖尿病、高脂血症、吸烟、遗传、Ang、AngⅣ均为影响认知的高危因素。结论ACI患者血清Ang、AngⅣ水平升高。随着认知功能障碍严重程度升高及梗死面积增大,ACI患者血清Ang、AngⅣ水平越高,且呈正相关。血清Ang、AngⅣ水平可以作为判断ACI认知功能障碍及严重程度的标志物,且影响认知的高危因素较多,其中血清Ang、AngⅣ水平也是其中之一。临床应结合高危因素优化治疗方案,以降低ACI后的认知功能障碍发生率。

Objective To explore the changes in serum angiotensin(Ang)and angiotensinⅣ(AngⅣ)levels in patients with acute cerebral infarction(ACI),and analyze the correlation of their levels with cognitive dysfunction and severity of the disease.Methods A total of 280ACI patients admitted in our hospital from January 2020to January 2023were enrolled in this study.According to the results of Mini-Mental Status Examination(MMSE),they were divided into normal cognitive group(MMSE score:≥27,n=147)and cognitive impairment(score:<27,n=133),and those in the latter group were further assigned into mild(score:21-26,n=50),moderate(score:10-20,n=44)and severe(score:<10,n=39)cognitive impairment subgroups.In addition,Pullicino formula was used to calculate the infarct volume(V),and then 280ACI patients were classified into mild(V<5cm^(3),n=80),moderate(V 5-10cm^(3),n=130),and severe(with>10 cm^(3),n=70)infarction groups.The serum levels of Ang and AngⅣwere compared among above different groups.Pearson correlation analysis was applied to study the correlation of serum Ang and AngⅣlevels with cognitive dysfunction and its severity in the ACI patients.Results The serum Ang and AngⅣlevels were higher in the cognitive impairment group than the normal cognitive group(P<0.01).Significant differences were seen in their levels among the mild,moderate,and severe cognitive impairment subgroups(P<0.01),and the levels were significantly highest in the severe cognitive impairment subgroup,followed by the moderate and then the mild subgroups(P<0.01).There were also obvious differences in the serum levels of the two indicators among the severe,moderate,and mild infarction groups(P<0.01).Pearson correlation analysis indicated that their serum levels were positively correlated with cognitive impairment(r=0.764,P=0.000;r=0.792,P=0.000),and with severity of infarction(r=0.801,P=0.000;r=0.807,P=0.000).Multivariate logistic regression analysis revealed that age,hypertension,diabetes,hyperlipidemia,smoking,genetics,and Ang and AngⅣlevels were high-risk factors for cognition impairment.Conclusion Serum Ang and AngⅣlevels are higher in ACI patients,and their levels are raised with increasing severity of cognitive impairment and increasing infarct size,in a positive correlation.The serum levels can be used as marker for cognitive impairment and severity of ACI.In addition,there are many high-risk factors for cognition,and serum Ang and AngⅣlevels are also one of them.Clinically,the treatment plan should be optimized by combining these high-risk factors to reduce the incidence of cognitive impairment after ACI.