ACI患者血清APN、Lp-PLA2、PECAM-1水平与出院后一年认知功能障碍的相关性探讨

Correlation between serum APN,Lp-PLA2,PECAM-1 levels and 1 year after discharge cognitive dysfunction in patients with acute cerebral infarction after discharge

目的 探讨急性脑梗死(ACI)患者出院时血清脂联素(APN)、脂蛋白相关磷脂酶A2(Lp-PLA2)、血小板内皮细胞黏附分子-1 (PECAM-1)水平与长期认知功能障碍(PSCI)的相关性,为临床预测PSCI提供相关标志物。方法 选取新疆维吾尔自治区人民医院2020年8月至2022年1月ACI患者108例,根据出院后1年时是否存在PSCI,分为认知正常组(77例)与认知障碍组(31例)。比较两组临床基本资料及入院时、出院时血清APN、Lp-PLA2、PECAM-1水平,分析血清APN、Lp-PLA2、PECAM-1水平与长期PSCI的相关性。结果 认知障碍组出院后1年简易精神状态评价量表(MMSE)评分为(22.13±2.06)分,低于认知正常组(29.14±0.31)分(P<0.05);两组年龄、神经功能缺损程度、合并糖尿病、糖化血红蛋白(HbAlc)、同型半胱氨酸(Hcy)水平差异有统计学意义(P<0.05);认知障碍组出院时血清APN水平低于认知正常组,Lp-PLA2、PECAM-1水平高于认知正常组(P<0.05);出院时血清APN水平与出院后1年MMSE评分呈正相关,Lp-PLA2、PECAM-1水平与出院后1年MMSE评分呈负相关(r=0.727、-0.667、-0.750,均P<0.05);Logistic回归分析,将其他因素校正前后,出院时血清APN、Lp-PLA2、PECAM-1水平均与ACI患者长期PSCI独立相关(P<0.05);出院时血清APN、LpPLA2、PECAM-1水平预测ACI患者长期PSCI的AUC分别为0.783 (95%CI:0.693~0.857)、0.736 (95%CI:0.643~0.817)、0.827 (95%CI:0.743~0.893),联合预测ACI患者长期PSCI的AUC为0.936 (95%CI:0.872~0.974),优于3者单独预测。结论 ACI患者出院时血清APN、Lp-PLA2、PECAM-1水平与长期PSCI独立相关,可作为临床早期预测指标,且联合预测价值可靠。

Objective To investigate the correlation between serum adiponectin(APN),lipoprotein-associated phospholipase A2(Lp-PLA2)and platelet endothelial cell adhesion molecule-1(PECAM-1)levels and long-term cognitive dysfunction(PSCI)in patients with acute cerebral infarction(ACI)after discharge,and to provide relevant markers for clinical prediction of PSCI.Methods 108 patients with ACI in People's Hospital of Xinjiang Uygur Autonomous Region from August 2020 to January 2022 were selected and divided into cognitive normal group(77 cases)and cognitive impairment group(31 cases)according to whether PSCI existed one year after discharge.Basic data,serum APN,Lp-PLA2,PECAM-1 levels at admission and discharge were compared between the two groups,and the correlation between serum APN,Lp-PLA2,PEC AM-1 levels and long-term PSCI was analyzed.Results The MMSE score of the cognitive impairment group was(22.13±2.06)points after discharge,which was lower than that of the cognitive normal group(29.14±0.31)points(P<0.05).There were significant differences in age,degree of neurological impairment,combined diabetes,HbAlc and Hey levels between the two groups(P<0.05).The level of APN in patients with cognitive impairment was lower than that in patients with normal cognition,and the levels of Lp-PLA2 and PECAM-1 were higher than those in patients with normal cognition(P<0.05).Serum APN level at discharge was positively correlated with MMSE score 1 year after discharge,while Lp-PLA2 and PECAM-1 levels were negatively correlated with MMSE score 1 year after discharge(r=0.727,-0.667,-0.750,allP<0.05).Logistic regression analysis showed that serum APN,Lp-PLA2 and PECAM-1 levels at discharge were independently correlated with long-term PSCI in ACI patients before and after adjustment for other factors(P<0.05).The AUC of serum APN,Lp-PLA2 and PECAM-1 levels predicting long-term PSCI in ACI patients at discharge was 0.783(95%CI:0.693-0.857),0.736(95%CI:0.643-0.817)and 0.827(95%CI:0.743-0.893),the combined prediction of long-term PSCI AUC in ACI patients was 0.936(95%CI:0.872-0.974),which was better than the three independent predictions.Conclusion Serum APN,Lp-PLA2 and PECAM-1 levels at discharge of ACI patients are independently correlated with long-term PSCI,which can be used as early clinical predictors,and the combined prediction value is reliable.