血清TIMP-1水平和脑梗死体积与老年患者脑卒中后认知功能障碍发生的关系

Association of serum TIMP-1 level and cerebral infarction volume with the occurrence of post-stroke cognitive impairment in elderly patients

目的探讨血清基质金属蛋白酶抑制剂-1(TIMP-1)水平和脑梗死体积与老年患者脑卒中后认知功能障碍(PSCI)发生的关系。方法选取2019年6月至2020年5月该院招募的80例老年急性缺血性脑卒中(AIS)患者作为研究对象。采用酶联免疫吸附试验检测所有患者入院时的血清TIMP-1水平;根据头部CT扫描计算脑梗死体积。采用蒙特利尔认知评估量表(MoCA)评估脑卒中发作后3个月的认知功能,将MoCA评分≤26分者纳入PSCI组,并至少完成6个月随访,将MoCA评分>26分者纳入非PSCI组。通过改良Rankin评分(mRS)评估脑卒中后神经功能状态。采用Spearman相关对血清TIMP-1水平与认知功能的相关性进行分析。采用多因素Logistic回归分析老年患者发生PSCI的影响因素。采用受试者工作特征曲线分析血清TIMP-1水平和脑梗死体积对PSCI发生和预后不良的预测价值。结果PSCI组血清TIMP-1水平高于非PSCI组,脑梗死体积大于非PSCI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血清TIMP-1水平和脑梗死体积是老年患者发生PSCI的独立影响因素(P<0.05)。Spearman相关分析结果显示,血清TIMP-1水平与PSCI患者视空间执行、延迟记忆评分均呈负相关(P<0.05)。发病6个月时预后不良(mRS≥3分)患者血清TIMP-1水平高于预后良好(mRS<3分)患者,脑梗死体积大于预后良好患者,差异均有统计学意义(P<0.05)。血清TIMP-1水平联合脑梗死体积可较好地预测PSCI发生,灵敏度和特异度分别为92.1%和85.7%;血清TIMP-1水平联合脑梗死体积可较好地预测脑卒中发作后6个月预后不良,灵敏和特异度分别为88.1%和76.3%。结论对于老年AIS患者,发病后早期血清TIMP-1水平升高,脑梗死体积增大,与PSCI发生风险增加及短期预后不良有关。

Objective To investigate the relationship between serum levels of matrix metalloproteinase inhibitor-1(TIMP-1)and cerebral infarction volume with post-stroke cognitive impairment(PSCI)in elderly patients.Methods A total of 80 elderly patients with acute ischemic stroke(AIS)recruited in the hospital from June 2019 to May 2020 were selected as the research objects.The serum level of TIMP-1 was detected by enzyme-linked immunosorbent assay.The volume of cerebral infarction was calculated based on the head CT scan.Montreal Cognitive Assessment Scale(MoCA)was used to assess cognitive function at 3 months after stroke onset.Patients with MoCA score≤26 were included in the PSCI group,and they completed at least 6 months of follow-up,patients with MoCA score>26 were included in the non-PSCI group.The modified Rankin score(mRS)was used to evaluate the neurological status after stroke.Spearman correlation was used to analyze the correlation between serum TIMP-1 level and cognitive function.Multivariate Logistic regression was used to analyze the influencing factors of PSCI in elderly patients.Receiver operating characteristic curve was used to analyze the predictive value of serum TIMP-1 level and cerebral infarct volume for the occurrence of PSCI and poor prognosis.Results The serum TIMP-1 level in the PSCI group was higher than that in the non-PSCI group,and the cerebral infarction volume was larger than that in the non-PSCI group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that serum TIMP-1 level and cerebral infarction volume were independent influencing factors for PSCI in elderly patients(P<0.05).Spearman correlation analysis showed that serum TIMP-1 level was negatively correlated with visuospatial execution and delayed memory scores in PSCI patients(P<0.05).At 6 months after onset,the serum TIMP-1 level of patients with poor prognosis(mRS≥3 points)was higher than that of patients with good prognosis(mRS<3 points),and the cerebral infarction volume was larger than that of patients with good prognosis,and the differences were statistically significant(P<0.05).Serum TIMP-1 level combined with cerebral infarction volume could well predict the occurrence of PSCI,with a sensitivity of 92.1%and a specificity of 85.7%.Serum TIMP-1 level combined with cerebral infarction volume could well predict poor prognosis at 6 months after stroke onset,with a sensitivity of 88.1%and a specificity of 76.3%.Conclusion In elderly patients with AIS,increased serum TIMP-1 level and increased cerebral infarction volume in the early stage after onset are associated with increased risk of PSCI and poor short-term prognosis.