入院时血清高敏肌钙蛋白T水平对老年轻中度脑梗死患者长期认知功能的影响

Effect of serum hs-cTnT level at admission on long-term cognitive function in elderly patients with mild to moderate cerebral infarction

目的 探讨入院时血清高敏肌钙蛋白T(high sensitive cardiac troponin T,hs-cTnT)与老年轻中度脑梗死患者长期认知功能的关系。方法 前瞻性纳入2020年2月至11月濮阳市人民医院住院治疗的轻、中度脑梗死患者207例,根据入院时血清hs-cTnT在脑梗死患者中的分布水平,将患者分为高水平组102例(hs-cTnT>12 ng/L),低水平组105例(hs-cTnT≤12 ng/L)。随访3年,190例脑梗死患者成功随访,高水平组94例,低水平组96例。分析2组患者一般资料、简易智能状态检查量表(mini-mental status examination, MMSE)评分,应用logisitic回归分析影响患者出院时和出院3年后的认知功能影响因素,ROC曲线分析入院时hs-cTnT水平预测脑梗死患者出院3年后发生认知功能障碍的价值。结果 2组出院3年后MMSE评分均高于出院时,发生认知功能障碍比例均低于出院时(P<0.01)。高水平组出院时、出院3年后MMSE评分均显著低于低水平组,发生认知功能障碍比例均显著高于低水平组(P<0.01)。logisitic回归分析显示,女性、入院时hs-cTnT高水平、谵妄持续时间>1 d是脑梗死患者出院时发生认知功能障碍的危险因素(P<0.05,P<0.01),文化程度大专及以上是脑梗死患者出院时发生认知功能障碍的保护因素(P<0.05);年龄、女性、出院时存在认知功能障碍、入院时hs-cTnT高水平是脑梗死患者出院3年后发生认知功能障碍的危险因素(P<0.05,P<0.01)。ROC曲线分析显示,入院时hs-cTnT水平预测脑梗死患者出院3年后发生认知功能障碍的曲线下面积为0.732(95%CI:0.531~0.927)。结论 入院时高水平hs-cTnT是老年轻中度脑梗死患者出院时和出院3年后发生认知功能障碍的危险因素,可帮助预测患者长期认知功能。

Objective To explore the correlation between hs-cTnT and long-term cognitive function in elderly patients with mild to moderate cerebral infarction.Methods A total of 207 inpatients with cerebral infarction admitted in our hospital from February to November 2020 were prospectively recruited, and according to the serum level of hs-cTnT at admission, they were divided into in a high-level group(hs-cTnT >12 ng/L,102 cases) and a low-level group(hs-cTnT ≤12 ng/L,105 cases).Among them, 190 patients completed a 3-year follow-up, including 94 from the high-level group and 96 from the low-level group.The general information and Mini-Mental Status Examination(MMSE) score were compared and analyzed in the two groups.Logistic regression analy-sis was used to identify the factors affecting cognitive function of the patients at discharge and in 3 years after discharge.ROC curve was plotted to analyze the value of the serum level of hs-cTnT at admission for cognitive impairment in 3 years after discharge.Results In 3 years after discharge, both groups had a higher MMSE score and lower proportion of cognitive impairment when compared with the conditions at discharge(P<0.01).The MMSE scores at discharge and 3 years after discharge were significantly lower, and the proportions of cognitive impairment at the two time points were obviously higher in the high-level group than the low-level group(P<0.01).Logistic regression analysis showed that female, high baseline hs-cTnT level, and delirium duration >1 d were risk factors(P<0.05,P<0.01),while education level of college or above was a protective factor for cognitive impairment in patients with cerebral infarction at discharge(P<0.05).Age, female, presence of cognitive impairment at discharge, and high baseline hs-cTnT level were risk factors for cognitive impairment in 3 years after discharge(P<0.05,P<0.01).ROC curve analysis indicated that the AUC value of baseline hs-cTnT in predicting cognitive impairment in 3 years after discharge was 0.732(95%CI:0.531-0.927).Conclusion High serum hs-cTnT level at admission is a risk factor for cognitive impairment in elderly patients with mild to moderate cerebral infarction at discharge and 3 years after discharge, and it can help predict long-term cognitive function in these patients.