血清胱抑素C与同型半胱氨酸对老年急性缺血性脑卒中患者认知功能恶化的预测价值

Predicitive value of serum cystatin C and homocysteine on cognitive deterioration in elderly patients with acute ischemic stroke

目的分析血清胱抑素C(Cys C)、同型半胱氨酸(Hcy)水平对早期老年急性缺血性脑卒中(AIS)患者发生认知功能恶化的预测价值。方法回顾性分析2023年2月至2024年2月葫芦岛市中心医院神经内科收治的182例初发AIS老年患者病历资料,患者均年龄≥60岁,根据简易精神状态量表评分变化将患者分为认知功能恶化组和认知功能未恶化组,分析老年AIS患者早期认知功能恶化的危险因素及诊断效能。结果182例患者中认知功能恶化组36例,未恶化组146例,2组患者在受教育程度、入院后美国国立卫生研究院卒中量表(NIHSS)评分、病灶累及额颞叶比例、血清Cys C、Hcy水平方面差异有统计学意义(P<0.05)。logistic回归分析提示,受教育程度低(OR=0.672,95%CI:0.536~0.842,P=0.001)、入院后NIHSS评分高(OR=1.732,95%CI:1.092~2.746,P=0.020)、血清Cys C(OR=3.905,95%CI:1.648~9.254,P=0.002)及Hcy(OR=1.330,95%CI:1.102~1.604,P=0.003)水平升高是老年AIS患者早期认知功能恶化的独立危险因素(P<0.05)。ROC曲线显示:Cys C预测曲线下面积为0.776(95%CI:0.691~0.861),截断值为1.81 mg/L;Hcy预测曲线下面积为0.827(95%CI:0.775~0.900),截断值为15.50μmol/L;Cys C联合Hcy预测曲线下面积为:0.876(95%CI:0.812~0.939),灵敏度为75.0%,特异度为87.0%。结论血清Cys C、Hcy升高是老年AIS患者早期出现认知功能恶化的独立危险因素。血清Cys C、Hcy联合预测老年AIS患者早期认知功能恶化具有一定的临床价值。

Objective To analyze the predictive value of serum cystatin C(Cys C)and homocysteine(Hcy)levels on the occurrence of cognitive deterioration in early-stage elderly patients with acute ischemic stroke(AIS),and to clarify the mechanism of occurrence and development of cognitive deterioration.Methods The selection in February 2023 to February 2024 in Department of Neurology of Huludao Central Hospital treated at the beginning of the 182 elderly patients with acute ischemic stroke,all patients were≥60 years old,according to the changes of MMSE scores in patients with acute ischemic stroke,they were divided into cognitive function deterioration group and cognitive function non-deterioration group.To analyze the risk factors and diagnostic efficacy of early cognitive deterioration in elderly patients with AIS.Results A total of 182 patients were enrolled,including 36 cases in the cognitive deterioration group and 146 cases in the non-cognitive deterioration group.There were statistically significant differences in education level,NIHSS score after admission,proportion of lesions involving frontotemporal lobe,serum Cys C and Hcy levels between the two groups(P<0.05).Logistic regression analysis showed that low education level(OR=0.672,95%CI:0.536-0.842,P=0.001),high NIHSS score after admission(OR=1.732,95%CI:1.092-2.746,P=0.020),serum Cys C(OR=3.905,95%CI:1.648-9.254,P=0.002)and Hcy(OR=1.330,95%CI:1.102-1.604,P=0.003)were independent risk factors for early cognitive deterioration in elderly AIS patients(P<0.05).ROC curve showed that the area under the curve of Cys C was 0.776(95%CI:0.691-0.861),and the critical value was 1.81mg/L.The area under the curve of Hcy was 0.827(95%CI:0.775-0.900),and the critical value was 15.50μmol/L.The area under the prediction curve of Cys C combined with Hcy was 0.876(95%CI:0.812-0.939),the sensitivity was 75.0%,and the specificity was 87.0%.Conclusions Elevated serum Cys C and Hcy are independent risk factors for early appeared deterioration of cognitive function in elderly patients with AIS.The combined prediction of serum Cys C and Hcy for early cognitive deterioration in elderly AIS patients has certain clinical value.