血清铁相关指标与脑卒中后认知障碍风险的相关性

Correlation analysis between serum iron-related indicators and risk of post-stroke cognitive impairment in stroke patients

目的探讨血清铁(SI)相关指标与脑卒中后认知障碍(PSCI)风险的相关性,为临床干预PSCI提供理论基础。方法回顾性选取2021年2月—2023年7月于温州市中西医结合医院诊治的281例脑卒中患者的临床资料,采用蒙特利尔认知评估量表(MoCA)对患者进行认知功能评估,并根据MoCA评分结果将<26分设为PSCI组,≥26分设为无PSCI组。收集并比较2组一般资料、血清铁相关指标、神经评测及影像学相关资料,采用多因素logistic回归分析研究影响PSCI的相关因素。结果281例脑卒中患者中有124例出现PSCI,发生率为44.13%。2组年龄、Hb比较,差异均有统计学意义(P<0.05)。2组SI、铁蛋白(SF)、转铁蛋白(TRF)、总铁结合力(TIBC)、转铁蛋白饱和度(TSAT)、铁调素(Hep)比较,差异均有统计学意义(P<0.05)。2组美国国立卫生研究院卒中量表(NIHSS)评分、梗死体积、血管周围间隙扩大率比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,高水平的Hb、SI、TRF和TIBC是发生PSCI的独立保护因素,而高水平的SF及Hep、高NIHSS评分、梗死体积增大、血管周围间隙扩大是发生PSCI的独立危险因素。结论PSCI发生风险较高,且SI、TRF、TIBC等血清铁相关指标与其发生风险具有相关性。

Objective To explore the correlation between serum iron(SI)related indexes and the risk of post-stroke cognitive impairment(PSCI),providing a theoretical basis for clinical intervention in PSCI.Methods A retrospective analysis was conducted on the clinical data of 281 stroke patients treated at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2021 to July 2023.Cognitive function was evaluated by Montreal cognitive assessment scale(MoCA).According to the results of MoCA score,the score of<26 was set as the PSCI group,and the score of≥26 was set as the non-PSCI group.The general data,serum iron-related indexes,neurological evaluations,and imaging-related data were collected and compared between the two groups.The related factors affecting PSCI were analyzed by multivariate logistic regression.Results Among the 281 stroke patients,124 patients developed PSCI,with an incidence rate of 44.13%.Significant differences were observed in age and Hb between the two groups(P<0.05).SI,serum ferritin(SF),transferrin(TRF),total iron binding capacity(TIBC),transferrin saturation(TSAT),and hepcidin(Hep)were compared between the two groups,with statistically significant differences(P<0.05).There were significant differences in National Institute of Health stroke scale(NIHSS)score,infarct volume,and perivascular space expansion rate between the two groups(P<0.05).Multivariate logistic regression analysis showed that higher levels of Hb,SI,TRF,and TIBC were independent protective factors against PSCI,while elevated SF,Hep levels,high NIHSS scores,increased infarct volume,and enlarged perivascular spaces were independent risk factors for PSCI.Conclusion The risk of PSCI is significant,and serum iron-related indexes such as SI,TRF,and TIBC are closely associated with its development.