血管性认知障碍患者血清胱抑素C水平研究

刘凯; 苏燕; 屈洪党; 杜苑苑; 熊勃超; 许力; 骆嵩

doi:10.16766/j.cnki.issn.1674-4152.002849

血管性认知障碍患者血清胱抑素C水平研究

doi: 10.16766/j.cnki.issn.1674-4152.002849

蚌埠医学院第一附属医院神经内科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0364

中匈科学合作基金-青年学者计划 20190629

详细信息

通讯作者:
屈洪党，E-mail：qhd820@sohu.com

中图分类号: R446 R741.04
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出版历程
- 收稿日期: 2022-05-05
- 网络出版日期: 2023-04-20

Study of serum cystatin C levels in patients with vascular cognitive impairment

Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的明确血清胱抑素C(CysC)在血管性认知障碍(VCI)患者中的表达，探讨两者间的相关性及CysC的临床预测价值。方法纳入蚌埠医学院第一附属医院2021年1月—2022年2月诊治的VCI患者96例。根据患者日常生活能力及蒙特利尔认知量表(MoCA)评分将患者分为血管性痴呆(VaD)组(35例)和血管性认知障碍非痴呆(VCIND)组(61例)，另选取83例认知和颅脑CT/MRI均表现正常的健康老人为对照(NC)组。比较3组基线资料及CysC水平，分析CysC与VCI患者总体认知及特定认知域的关系，采用二元logistic回归分析和ROC曲线评估VCI发生的相关危险因素及CysC对其发生的预测价值。结果 3组年龄、高血压、糖尿病、卒中史、CysC和MoCA评分差异有统计学意义(均P < 0.05)；NC组、VCIND组和VaD组CysC表达水平依次升高，两两比较差异有统计学意义(均P < 0.05)；CysC与VCI患者MoCA总评分以及视空间与执行力、命名、计算与注意力、语言、定向、延迟记忆呈负相关关系(均P < 0.05)；Logistic回归分析显示CysC表达升高可能是VCI发生的独立危险因素(P < 0.05)；ROC曲线分析显示CysC预测VCI发生的AUC为0.758，灵敏度为70.8%，特异度为77.1%，最佳截断值为0.99 mg/L。结论血清胱抑素C在VCI中高表达并与认知损害严重程度相关，是认知障碍发生的独立影响因素，有望成为VCI早期评估的生物学指标。
- 血管性认知障碍 /
- 胱抑素C /
- 阿尔茨海默病 /
- 认知功能
Abstract: Objective To determine the expression of serum cystatin C (CysC) in patients with vascular cognitive impairment (VCI), and to explore the correlation between them and the clinical predictive value of CysC. Methods This study included 96 patients with VCI who were enrolled in the First Affiliated Hospital of Bengbu Medical College from January 2021 to February 2022. They were divided into vascular dementia group (VaD, n=35) and vascular cognitive impairment without dementia group (VCIND, n=61) according to the Montreal Cognitive Assessment (MoCA) and ability of daily living (ADL) scores. In addition, 83 healthy elderly with normal cognitive function and brain MRI/CT were selected as normal controls (NC group). Baseline data and serum CysC levels were compared to analyse the relationship of CysC with overall cognition and its specific cognitive domains in patients with VCI. Binary logistic regression and ROC curves were used to evaluate VCI-related risk factors and the predictive value of CysC for the occurrence of VCI. Results Significant differences in age, history of hypertension, diabetes, stroke, MoCA scores and CysC were found among the three groups (all P < 0.05). The serum CysC expression increased sequentially in the NC, VCIND and VaD groups, and the differences were statistically significant (all P < 0.05). CysC was negatively correlated with MoCA overall cognition, visual space and executive function, naming, attention and computation, language, delayed memory and orientation in the VCI group (all P < 0.05). The results of multivariate logistic regression model indicated that higher levels of CysC were independent risk factors for VCI (P < 0.05). ROC curve analysis showed that the area under curve (AUC) for predicting the occurrence of VCI by serum CysC level was 0.758, the sensitivity was 70.8%, the specificity was 77.1% and the optimal cut-off value was 0.99 mg/L. Conclusion Serum CysC is highly expressed in VCI and is related to the severity of cognitive impairment. It is an independent influencing factor of cognitive impairment and is expected to become a biological indicator for early assessment of VCI.
- Vascular cognitive impairment /
- Cystatin C /
- Alzheimer' s disease /
- Cognitive function

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图 1 血清CysC预测血管性认知障碍发生的ROC曲线分析

Figure 1. ROC curve analysis of serum CysC in predicting vascular cognitive impairment

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表 1 3组研究对象一般资料及MoCA评分比较

Table 1. Comparison of general information and MoCA scores among the three groups

项目	NC组(n=83)	VCIND组(n=61)	VaD组(n=35)	统计量	P值
性别(男/女, 例)	40/43	28/33	17/18	0.095^c	0.954
年龄(x±s, 岁)	66.48±6.97	68.05±7.36	71.00±6.51^ab	5.111^d	0.007
BMI(x±s)	24.58±2.99	24.22±3.28	23.73±3.89	0.835^d	0.435
受教育年限(x±s, 年)	9.01±2.32	8.62±3.04	7.98±2.80	0.345^d	0.693
吸烟史[例(%)]	18(21.68)	18(29.50)	8(22.85)	1.230^c	0.541
饮酒史[例(%)]	11(13.25)	11(18.03)	5(14.28)	0.649^c	0.723
高血压史[例(%)]	39(46.98)	41(67.21)^a	31(88.57)^ab	19.134^c	< 0.001
糖尿病史[例(%)]	15(18.07)	29(47.54)^a	17(48.57)^a	17.659^c	< 0.001
高脂血症[例(%)]	28(33.73)	31(50.81)	16(45.71)	4.476^c	0.107
卒中史[例(%)]	13(15.66)	32(52.45)^a	30(85.71)^ab	53.865^c	< 0.001
TC(x±s, mmol/L)	3.84±0.94	3.70±1.06	3.82±1.21	0.312^d	0.732
TG[M(P₂₅, P₇₅), mmol/L]	1.21(0.87, 1.70)	1.34(0.88, 1.77)	1.16(0.78, 1.76)	0.848^e	0.654
LDL-C(x±s, mmol/L)	2.38±0.68	2.15±0.79	2.17±0.71	2.000^d	0.138
HDL-C(x±s, mmol/L)	1.02±0.28	1.00±0.24	0.98±0.26	0.378^d	0.686
FBG[M(P₂₅, P₇₅), mmol/L]	5.19(4.69, 6.05)	5.36(4.69, 6.84)	5.72(4.63, 8.22)	1.909^e	0.385
UA[M(P₂₅, P₇₅), μmol/L]	304(255, 335)	285(234, 335)	271(211, 336)	2.164^e	0.339
BUN(x±s, mmol/L)	6.53±1.06	6.82±0.98	7.09±1.72	0.820^d	0.441
SCr(x±s, μmol/L)	69.32±15.06	71.56±16.54	73.68±21.43	1.529^d	0.219
CysC(x±s, mg/L)	0.85±0.32	1.07±0.32^a	1.29±0.63^ab	9.662^d	< 0.001
MoCA评分[M(P₂₅, P₇₅), 分]	28(27, 28)	18(13, 20)^a	10(8, 14)^ab	148.693^e	< 0.001
注：与NC组比较，^aP < 0.05；与VCIND组比较，^bP < 0.05。^c为χ²值，^d为t值，^e为H值。

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表 2 VCI患者血清CysC与MoCA及特定认知域的相关性分析

Table 2. Correlation analysis of serum CysC with MoCA and specific cognitive domains in patients with VCI

项目	MoCA	视空间与执行	命名	注意	计算	语言	抽象	延迟记忆	定向
r值	-0.472	-0.380	-0.230	-0.269	-0.274	-0.311	-0.164	-0.363	-0.303
P值	< 0.001	< 0.001	0.024	0.008	0.007	0.002	0.110	< 0.001	0.003

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表 3 VCI发生的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of VCI occurrence

模型	B	SE	Wald χ²	P值	OR值	95% CI
单变量分析	2.476	0.577	18.423	< 0.001	11.898	3.840~36.862
多变量模型1	1.533	0.644	5.662	0.017	4.630	1.310~16.360
多变量模型2	1.706	0.729	5.472	0.019	5.507	1.319~23.001

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