血清Aβ1-42、tau蛋白及甲状腺激素水平对缺血性卒中后认知障碍发生的预测价值  

Clinical value of Aβ1-42, tau protein and thyroid hormone levels in predicting cognitive impairment after ischemic stroke

作　　者：毛蕾[1,2] 李澎[1] 陈晓晗[1] 马天君 许义新 潘霄[1] 庄建华[1] 尹又[1] MAO Lei;LI Peng;CHEN Xiaohan;MA Tianjun;XU Yixin;PAN Xiao;ZHUANG Jianhua;YIN You(Department of Neurology,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)

机构地区：[1]第二军医大学附属上海长征医院神经内科,上海200003 [2]上海市第一人民医院宝山分院神经内科

出　　处：《中国神经精神疾病杂志》2019年第7期385-389,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：上海市科委“科技创新行动计划”（编号:17411950104）;海军医大大学军事医学创新专项（编号:2017JS07）;上海市科学技术委员会科研计划项目（编号:19441907500）

摘　　要：目的探究脑梗死急性期血清标志物β淀粉样蛋白(Aβ)、tau蛋白及甲状腺激素水平与卒中后认知障碍(post-stroke cognitive impairment,PSCI)的关系及其预测价值。方法纳入急性脑梗死患者214例,记录患者基线资料及血清学指标,评估患者认知功能。根据随访结果分为认知障碍组及正常组,分析两组患者Aβ1-42、tau蛋白及甲状腺素水平的差异及其与患者病情进展的关系,运用Cox回归分析及ROC曲线比较上述指标预测PSCI发展的能力。结果认知障碍组Tau总蛋白(210.6±98.9pg/mL)高于正常组,Aβ1-42(426.1±123.5pg/mL)、三碘甲状腺原氨酸(T3)(1.43±0.57nmol/L)、游离甲状腺素(FT4)(13.15±2.23pmol/L)低于正常组,差异有统计学意义(P<0.05)。Tau蛋白(r=-0.457)、Aβ1-42(r=0.348)、T3(r=0.211)、FT4(r=0.306)均与病情进展相关(P<0.05)。Cox回归分析显示Aβ1-42及T3为PSCI发生的重要影响因子。ROC曲线下,Aβ1-42与T3联合的曲线下面积为0.841,诊断界值0.572,特异性74.8%,敏感性85.3%。结论脑梗死急性期检测Aβ1-42及T3水平有可能预测PSCI的进展。Objective To investigate the relationship between serum markers β amyloid (Aβ),tau and thyroid hormone levels and post-stroke cognitive impairment (PSCI) in the acute phase of cerebral infarction.Methods A total of 214 patients with acute cerebral infarction were enrolled.The baseline data and serological indicators were collected and the cognitive function of patients was evaluated.All patients were divided into cognitive impairment group and normal group based on follow-up results.The differences of Aβ1-42,tau protein and thyroxine levels between the two groups and their relationship with disease progression were analyzed.The Cox regression analysis and ROC curve were used to compare the above parameters to predict the development of PSCI.Results The total protein level of Tau (210.6±98.9 pg/mL) was higher and Aβ1-42 (426.1±123.5 pg/mL) and triiodothyronine (T3)(1.43±0.57 nmol/L),free thyroxine (FT4)(13.15±2.23 pmol/L) was significantly lower in the cognitive impairment group than in the normal group (P<0.05).Tau protein (r=-0.457),Aβ1-42 (r=0.348),T3 (r=0.211),and FT4 (r=0.306) were all associated with disease progression (P<0.05).Cox regression analysis showed that Aβ1-42 and T3 were important influencing factors in the occurrence of PSCI.The area under the curve of Aβ1-42 combined with T3 was 0.841.The specificity and the sensitivity were 74.8% and 85.3%,respectively,with a diagnostic cutoff value of 0.572.Conclusion Aβ1-42 and T3 levels in the acute phase of cerebral infarction may predict the progression of PSCI.

关 键 词：卒中后认知障碍 甲状腺激素水平 Β淀粉样蛋白 TAU蛋白 

分 类 号：R741[医药卫生—神经病学与精神病学]