Lp-PLA2与腔隙性脑梗死患者认知损害的相关性研究  

The correlational research between Lp-PLA2 and cognitive impairment in patients with lacunar infarction

作　　者：陆达[1] 郑娜[2] 张惠红[1] 周玉颖[1] 徐小林[1] LU Da;ZHENG Na;ZHANG Hui-hong;ZHOU Yu-ying;XU Xiao-lin(Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China;Tianjin Huanhu Hospital)

机构地区：[1]天津市环湖医院神经内科,天津300350 [2]天津市环湖医院

出　　处：《中国城乡企业卫生》2020年第7期23-26,共4页Chinese Journal of Urban and Rural Enterprise Hygiene

摘　　要：目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)对腔隙性脑梗死患者急性期认知损害的影响及其在疾病风险评估中的临床价值。方法选择2016年1月-2019年10月天津市环湖医院收治的符合入组条件的急性腔隙性脑梗死患者共582例,分别应用简易精神状态检查量表(MMSE)及蒙特利尔认知评价量表(MoCA)评价认知功能,日常活动能力量表(ADL)评价日常生活活动能力,神经精神量表(NPI)衡量神经精神行为,以及汉密尔顿抑郁量表21项版本(HAMD-21)评价情绪状态。同时测定Lp-PLA2、超敏C-反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、低密度脂蛋白胆固醇(LDL-C)等生化指标的水平。结果与认知正常组患者相比,认知障碍组患者Lp-PLA2、LDL-C、HCY水平均较高,差异有统计学意义(P<0.05)。急性腔隙性脑梗死患者MMSE和MoCA评分与Lp-PLA2水平呈负相关;NPI评分和HAMD-21与Lp-PLA2水平呈正相关。为校正混杂因素影响,进一步行偏相关分析发现,MMSE与Lp-PLA2水平呈负相关,HAMD-21评分与Lp-PLA2水平呈正相关,急性脑梗死后认知障碍的危险性明显增加。结论 Lp-PLA2水平增高是腔隙性脑梗死患者急性期认知损害的危险因素,可作为对于腔隙性脑卒中患者血管性认知功能障碍危险评估的有效测量指标和防治靶点。Objective To investigate the effect of plasma lipoprotein related phospholipase A2(Lp-PLA2)on acute cognitive impairment in patients with lacunar infarction and its clinical value in disease risk assessment. Methods From January 2016 to October 2019,a total of 582 patients with acute lacunar cerebral infarction eligible for admission,admitted to Tianjin Huanhu Hospital,were selected and respectively evaluated the emotional state with simple mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA)to evaluate the cognitive function,daily activity ability scale(ADL)evaluation of daily life activities ability,neuropsychological scale(NPI)to measure neural behavior,and Hamilton depression rating scale version 21 items(HAMD-21). Plasma lipoprotein related phospholipase A2(Lp-PLA2),hypersensitive c-reactive protein(hs-CRP),homocysteine(Hcy),low-density lipoprotein cholesterol(LDL-C)and other biochemical indexes were also measured. Results Compared with the cognitive normal group,the Lp-PLA2,LDL-C and HCY indexes in the cognitive impairment group were all higher,the difference were statistically significant(P<0.05). MMSE and MoCA scores were negatively correlated with Lp-PLA2 level in patients with acute lacunar infarction. NPI score and HAMD-21 were positively correlated with the Lp-PLA2 level. In order to correct the influence of confounding factors,further partial correlation analysis revealed a negative correlation between MMSE and Lp-PLA2 level,a positive correlation between HAMD-21 score and Lp-PLA2 level,and a significantly increased risk of cognitive impairment after acute infarction. Conclusion The increased level of Lp-PLA2 was a risk factor for acute cognitive impairment in patients with lacunar infarction and could be used as an effective measurement indicator and control target for assessing the risk of vascular cognitive dysfunction in patients with lacunar infarction.

关 键 词：血浆脂蛋白相关磷脂酶A2 急性腔隙性脑梗死 认知障碍 精神行为障碍 

分 类 号：R743.33[医药卫生—神经病学与精神病学]