脑出血患者血清脑源性神经营养因子与痴呆的相关性分析  

Correlation of serum brain-derived neurotrophic factor and dementia in patients with cerebral hemorrhage

作　　者：李万里 曹金娟 王焕焕 孟聪聪 于荣焕 LI Wanli;CAO Jinjuan;WANG Huanhuan;MENG Congcong;YU Ronghuan(Kaifeng Central Hospital,Kaifeng 475000,China)

机构地区：[1]开封市中心医院,河南开封475000

出　　处：《中国实用神经疾病杂志》2021年第7期570-577,共8页Chinese Journal of Practical Nervous Diseases

基　　金：开封市科技发展计划项目(编号:1703035)。

摘　　要：目的探讨脑出血患者血清脑源性神经营养因子(BDNF)与痴呆的相关性。方法选取180例脑出血患者,出院后6个月根据认知功能评分分为血管性认知功能障碍组(VCI)60例,其中血管性痴呆组(VD)22例,非痴呆型血管性认知功能障碍组(VCIND)38例;对照组为无认知障碍者120例。入院后及出院后6个月采用酶联免疫吸附法(ELISA)检测血清BDNF水平,分析其与认知功能障碍的相关性。采用ROC曲线分析BDNF对VCI发生的预测价值。结果VCI组年龄、NIHSS评分、出血量、出血部位、Hcy水平及BDNF水平与对照组比较差异有统计学意义(P<0.05)。多因素分析示高龄、NIHSS评分高、大量出血、脑叶出血、Hcy水平升高及BDNF水平降低是脑出血患者发生VCI的危险因素(P<0.05)。出院时6个月VCIND组与对照组MMSE评分、BDNF水平均高于入院时(P<0.05)。出院后6个月VD组BDNF水平高于入院时(P<0.05)。出院后6个月3组MMSE评分比较差异有统计学意义(P<0.05),两两比较,VD组与VCIND组MMSE评分低于对照组(P<0.05),VD组MMSE评分低于VCIND组(P<0.05)。入院时及出院后6个月3组BDNF水平比较差异有统计学意义(P<0.05),两两比较,入院时及出院后6个月VD组与VCIND组BDNF水平均低于对照组(P<0.05),VD组BDNF水平低于VCIND组(P<0.05)。出院后6个月BDNF水平与MMSE评分呈正相关(P<0.05)。BDNF预测VD及预测VCIND的AUC面积分别为0.749、0.704,均>0.7,灵敏度分别为84.2%、85.9%,特异度分别为80.9%、80.6%。结论脑出血患者血清BDNF水平与出血后VCI的发生相关,随着BDNF水平的降低,VCI严重程度随之增加,且入院后血清BDNF水平可以预测VCI的发生,特别是VD发生的标记物之一,临床上血清BDNF水平低的患者需引起重视。Objective To explore the effect of serum brain-derived neurotrophic factor(BDNF)on dementia in patients with cerebral hemorrhage.Methods A total of 180 patients with cerebral hemorrhage were selected as the research objects.Six months af⁃ter discharge,they were divided into vascular cognitive dysfunction(VCI)group 60 cases,of which 22 cases were vascular dementia group(VD),and non-dementia vascular recognition known dysfunction group(VCIND)38 cases;control group(no cognitive impair⁃ment)120 cases.ELISA method(enzyme-linked immunosorbent assay)was used to detect serum BDNF levels after admission and 6 months after discharge,and to analyze its correlation with cognitive dysfunction.And use ROC curve to analyze the predictive value of BDNF to the occurrence of VCI.Results There were differences in age,NIHSS score,bleeding volume,bleeding site,Hcy level and BDNF level in the VCI group compared with the control group(P<0.05).Multivariate analysis:advanced age,high NIHSS score,mas⁃sive hemorrhage,cerebral lobe hemorrhage,increased Hcy level and decreased BDNF level are risk factors for VCI in patients with ce⁃rebral hemorrhage(P<0.05).The MMSE scores and BDNF levels of the VCIND group and the control group at 6 months after dis⁃charge were higher than those after admission(P<0.05).The BDNF level of VD group was higher than that after admission in 6 months after discharge(P<0.05).Whether there was a difference in the MMSE scores of the 3 groups at 6 months after discharge(P<0.05),pairwise comparison:the VD group and the VCIND group had a low MMSE score control group(P<0.05),and the VD group had a lower MMSE score than the VCIND group(P<0.05).There was a difference in BDNF levels between the 3 groups after admission and 6 months after discharge(P<0.05).Pairwise comparison:VD group and VCIND group had low BDNF levels after admission and 6 months after discharge,control group(P<0.05),VD group BDNF level was lower than VCIND group(P<0.05).BDNF level was positively correlated with MMSE score in 6 months after disch

关 键 词：脑出血 痴呆 认知障碍 脑源性神经营养因子 血清 预测价值 

分 类 号：R743.34[医药卫生—神经病学与精神病学]