缺血性脑卒中后认知功能障碍老年患者血清神经丝轻链蛋白和CXC型趋化因子配体16水平变化及意义  

Changes and significances of serum neurofilament light chain protein and CXC-chemokine ligand 16 in elderly patients with cognitive impairment after ischemic stroke

作　　者：张茗 郭翃江[1] 严之红[1] 纪红[1] ZHANG Ming;GUO Hong-jiang;YAN Zhi-hong;JI Hong(Department of Geriatric Medicine,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院老年医学科,北京100049

出　　处：《中华实用诊断与治疗杂志》2022年第5期500-504,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：中国航天科工集团课题项目(2019-LCYL-012)。

摘　　要：目的观察缺血性脑卒中后认知功能障碍老年患者血清神经丝轻链蛋白(neurofilament light chain protein,NfL)、CXC型趋化因子配体16(CXC-chemokine ligand 16,CXCL16)水平变化,探讨二者对缺血性脑卒中老年患者发生认知功能障碍的预测价值。方法缺血性脑卒中老年患者206例,均给予规范治疗。出院后随访3个月,依据蒙特利尔认知评估基础量表(Montreal cognitive assessment-basic,MoCA-B)评分,将206例患者分为认知障碍组89例(MoCA-B评分<26分)和非认知障碍组117例(MoCA-B评分≥26分)。比较2组性别、年龄、体质量指数等临床资料;比较2组入院次日血清NfL、CXCL16、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、C反应蛋白、尿酸及肌酐水平;Pearson相关法分析血清NfL、CXCL16水平与MoCA-B评分的相关性;多因素logistic回归分析缺血性脑卒中老年患者发生认知功能障碍的影响因素;绘制ROC曲线,评估血清NfL、CXCL16预测缺血性脑卒中老年患者发生认知功能障碍的价值。结果认知障碍组受教育时间[7(10,14)年]短于非认知障碍组[13(9,17)年](U=3.546,P<0.001),合并高血压比率(55.06%)高于非认知障碍组(40.17%)(χ^(2)=4.501,P=0.034),年龄、体质量指数、缺血性脑卒中病因及男性、饮酒、吸烟、合并糖尿病比率与非认知障碍组比较差异均无统计学意义(P>0.05)。认知障碍组血清NfL[(75.97±9.93)ng/L]、CXCL16[(2.80±0.62)μg/L]、三酰甘油[1.96(1.46,2.47)mmol/L]、低密度脂蛋白胆固醇[(3.18±0.86)mmol/L]、同型半胱氨酸[(15.61±4.15)μmol/L]、C反应蛋白[7.41(4.88,10.63)mg/L]水平均高于非认知障碍组[(60.59±11.42)ng/L、(1.94±0.63)μg/L、1.69(1.11,2.46)mmol/L、(2.92±0.96)mmol/L、(14.13±4.77)μmol/L、4.38(2.85,6.37)mg/L](P<0.05),MoCA-B评分[(20.76±2.88)分]低于非认知障碍组[(27.31±1.21)分](P<0.05),血清总胆固醇、高密度脂蛋白胆固醇、尿酸、肌酐水平与非Objective To observe the changes of serum neurofilament light chain(NfL)and CXC-chemokine ligand 16(CXCL16)in elderly patients with cognitive impairment(CI)after ischemic stroke,and to investigate their values to the prediction of CI after ischemic stroke.Methods Total 206elderly patients with ischemic stroke were given standardized treatment and followed up for 3months after discharge.According to the Montreal cognitive assessment-basic(MoCA-B)score,206patients were divided into 89patients with MoCA-B score<26(CI group)and 117patients with MoCA-B score≥26(non-CI group).The general data including gender,age and body mass index were compared between two groups.The levels of serum NfL,CXCL16,total cholesterol,triacylglycerol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homocysteine,C-reactive protein,uric acid and serum creatinine were detected on the next day after admission and were compared between two groups.Pearson correlation method was used to analyze the correlations of serum NfL and CXCL16levels with MoCA-B score.Multivariate logistic regression analysis was done to study the influencing factors of CI in elderly patients with ischemic stroke.ROC curve was drawn to evaluate the values of serum NfL and CXCL16to the prediction of CI in elderly patients with ischemic stroke.Results The schooling year was shorter in CI group[7(10,14)years]than that in non-CI group[13(9,17)years](U=3.546,P<0.001),the percentage of patients with hypertension was higher in CI group(55.06%)than that in non-CI group(40.17%)(χ^(2)=4.501,P=0.034),and there were no significant differences in the age,body mass index,cause of ischemic stroke,male ratio,and percentages of patients with drinking,smoking and diabetes mellitus between two groups(P>0.05).The levels of serum NfL,CXCL16,triacylglycerol,low-density lipoprotein cholesterol,homocysteine and C-reactive protein were higher in CI group[(75.97±9.93)ng/L,(2.80±0.62)μg/L,1.96(1.46,2.47)mmol/L,(3.18±0.86)mmol/L,(15.61±4.15)μmol/L,7.41(4.88,10.63)mg/L]

关 键 词：缺血性脑卒中 认知功能障碍 神经丝轻链蛋白 CXC型趋化因子配体16 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]