非高密度脂蛋白胆固醇、同型半胱氨酸水平与丘脑梗死患者认知障碍及预后的相关性  

Correlation between non-high density lipoprotein cholesterol,homocysteine levels and cognitive impairment,prognosis in patients with thalamic infarction

作　　者：刘小双[1] 郭宁[1] 赵宛玉 LIU Xiaoshuang;GUO Ning;ZHAO Wanyu(Department of Neurology,Puyang People′s Hospital,Puyang 457000,Henan Province,China)

机构地区：[1]濮阳市人民医院神经内科,河南濮阳457000

出　　处：《新乡医学院学报》2024年第1期43-48,共6页Journal of Xinxiang Medical University

摘　　要：目的探讨非高密度脂蛋白胆固醇(non-HDL-C)、同型半胱氨酸(Hcy)水平与丘脑梗死患者认知障碍及预后的相关性。方法选择2017年3月至2021年3月濮阳市人民医院收治的丘脑梗死患者80例为研究对象。根据蒙特利尔认知评估(MoCA)量表得分将患者分为认知障碍组(MoCA评分<26分,n=35)和认知正常组(MoCA评分26~30分,n=45);另选择同期健康体检者50例作为对照组。采用全自动生物化学分析仪检测所有受试者血清中总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、Hcy水平,并计算non-HDL-C水平。采用Perason相关分析non-HDL-C、Hcy水平与MoCA评分的相关性,受试者操作特征曲线分析non-HDL-C、Hcy水平诊断丘脑梗死患者认知障碍的效能。根据改良Rankin量表(mRS)评分将丘脑梗死患者分为预后良好组(mRS评分≤2分,n=50)和预后不良组(mRS评分3~6分,n=50),采用多因素logistic回归分析丘脑梗死患者预后不良的独立危险因素。结果认知障碍组患者血清non-HDL-C、Hcy水平显著高于认知正常组和对照组(P<0.05);对照组与认知正常组受试者血清non-HDL-C、Hcy水平比较差异无统计学意义(P>0.05)。丘脑梗死患者non-HDL-C、Hcy水平与MoCA评分均呈负相关(P<0.05)。Hcy水平诊断认知障碍的曲线下面积(AUC)为0.709,敏感度为0.724,特异度为0.630;non-HDL-C水平诊断认知障碍的AUC为0.738,敏感度为0.701,特异度为0.870;Hcy联合non-HDL-C诊断认知障碍的AUC为0.769,敏感度为0.758,特异度为0.889。Hcy联合non-HDL-C诊断认知障碍的效能优于non-HDL-C、Hcy单独诊断。心房颤动及non-HDL-C、Hcy水平和NIHSS评分升高是丘脑梗死患者预后不良的独立危险因素(P<0.05)。结论non-HDL-C、Hcy水平均与丘脑梗死患者认知障碍呈正相关,non-HDL-C、Hcy水平可用于诊断丘脑梗死患者认知障碍,且联合检测诊断效果更优。心房颤动及non-HDL-C、Hcy水平和NIHSS评分升高是丘脑梗死患者预后不良的独立危险Objective To investigate the correlation between non-high density lipoprotein cholesterol(non-HDL-C),homocysteine(Hcy)levels and cognitive impairment,prognosis in patients with thalamic infarction.Methods Eighty thalamic infarction patients admitted to Puyang People′s Hospital from March 2017 to March 2021 were selected as the research subjects.According to Montreal cognitive assessment(MoCA)score,the patients were divided into cognitive impairment group(MoCA score<26,n=35)and cognitive normal group(MoCA score 26-30,n=45).Another 50 healthy individuals who underwent physical examinations during the same period were selected as the control group.The serum cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),Hcy levels of all subjects were detected by fully automated biochemical analyzer,and the non-HDL-C levels were calculated.The correlations between non-HDL-C,Hcy levels and MoCA scores were analyzed by Pearson correlation analysis,and the diagnostic efficacy of non-HDL-C,Hcy levels for cognitive impairment of patients with thalamic infarction was analyzed by receiver operating characteristic curve.According to the modified Rankin scale(mRS)score,the patients with thalamic infarction were divided into good prognosis group(mRS score≤2,n=50)and poor prognosis group(mRS score 3-6,n=50).The independent risk factors for poor prognosis of patients with thalamic infarction was analyzed by multivariate logistic regression.Results The serum levels of non-HDL-C and Hcy of patients in the cognitive impairment group were significantly higher than those in the cognitive normal group and control group(P<0.05);there was no significant difference in the serum non-HDL-C,Hcy levels of subjects between the control group and the cognitive normal group(P>0.05).The non-HDL-C,Hcy levels were negatively correlated with MoCA scores in thalamic infarction patients(P<0.05).The area under the curve(AUC)of Hcy level in the diagnosis of cognitive impairment was 0.709,the sensitivity was 0.724 and the specificity was 0.630;the AUC o

关 键 词：丘脑梗死 认知障碍 非高密度脂蛋白胆固醇 同型半胱氨酸 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]