缺血性卒中后认知障碍与炎性因子的相关性  

Correlation between cognitive impairment and inflammatory factors after ischemic stroke

作　　者：郭亚堃 杨清成[2] 郭艳平[2] GUO Yakun;YANG Qingcheng;GUO Yanping(Graduate School of Xinxiang Medical University,Xinxiang 453000,China;Anyang People’s Hospital,Anyang 455000,China)

机构地区：[1]新乡医学院研究生院,河南新乡453000 [2]安阳市人民医院,河南安阳455000

出　　处：《中国实用神经疾病杂志》2025年第2期161-166,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20191269)。

摘　　要：目的探讨缺血性脑卒中患者急性期体内炎症因子水平与卒中后认知障碍的相关性,为卒中后认知障碍早期诊断及预防提供帮助。方法选取2022-01—2023-03于安阳市人民医院就诊的261例缺血性脑卒中住院患者,采集入院24 h内外周血检测血清CRP、IL-6和补体C3水平,并于卒中后进行6个月追踪随访,根据MoCA评分将实际完成随访的223例患者分为卒中后认知障碍组(PSCI)及卒中后非认知障碍组(PSNCI)。结果PSCI组与PSNCI组年龄及学历有统计学差异(P<0.05),性别、既往病史及Hcy水平无统计学差异(P>0.05)。PSCI组患者急性期血清CRP[4.98(2.98~6.66)]及IL-6水平[5.7(4.2~7.5)]显著高于PSNCI组(P<0.001),2组患者间补体C3无统计学差异(P>0.05)。相关性分析得出PSCI组患者急性期血清CRP(r=0.311,P<0.001)及IL-6(r=0.263,P<0.005)水平与MoCA评分呈负相关,未见补体C3与MoCA评分的明显相关性。Logistic回归分析显示CRP(OR=1.348,95%CI:1.153~1.575,P<0.001)及IL-6(OR=1.155,95%CI:1.001~1.320,P<0.05)是PSCI发生的独立危险因素,列线图显示联合年龄及学历可有效判断PSCI发生率。ROC曲线下面积联合诊断>CRP>IL-6,CRP联合IL-6共同诊断PSCI的准确度最高;DCA曲线显示,当风险阈值为0.2~0.87、CRP与IL-6联合诊断净收益率>0时有临床意义。结论炎症反应对卒中后认知障碍的发生、发展有重要影响,卒中患者入院时外周血较高水平的CRP及IL-6是PSCI的独立危险因素,二者联合可共同判断PSCI发生率并进行早期预防。Objective To investigate the correlation between the level of inflammatory factors and post-stroke cognitive impairment in patients with ischemic stroke in the acute stage,and to provide help for the early diagnosis and prevention of post-stroke cognitive impairment.Methods A total of 261 hospitalized patients with ischemic stroke who were admitted to Anyang People’s Hospital from January 2022 to March 2023 were selected,and the serum CRP,IL-6 and complement C3 levels were detected in peripheral blood 24 hours after admission,and the 223 patients who actually completed the follow-up were divided into post-stroke cognitive impairment group(PSCI)and post-stroke non-cognitive impairment group(PSNCI)according to the MoCA score.Results There were significant differences in age and educational background between the PSCI group and the PSNCI group(P<0.05),there were no significant differences in gender,past medical history and Hcy level(P>0.05).The serum CRP(4.98(2.98-6.66))and IL-6 levels(5.7(4.2-7.5))in the acute phase of patients in the PSCI group were significantly higher than those in the PSNCI group(P<0.001),while there was no significant difference in complement C3 between the two groups.Correlation analysis showed that the serum CRP(r=0.311,P<0.001)and IL-6(r=0.263,P<0.005)levels in the acute phase were negatively correlated with MoCA score,and there was no obvious correlation between complement C3 and MoCA score.Logistic regression analysis showed that CRP(OR=1.348,95%CI:1.153-1.575,P<0.001)and IL-6 were independent risk factors for the occurrence of PSCI(OR=1.155,95%CI:1.001-1.320,P<0.05).The area under the ROC curve was the combined diagnosis>CRP>IL-6,which proved that the combined CRP and IL-6 had the highest accuracy in the diagnosis of PSCI.The DCA curve showed that when the risk threshold was 0.2-0.87,the combined diagnosis of CRP and IL-6 was clinically meaningful with a net return of>0.Conclusion Inflammatory response has an important impact on the occurrence and development of cognitive impairment af

关 键 词：缺血性脑卒中 卒中后认知障碍 炎性因子 C反应蛋白 白介素-6 补体C3 

分 类 号：R743.3[医药卫生—神经病学与精神病学]