[1]黄晓芸,刘　军,黄凯帆,等.血管性认知障碍患者血清脂蛋白相关磷脂酶A2水平变化及其对认知障碍的预测价值[J].新乡医学院学报,2021,38(1):031-35.[doi:10.7683/xxyxyxb.2021.01.006]
　HUANG Xiaoyun,LIU Jun,HUANG Kaifan,et al.Changes of serum lipoprotein phospholipase A2 levels in patients with vascular cognitive impairment and its predictive value in cognitive impairment[J].Journal of Xinxiang Medical University,2021,38(1):031-35.[doi:10.7683/xxyxyxb.2021.01.006]
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血管性认知障碍患者血清脂蛋白相关磷脂酶A2水平变化及其对认知障碍的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年1
页码:
031-35
栏目:
临床研究
出版日期:
2021-01-05

文章信息/Info

Title:
Changes of serum lipoprotein phospholipase A2 levels in patients with vascular cognitive impairment and its predictive value in cognitive impairment
作者:
黄晓芸1; 刘　军2; 黄凯帆3; 付文金1; 陈建军1; 林　菡1; 梅志忠1
(1.广东医科大学附属东莞厚街医院神经内科,广东　东莞　5239452.中山大学孙逸仙纪念医院神经内科，广东　广州　5101203.东莞市厚街镇社区卫生服务中心，广东　东莞　523961)
Author(s):
HUANG Xiaoyun1 ; LIU Jun2; HUANG Kaifan3; FU Wenjin1; CHEN Jianjun1; LIN Han1; MEI Zhizhong1
(1.Department of Neurology,Houjie Hospital Affiliated to Guangdong Medical University,Dongguan 523945,Guangdong Province,China2.Department of Neurology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,Guangdong Province,China3.Dongguan Houjie Town Community Health Service Center,Dongguan 523961,Guangdong Pro-vince,China)
关键词:
脂蛋白相关磷脂酶A2; 血管性认知障碍; 相关性; 预测价值
Keywords:
lipoprotein-associated phospholipase A2vascular cognitive impairmentcorrelationpredictive value
分类号:
R749.13
DOI:
10.7683/xxyxyxb.2021.01.006
文献标志码:
A
摘要:
目的　探讨血管性认知障碍（VCI）患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平变化及其对认知障碍的预测价值。方法　选择2018年5月至2019年1月东莞厚街医院收治的50例脑卒中后认知障碍患者作为VCI组，另选择同期无认知障碍脑卒中患者50例作为对照组。VCI组患者根据认知障碍程度分为血管性痴呆（VD）组（n=28）和非痴呆型血管性认知功能障碍(VCIND)组（n=22）。采用酶联免疫吸附法检测患者发病时、发病后6个月、发病后1 a血清Lp-PLA2水平；分别于发病时、发病后6个月、发病后1 a采用简易智能筛查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估所有患者认知功能。分析3组患者血清Lp-PLA2水平变化，并采用受试者工作特征曲线分析血清Lp-PLA2水平预测VCI发生的价值。结果　梗死次数、饮酒史、年龄、美国国立卫生研究院卒中量表（NIHSS）评分、受教育年限、同型半胱氨酸水平及Lp-PLA2水平与脑卒中后发生VCI有关(P<0.05)。多因素logistic回归分析显示，高龄、NIHSS评分高、受教育年限少、同型半胱氨酸水平升高及Lp-PLA2水平升高是脑卒中患者发生VCI的独立危险因素(P<0.05)。对照组患者发病时、发病后6个月及发病后1 a MMSE、MoCA评分及血清Lp-PLA2水平比较差异均无统计学意义(P>0.05)。VD组和VCIND组患者发病后6个月、发病后1 a MMSE、MoCA评分及血清Lp-PLA2水平均低于发病时 (P<0.05)；VD组患者发病后1 a MMSE、MoCA评分均低于发病后6个月 (P<0.05)；VCIND组患者发病后6个月及发病后1 a MMSE、MoCA评分及血清Lp-PLA2水平比较差异无统计学意义(P>0.05)。发病时，3组患者MMSE、MoCA评分比较差异无统计学意义(P>0.05)；VD组和VCIND组患者血清Lp-PLA2水平高于对照组(P<0.05)；VCIND组患者血清Lp-PLA2水平低于VD组(P<0.05)。发病后6个月及发病后1 a，VD组和VCIND组患者MMSE、MoCA评分均低于对照组 (P<0.05)；VCIND组患者MMSE、MoCA评分高于VD组 (P<0.05)；发病后6个月及发病后1 a 3组患者血清Lp-PLA2 水平比较差异无统计学意义(P>0.05)。Lp-PLA2 水平预测VD及VCIND的效能优于其他指标，曲线下面积均≥0.70，其预测VD和VCIND的截断值分别为181.65、140.23 mg·L-1。 结论　随着血清Lp-PLA2水平升高，VCI严重程度随之增加，血清Lp-PLA2可以作为预测脑卒中后VCI发生，特别是VD发生的标志物。
Abstract:
Objective　To investigate the changes of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) levels in patients with vascular cognitive impairment (VCI) and its predictive value in the cognitive impairment.Methods　Fifty patients with cognitive impairment after stroke admitted to Dongguan Houjie Hospital from May 2018 to January 2019 were selected as VCI group,and another 50 patients without cognitive impairment during the same period were selected as control group.The patients in the VCI group were divided into vascular dementia (VD) group (n=28) and non dementia vascular cognitive impairment (VCIND) group (n=22) according to the degree of cognitive impairment.The serum level of Lp-PLA2 of all patients was detected by enzyme-linked immunosorbent assay at onset,6 months and 1 year after onset;the cognitive function of all patients was evaluated by mini-mental state examination(MMSE) and montreal cognitive assessment(MoCA).The changes of serum Lp-PLA2 levels of patients in the three groups were analyzed,and the receiver operating characteristic curve was used to analyze the value of the serum Lp-PLA2 level in predicting the occurrence of VCI.Results　The number of infarction,history of alcohol consumption,age,National Institute of Health stroke scale(NIHSS) score,years of education,the levels of homocysteine and Lp-PLA2 were correlated with the occurrence of post-stroke VCI (P<0.05).Multivariate logistic regression analysis showed that the old age,high NIHSS score,less educational experience,elevated homocysteine and Lp-PLA2 levels were the independent risk factors of VCI in stroke patients (P<0.05).There was no significant difference in MMSE,MOCA scores and serum Lp-PLA2 level at onset,6 months and 1 year after onset in the control group (P>0.05).The MMSE,MOCA scores and serum Lp-PLA2 levels of patients at 6 months and 1 year after onset were lower than those at onset in the VD group and VCIND group (P<0.05);the MMSE and MOCA scores of patients at 1 year after onset were lower than those at 6 months after onset in VD group (P<0.05);there was no significant difference in MMSE,MOCA scores and serum Lp-PLA2 level between the 6 months after onset and 1 year after onset in VCIND group (P>0.05).On the onset,there was no significant difference in MMSE and MOCA scores among the three groups (P>0.05);the serum Lp-PLA2 level of patients in the VD group and VCIND group was higher than that in the control group(P<0.05);the serum Lp-PLA2 level of patients in the VCIND group was lower than that in the VD group(P<0.05).At 6 months and 1 year after onset,the MMSE and MOCA scores of patients in the VD group and VCIND group were lower than those in the control group (P<0.05);the MMSE and MOCA scores of patients in the VCIND group were higher than those in the VD group (P<0.05).There was no significant difference in the serum Lp-PLA2 level among the VD group,VCIND group and the control group at 6 months and 1 year after onset (P>0.05).The serum Lp-PLA2 level was better than other indexes in predicting the occurrence of VD and VCIND,the area under curve was more than or equal to 0.70;the cutoff of Lp-PLA2 in predicting the occurrence of VD and VCIND was 181.65,140.23 mg·L-1 ，respectively.Conclusion　With the increase of serum Lp-PLA2 level,the severity of VCI increased； and the serum Lp-PLA2 level can be used as a marker to predict the occurrence of VCI after stroke,especially VD.

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更新日期/Last Update: 2021-01-05