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中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 358 -361. doi: 10.3877/cma.j.issn.2095-123X.2021.06.008

临床研究

老年轻型缺血性卒中后认知障碍与血清神经丝蛋白轻链的相关性研究
王未飞1, 李广峰2, 庄献博1, 闫冠华1,†()   
  1. 1. 252000　山东聊城，聊城市人民医院神经内科
    2. 252000　山东聊城，聊城市人民医院神经外科
  • 收稿日期:2021-10-21 出版日期:2021-12-15
  • 通信作者: 闫冠华

Correlation between cognitive impairment and serum neurofilament-light level in eldly patients with minor ischemic stroke

Weifei Wang1, Guangfeng Li2, Xianbo Zhuang1, Guanhua Yan1,†()   

  1. 1. Department of Neurology, Liaocheng People’s Hospital, Liaocheng 252000, China
    2. Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng 252000, China
  • Received:2021-10-21 Published:2021-12-15
  • Corresponding author: Guanhua Yan
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王未飞, 李广峰, 庄献博, 闫冠华. 老年轻型缺血性卒中后认知障碍与血清神经丝蛋白轻链的相关性研究[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(06): 358-361.

Weifei Wang, Guangfeng Li, Xianbo Zhuang, Guanhua Yan. Correlation between cognitive impairment and serum neurofilament-light level in eldly patients with minor ischemic stroke[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(06): 358-361.

目的

探讨血清神经丝蛋白轻链（NfL）与老年轻型缺血性卒（MIS）中6个月后认知障碍的相关性。

方法

前瞻性纳入自2019年3月至2020年6月于聊城市人民医院神经科住院治疗的老年MIS患者，采用单分子免疫阵列分析法测定血清NfL水平；发病后6个月时采用蒙特利尔认知功能量表进行测评，分为认知障碍组和认知正常组，比较2组患者血清NfL水平的差异，通过统计分析血清NfL水平与认知障碍的关系。

结果

最终纳入113例患者，6个月随访时47例（41.6%）出现认知功能障碍（认知障碍组），余66例（58.4%）为认知正常组。认知障碍组患者血清NfL水平、年龄、Fazekas评分、高血压患者占比均高于认知正常组，差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示高血压、Fazeka评分、血清NfL水平是老年MIS后认知障碍的危险因素（P<0.05）。

结论

对于老年MIS患者，血清NfL水平升高是发生认知障碍的独立预测指标。

关键词: 轻型缺血性卒中, 认知障碍, 血清神经丝蛋白轻链
Objective

To investigate the relationship between serum neurofilament-light (NfL) level and post-stroke cognitive impairment 6 months after minor ischemic stroke (MIS) in eldly patients.

Methods

From March 2019 to June 2020, eldly patients with mild ischemic stroke who were admitted to the Neurology Department of Liaocheng People’s Hospital were prospectively enrolled. Serum NfL levels were measured by single molecule array. On the 6 months, all patients were divided into cognitive impairment group and cognitive normal group according to the score of Montreal cognitive assessment. The difference of serum NfL levels between the two groups was tested, and the relationship between the serum NfL level and cognitive impairment was statistically analyzed.

Results

Finally 113 elderly patients were included statistical analysis. At 6-month follow-up, 47 cases (41.6%) were diagnosed as post-stroke cognitive impairment (the cognitive impairment group), and the remaining 66 cases (58.4%) were the cognitive normal group. Compared with the cognitive normal group, the serum NfL level age, Fazekas score and the percentage of hypertension in the cognitive impairment group were all significantly higher (P<0.05). Multivariate logistic regression analysis showed that hypertension, Fazekas scale and serum NfL level were risk factors for cognitive impairment after MIS in the elderly (P<0.05).

Conclusion

For elderly patients with MIS, elevated serum neurofilament light levels are independent risk factors for cognitive impairment.

Key words: Minor ischemic stroke, Cognitive impairment, Serum neurofilament-light
表1 认知障碍组与认知正常碍组患者基线资料及血清NfL水平比较
组别 例数 年龄（岁，Mean±SD） 男性[例（%）] 吸烟[例（%）] 饮酒[例（%）] 高血压[例（%）] 糖尿病[例（%）] 高脂血症[例（%）] Fazeka评分[分，M（QR）] NIHSS评分[分，M（QR）] NfL（pg/mL，Mean±SD）
认知正常组 66 68.9±7.2 35（53.0） 17（25.8） 20（30.3） 34（51.5） 26（39.4） 28（42.4） 2.0（2.0） 1.5（3.0） 55.32±12.41
认知障碍组 47 74.2±10.3 28（59.6） 14（29.8） 12（25.5） 36（76.6） 21（44.7） 19（40.4） 3.0（3.0） 2.0（3.0） 73.84±19.25
t/χ2/Z值   3.061 0.028 0.405 1.014 5.806 0.003 0.011 3.488 0.367 3.460
P值   0.003 0.896 0.536 0.375 0.018 0.952 0.924 <0.001 0.592 0.001
表2 认知障碍组与认知正常组患者各亚认知域评分比较（Mean±SD）
组别 例数 视空间与执行能力 命名 注意与计算力 语言 抽象能力 延迟记忆 定向力
认知正常组 66 4.56±0.43 2.89±0.32 5.52±0.48 2.74±0.22 1.89±0.14 4.37±0.46 5.81±0.33
认知障碍组 47 3.67±0.35 2.87±0.31 5.06±0.36 2.61±0.18 1.42±0.25 3.18±0.61 5.77±0.30
t值   2.714 0.612 2.139 0.750 2.187 3.035 0.402
P值   0.007 0.536 0.042 0.446 0.035 0.004 0.731
表3 老年轻型缺血性卒中后认知障碍的多因素Logistic回归分析
自变量 回归系数 标准误 Wald值 OR值 95%CI P值
高血压 1.024 1.275 3.151 2.516 1.195~8.263 0.038
Fazeka评分 0.869 1.161 7.041 1.824 1.337~3.290 0.004
血清NfL 1.328 0.947 4.267 1.216 1.016~2.382 0.016
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