摘要
目的 探讨血清Klotho、抗心磷脂抗体(ACA)及血管内皮生长因子(VEGF)水平与进展性脑梗死(PCI)患者认知功能的相关性.方法 回顾性分析2021年8月至2023年8月长治医学院附属和平医院收治的80例PCI患者的临床资料,根据蒙特利尔认知评估量表(MoCA)得分将患者分为认知功能障碍(CD)组(MoCA评分＜26分,共31例)与非CD组(MoCA评分≥26分,共49例).收集患者一般资料[性别、年龄、体重指数、吸烟、饮酒、高血压、糖尿病、高血脂、入院时间、MoCA分值、C反应蛋白(CRP)、血肌酐、血小板计数、天冬氨酸转氨酶(AST)、空腹血糖],比较两组Klotho、ACA、VEGF水平;采取多因素非条件Logistic回归分析对PCI患者发生CD的危险因素进行分析;采取Pearson相关系数分析对Klotho、ACA、VEGF水平与PCI患者认知功能评分的相关性进行分析;通过受试者操作特征(ROC)曲线分析Klotho、ACA、VEGF评估PCI患者发生CD的价值.结果 两组的性别、体重指数、吸烟、饮酒、糖尿病、高血脂、入院时间、CRP、血肌酐、血小板计数、AST、空腹血糖组间比较,差异均无统计学意义(P＞0.05). CD组的年龄、高血压人数占比、ACA 分别为(65.13±7.08)岁、64.52％、(1.46±0.41)mg/L,均明显高于非 CD 组[(58.67±8.42)岁、40.82％、(0.86±0.19)mg/L],CD 组 MoCA 评分、Klotho水平、VEGF 水平分别为(21.14±2.06)分、(284.19±73.37)pg/mL、(193.21±7.05)pg/mL,均明显低于非 CD 组[(28.05±1.79)分、(428.46±92.58)pg/mL、(208.43±7.72)pg/mL],差异均有统计学意义(P＜0.05).多因素非条件Logistic回归分析结果显示,年龄、高血压、Klotho水平、ACA水平、VEGF水平是PCI患者发生CD的危险因素(P＜0.05).Pearson相关性分析结果显示,Klotho水平、VEGF水平与PCI患者认知功能评分呈正相关,ACA水平与PCI患者认知功能评分呈负相关,且均有P＜0.05.ROC曲线分析结果显示,Klotho水平、ACA水平、VEGF水平评估PCI患者发生CD的曲线下面积分别为0.876、0.888、0.852,敏感度分别为0.816、0.898、0.857,3项指标曲线下面积差异无统计学意义(Z=0.861,P=0.574).结论 Klotho水平、VEGF水平与PCI患者认知功能呈正相关,ACA水平与PCI患者认知功能呈负相关,以上指标可用于临床评估患者是否发生CD.
Abstract
Objective To investigate the correlation between serum levels of Klotho,anti cardiolipin antibody(ACA)and vascular endo-thelial growth factor(VEGF)and cognitive function in patients with progressive cerebral infarction(PCI).Methods The clinical data of 80 PCI patients admitted to Peace Hospital Affiliated to Changzhi Medical College from August 2021 to August 2023 were retrospectively analyzed.Accord-ing to Montreal Cognitive Assessment Scale(MoCA)scores,they were divided into the cognitive dysfunction(CD)group(31 cases with MoCA score＜26 points)and the non-CD group(49 cases with MoCA score ≥26 points).The general data of patients were collected,and the levels of Klotho,ACA and VEGF were detected.The general data[gender,age,body mass index,smoking,drinking,hypertension,diabetes,hyper-lipidemia,admission time,MoCA score,C-reactive protein(CRP),serum creatinine,platelet count,aspartate transaminase(AST),fasting blood glucose]and the levels of Klotho,ACA and VEGF were compared between the two groups.The correlation between Klotho,ACA,VEGF levels and cognitive function scores in patients with PCI was analyzed using Pearson correlation coefficient.The risk factors of CD in patients with PCI were analyzed by Multivariate non-conditional Logistic regression analysis.The value of Klotho,ACA and VEGF in the assessment of CD in patients with PCI was analyze using receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in gender,body mass index,smoking,drinking,diabetes,hyperlipidemia,time of admission,CRP,serum creatinine,platelet count,AST and fasting blood glucose between the two groups(P＞0.05).The age,proportion of hypertension and ACA in CD group were(65.13±7.08)years,64.52％and(1.46±0.41)mg/L,respectively,which were significantly higher than those in non-CD group[(58.67±8.42)years,40.82％and(0.86±0.19)mg/L],while the MoCA score,the levels of Klotho and VEGF in group CD were(21.14±2.06)points,(284.19±73.37)pg/mL and(193.21±7.05)pg/mL,respectively,which were significantly lower than that in non-CD group[(28.05±1.79)points,(428.46±92.58)pg/mL,(208.43±7.72)pg/mL],the differences were statistically significant(P＜0.05).Correlation analysis results showed that the levels of Klotho and VEGF were positively correlated with the cognitive function score of patients with PCI,while AC A was negatively correlated with the cognitive function score of patients with PCI(P＜0.05).Multivariate Logistic regression analysis showed that age,hypertension,the levels of Klotho,AC A and VEGF were risk factors for CD in patients with PCI(P＜0.05).ROC curve analysis results showed that the area under the curve of Klotho,ACA and VEGF to evaluate CD in patients with PCI were 0.876,0.888 and 0.852,and the sensitivity was 0.816,0.898 and 0.857,respectively.There was no statistically significant difference in the area under the curve of the three indicators(Z=0.861,P=0.574).Conclusion Klotho and VEGF were positively correlated with cognitive function in patients with PCI,while ACA was negatively correlated with cognitive function in patients with PCI.The above indicators can be used for clinical assessment of CD in patients.
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