Value of serum HCY and Cys-C levels for cognitive impairment assessment in elderly patients with both cerebral small vessel disease and obstructive sleep apnea-hypopnea syndrome
Objective To explore the value of serum homocysteine(HCY)and cystatin C(Cys-C)levels for evalu-ating the presence and severity of cognitive impairment in elderly patients with both cerebral small vessel disease(CSVD)and obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A retrospective study was performed on 150 el-derly patients with both CSVD and OSAHS who were treated in our hospital from January to December 2020.The data about HCY and Cys-C levels were collected.According to the presence or absence of cognitive impairment,they were di-vided into observation group(with cognitive impairment,41 cases)and control group(without cognitive impairment,109 cases).The serum HCY and Cys-C levels of the two groups were compared.The correlations between serum HCY and Cys-C levels and cognitive impairment in patients with both CSVD and OSAHS were analyzed.A binary Logistic regression analysis was performed to determine independent factors affecting cognitive impairment to establish a predictive logistic re-gression model.Receiver operating characteristic(ROC)curves were plotted to examine the predictive value of HCY,Cys-C,and their combination for cognitive impairment in patients with both CSVD and OSAHS.According to the severity of cognitive impairment,the patients in the observation group were further divided into mild cognitive impairment group(32 cases)and severe cognitive impairment group(9 cases)to compare HCY and Cys-C levels and analyze the value of HCY,Cys-C,and their combination in evaluating the staging of cognitive impairment by using ROC curves.Results The levels of HCY and Cys-C in the observation group were significantly higher than those in the control group(both P<0.05).The total score of Montreal Cognitive Assessment was negatively correlated with serum HCY and Cys-C level(r=-0.756,-0.713,both P<0.001).The logistic regression analysis showed that HCY and Cys-C levels were inde-pendent influencing factors for cognitive impairment(both P<0.05).The area under the curve(AUC)of HCY plus Cys-C for prediction was 0.843(0.747-0.934),which was higher than that of any single indicator(P<0.05),with the sensitiv-ity and specificity being 89.32%and 79.25%,respectively.The levels of HCY and Cys-C were significantly lower in the patients with mild cognitive impairment than in those with severe cognitive impairment(both P<0.05).The AUC of HCY plus Cys-C in cognitive impairment staging was 0.925(0.849-0.976),which was higher than that of any single index(P<0.05).The sensitivity and specificity were 95.67%and 89.67%,respectively.Conclusion Serum HCY and Cys-C levels are negatively correlated with the development and progression of cognitive impairment in elderly pa-tients with both CSVD and OSAHS.The combined pre-diction with the two indicators can facilitate the evalua-tion of the risk and stage of cognitive impairment.
HomocysteineCystatinCerebral small vessel diseaseObstructive sleep apnea-hypopnea syndromeCognitive impairment
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