留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

血管性认知障碍患者血清胱抑素C水平研究

刘凯 苏燕 屈洪党 杜苑苑 熊勃超 许力 骆嵩

刘凯, 苏燕, 屈洪党, 杜苑苑, 熊勃超, 许力, 骆嵩. 血管性认知障碍患者血清胱抑素C水平研究[J]. 中华全科医学, 2023, 21(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.002849
引用本文: 刘凯, 苏燕, 屈洪党, 杜苑苑, 熊勃超, 许力, 骆嵩. 血管性认知障碍患者血清胱抑素C水平研究[J]. 中华全科医学, 2023, 21(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.002849
LIU Kai, SU Yan, QU Hong-dang, DU Yuan-yuan, XIONG Bo-chao, XU Li, LUO Song. Study of serum cystatin C levels in patients with vascular cognitive impairment[J]. Chinese Journal of General Practice, 2023, 21(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.002849
Citation: LIU Kai, SU Yan, QU Hong-dang, DU Yuan-yuan, XIONG Bo-chao, XU Li, LUO Song. Study of serum cystatin C levels in patients with vascular cognitive impairment[J]. Chinese Journal of General Practice, 2023, 21(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.002849

血管性认知障碍患者血清胱抑素C水平研究

doi: 10.16766/j.cnki.issn.1674-4152.002849
基金项目: 

安徽省教育厅重点项目 KJ2019A0364

中匈科学合作基金-青年学者计划 20190629

详细信息
    通讯作者:

    屈洪党,E-mail:qhd820@sohu.com

  • 中图分类号: R446  R741.04

Study of serum cystatin C levels in patients with vascular cognitive impairment

  • 摘要:   目的  明确血清胱抑素C(CysC)在血管性认知障碍(VCI)患者中的表达,探讨两者间的相关性及CysC的临床预测价值。  方法  纳入蚌埠医学院第一附属医院2021年1月—2022年2月诊治的VCI患者96例。根据患者日常生活能力及蒙特利尔认知量表(MoCA)评分将患者分为血管性痴呆(VaD)组(35例)和血管性认知障碍非痴呆(VCIND)组(61例),另选取83例认知和颅脑CT/MRI均表现正常的健康老人为对照(NC)组。比较3组基线资料及CysC水平,分析CysC与VCI患者总体认知及特定认知域的关系,采用二元logistic回归分析和ROC曲线评估VCI发生的相关危险因素及CysC对其发生的预测价值。  结果  3组年龄、高血压、糖尿病、卒中史、CysC和MoCA评分差异有统计学意义(均P < 0.05);NC组、VCIND组和VaD组CysC表达水平依次升高,两两比较差异有统计学意义(均P < 0.05);CysC与VCI患者MoCA总评分以及视空间与执行力、命名、计算与注意力、语言、定向、延迟记忆呈负相关关系(均P < 0.05);Logistic回归分析显示CysC表达升高可能是VCI发生的独立危险因素(P < 0.05);ROC曲线分析显示CysC预测VCI发生的AUC为0.758,灵敏度为70.8%,特异度为77.1%,最佳截断值为0.99 mg/L。  结论  血清胱抑素C在VCI中高表达并与认知损害严重程度相关,是认知障碍发生的独立影响因素,有望成为VCI早期评估的生物学指标。

     

  • 图  1  血清CysC预测血管性认知障碍发生的ROC曲线分析

    Figure  1.  ROC curve analysis of serum CysC in predicting vascular cognitive impairment

    表  1  3组研究对象一般资料及MoCA评分比较

    Table  1.   Comparison of general information and MoCA scores among the three groups

    项目 NC组(n=83) VCIND组(n=61) VaD组(n=35) 统计量 P
    性别(男/女, 例) 40/43 28/33 17/18 0.095c 0.954
    年龄(x±s, 岁) 66.48±6.97 68.05±7.36 71.00±6.51ab 5.111d 0.007
    BMI(x±s) 24.58±2.99 24.22±3.28 23.73±3.89 0.835d 0.435
    受教育年限(x±s, 年) 9.01±2.32 8.62±3.04 7.98±2.80 0.345d 0.693
    吸烟史[例(%)] 18(21.68) 18(29.50) 8(22.85) 1.230c 0.541
    饮酒史[例(%)] 11(13.25) 11(18.03) 5(14.28) 0.649c 0.723
    高血压史[例(%)] 39(46.98) 41(67.21)a 31(88.57)ab 19.134c < 0.001
    糖尿病史[例(%)] 15(18.07) 29(47.54)a 17(48.57)a 17.659c < 0.001
    高脂血症[例(%)] 28(33.73) 31(50.81) 16(45.71) 4.476c 0.107
    卒中史[例(%)] 13(15.66) 32(52.45)a 30(85.71)ab 53.865c < 0.001
    TC(x±s, mmol/L) 3.84±0.94 3.70±1.06 3.82±1.21 0.312d 0.732
    TG[M(P25, P75), mmol/L] 1.21(0.87, 1.70) 1.34(0.88, 1.77) 1.16(0.78, 1.76) 0.848e 0.654
    LDL-C(x±s, mmol/L) 2.38±0.68 2.15±0.79 2.17±0.71 2.000d 0.138
    HDL-C(x±s, mmol/L) 1.02±0.28 1.00±0.24 0.98±0.26 0.378d 0.686
    FBG[M(P25, P75), mmol/L] 5.19(4.69, 6.05) 5.36(4.69, 6.84) 5.72(4.63, 8.22) 1.909e 0.385
    UA[M(P25, P75), μmol/L] 304(255, 335) 285(234, 335) 271(211, 336) 2.164e 0.339
    BUN(x±s, mmol/L) 6.53±1.06 6.82±0.98 7.09±1.72 0.820d 0.441
    SCr(x±s, μmol/L) 69.32±15.06 71.56±16.54 73.68±21.43 1.529d 0.219
    CysC(x±s, mg/L) 0.85±0.32 1.07±0.32a 1.29±0.63ab 9.662d < 0.001
    MoCA评分[M(P25, P75), 分] 28(27, 28) 18(13, 20)a 10(8, 14)ab 148.693e < 0.001
    注:与NC组比较,aP < 0.05;与VCIND组比较,bP < 0.05。c为χ2值,dt值,eH值。
    下载: 导出CSV

    表  2  VCI患者血清CysC与MoCA及特定认知域的相关性分析

    Table  2.   Correlation analysis of serum CysC with MoCA and specific cognitive domains in patients with VCI

    项目 MoCA 视空间与执行 命名 注意 计算 语言 抽象 延迟记忆 定向
    r -0.472 -0.380 -0.230 -0.269 -0.274 -0.311 -0.164 -0.363 -0.303
    P < 0.001 < 0.001 0.024 0.008 0.007 0.002 0.110 < 0.001 0.003
    下载: 导出CSV

    表  3  VCI发生的多因素logistic回归分析

    Table  3.   Multivariate logistic regression analysis of VCI occurrence

    模型 B SE Wald χ2 P OR 95% CI
    单变量分析 2.476 0.577 18.423 < 0.001 11.898 3.840~36.862
    多变量模型1 1.533 0.644 5.662 0.017 4.630 1.310~16.360
    多变量模型2 1.706 0.729 5.472 0.019 5.507 1.319~23.001
    下载: 导出CSV
  • [1] DICHGANS M, LEYS D. Vascular cognitive impairment[J]. Circ Res, 2017, 120(3): 573-591. doi: 10.1161/CIRCRESAHA.116.308426
    [2] LIVINGSTON G, HUNTLEY J, SOMMERLAD A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission[J]. Lancet, 2020, 396(10248): 413-446. doi: 10.1016/S0140-6736(20)30367-6
    [3] LEES J S, WELSH C E, CELIS-MORALES C A, et al. Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease[J]. Nat Med, 2019, 25(11): 1753-1760. doi: 10.1038/s41591-019-0627-8
    [4] ROTHENBACHER D, REHM M, IACOVIELLO L, et al. Contribution of cystatin C and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project[J]. BMC Med, 2020, 18(1): 300. doi: 10.1186/s12916-020-01776-7
    [5] VIGGIANO D, WAGNER C A, MARTINO G, et al. Mechanisms of cognitive dysfunction in CKD[J]. Nat Rev Nephrol, 2020, 16(8): 452-469. VIGGIANO D, WAGNER C A, MARTINO G, et al. Mechanisms of cognitive dysfunction in CKD[J]. Nat Rev Nephrol, 2020, 16(8): 452-469. doi: 10.1038/s41581-020-0266-9
    [6] CUI Z Z, CAO G Z, WANG Y Y, et al. Effects of cystatin C on cognitive impairment in older Chinese adults[J]. Am J Alzheimers Dis Other Demen, 2020, 35: 1533317520965101. DOI: 10.1177/1533317520965101.
    [7] CHEN X P, HUANG Y, BAO T, et al. Changes in serum cystatin C levels and the associations with cognitive function in Alzheimer's disease patients[J]. Front Aging Neurosci, 2022, 13: 790939. DOI: 10.3389/fnagi.2021.790939.
    [8] GHIDONI R, BENUSSI L, GLIONNA M, et al. Plasma cystatin C and risk of developing Alzheimer's disease in subjects with mild cognitive impairment[J]. J Alzheimers Dis, 2010, 22(3): 985-991. doi: 10.3233/JAD-2010-101095
    [9] 中国医师协会神经内科分会认知障碍专业委员会, 《中国血管性认知障碍诊治指南》编写组. 2019年中国血管性认知障碍诊治指南[J]. 中华医学杂志, 2019, 99(35): 2737-2744. doi: 10.3760/cma.j.issn.0376-2491.2019.35.005

    Cognitive Disorders Professional Committee, Neurology Branch, Chinese Medical Doctor Association, Writing group of Chinese Guidelines for the diagnosis and treatment of vascular cognitive Impairment. Guidelines for Diagnosis and Treatment of vascular cognitive Impairment in China, 2019[J]. 中华医学杂志, 2019, 99(35): 2737-2744. doi: 10.3760/cma.j.issn.0376-2491.2019.35.005
    [10] 甘露, 刘涛, 王淑华, 等. 中文版简明精神状态量表与蒙特利尔认知评估量表临床应用进展[J]. 中国康复医学杂志, 2017, 32(7): 842-845. doi: 10.3969/j.issn.1001-1242.2017.07.026

    GAN L, LIU T, WANG S H, et al. Clinical application of the Chinese version of the concise mental state scale and the montreal cognitive assessment scale[J]. Chinese Journal of Rehabilitation Medicine, 2017, 32(7): 842-845. doi: 10.3969/j.issn.1001-1242.2017.07.026
    [11] BOLAND J R. DSM-5 (R) guidebook: the essential companion to the diagnostic and statistical manual of mental disorders, 5th edition[J]. J Psychiatr Pract, 2015, 21(2): 171-173. doi: 10.1097/01.pra.0000462610.04264.fa
    [12] ZENG Q, HUANG Z H, WEI L L, et al. Correlations of serum cystatin C level and gene polymorphism with vascular cognitive impairment after acute cerebral infarction[J]. Neurol Sci, 2019, 40(5): 1049-1054. doi: 10.1007/s10072-019-03777-8
    [13] 叶明, 陈育华, 刘晓林, 等. 帕金森病患者血清半胱氨酸蛋白酶抑制剂C水平的变化及其临床意义[J]. 中华全科医学, 2016, 14(12): 2004-2007. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.010

    YE M, CHEN Y H, LIU X L, et al. The clinical significance of serum cystatin C level change in Parkinson's disease[J]. Chinese Journal of General Practice, 2016, 14(12): 2004-2007. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.010
    [14] YAO T T, SONG G P, LI Y H, et al. Chronic kidney disease correlates with MRI findings of cerebral small vessel disease[J]. Ren Fail, 2021, 43(1): 255-263. doi: 10.1080/0886022X.2021.1873804
    [15] DUAN J H, MARCELLUS K A, QIN X K, et al. Cystatin C promotes tau protein phosphorylation and causes microtubule instability by inhibiting intracellular turnover of GSK3β in neurons[J]. Mol Cell Neurosci, 2018, 89: 1-8. doi: 10.1016/j.mcn.2018.03.009
    [16] PERLENFEIN T J, MURPHY R M. A mechanistic model to predict effects of cathepsin B and cystatin C on β-amyloid aggregation and degradation[J]. J Biol Chem, 2017, 292(51): 21071-21082. doi: 10.1074/jbc.M117.811448
    [17] SHEIKH A M, WADA Y, TABASSUM S, et al. Aggregation of cystatin C changes its inhibitory functions on protease activities and amyloid β fibril formation[J]. Int J Mol Sci, 2021, 22(18): 9682. doi: 10.3390/ijms22189682
    [18] FANG Z P, FENG Y, LI Y H, et al. Neuroprotective autophagic flux induced by hyperbaric oxygen preconditioning is mediated by cystatin C[J]. Neurosci Bull, 2019, 35(2): 336-346. doi: 10.1007/s12264-018-0313-8
    [19] WU H X, DU Q N, DAI Q Y, et al. Cysteine protease cathepsins in atherosclerotic cardiovascular diseases[J]. J Atheroscler Thromb, 2018, 25(2): 111-123. doi: 10.5551/jat.RV17016
    [20] ZHANG Y R, SUN L. Cystatin C in cerebrovascular disorders[J]. Curr Neurovasc Res, 2017, 14(4): 406-414.
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  226
  • HTML全文浏览量:  67
  • PDF下载量:  8
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-05-05
  • 网络出版日期:  2023-04-20

目录

    /

    返回文章
    返回