血清铁相关指标与脑卒中后认知障碍风险的相关性

陈娟; 陈世宣; 王丰; 黄文文

doi:10.16766/j.cnki.issn.1674-4152.003754

血清铁相关指标与脑卒中后认知障碍风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003754

温州市中西医结合医院神经外科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2021ZB276

详细信息

通讯作者:
陈娟，E-mail：chen1173709943@163.com

中图分类号: R749.13
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出版历程
- 收稿日期: 2024-02-27
- 网络出版日期: 2024-12-31

Correlation analysis between serum iron-related indicators and risk of post-stroke cognitive impairment in stroke patients

Department of Neurosurgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨血清铁(SI)相关指标与脑卒中后认知障碍(PSCI)风险的相关性，为临床干预PSCI提供理论基础。方法回顾性选取2021年2月—2023年7月于温州市中西医结合医院诊治的281例脑卒中患者的临床资料，采用蒙特利尔认知评估量表(MoCA)对患者进行认知功能评估，并根据MoCA评分结果将＜26分设为PSCI组，≥26分设为无PSCI组。收集并比较2组一般资料、血清铁相关指标、神经评测及影像学相关资料，采用多因素logistic回归分析研究影响PSCI的相关因素。结果 281例脑卒中患者中有124例出现PSCI，发生率为44.13%。2组年龄、Hb比较，差异均有统计学意义(P＜0.05)。2组SI、铁蛋白(SF)、转铁蛋白(TRF)、总铁结合力(TIBC)、转铁蛋白饱和度(TSAT)、铁调素(Hep)比较，差异均有统计学意义(P＜0.05)。2组美国国立卫生研究院卒中量表(NIHSS)评分、梗死体积、血管周围间隙扩大率比较，差异均有统计学意义(P＜0.05)。多因素logistic回归分析显示，高水平的Hb、SI、TRF和TIBC是发生PSCI的独立保护因素，而高水平的SF及Hep、高NIHSS评分、梗死体积增大、血管周围间隙扩大是发生PSCI的独立危险因素。结论 PSCI发生风险较高，且SI、TRF、TIBC等血清铁相关指标与其发生风险具有相关性。
- 缺血性脑卒中 /
- 血清铁类 /
- 认知功能障碍 /
- 风险 /
- 预后
Abstract: Objective To explore the correlation between serum iron (SI) related indexes and the risk of post-stroke cognitive impairment (PSCI), providing a theoretical basis for clinical intervention in PSCI. Methods A retrospective analysis was conducted on the clinical data of 281 stroke patients treated at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2021 to July 2023. Cognitive function was evaluated by Montreal cognitive assessment scale (MoCA). According to the results of MoCA score, the score of < 26 was set as the PSCI group, and the score of ≥26 was set as the non-PSCI group. The general data, serum iron-related indexes, neurological evaluations, and imaging-related data were collected and compared between the two groups. The related factors affecting PSCI were analyzed by multivariate logistic regression. Results Among the 281 stroke patients, 124 patients developed PSCI, with an incidence rate of 44.13%. Significant differences were observed in age and Hb between the two groups (P < 0.05). SI, serum ferritin (SF), transferrin (TRF), total iron binding capacity (TIBC), transferrin saturation (TSAT), and hepcidin (Hep) were compared between the two groups, with statistically significant differences (P < 0.05). There were significant differences in National Institute of Health stroke scale (NIHSS) score, infarct volume, and perivascular space expansion rate between the two groups (P < 0.05). Multivariate logistic regression analysis showed that higher levels of Hb, SI, TRF, and TIBC were independent protective factors against PSCI, while elevated SF, Hep levels, high NIHSS scores, increased infarct volume, and enlarged perivascular spaces were independent risk factors for PSCI. Conclusion The risk of PSCI is significant, and serum iron-related indexes such as SI, TRF, and TIBC are closely associated with its development.
- Ischemic stroke /
- Serum iron /
- Cognitive impairment /
- Risk /
- Prognosis

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表 1 PSCI组和无PSCI组脑卒中患者临床一般资料比较[例(%)]

Table 1. Comparison of clinical general data between the PSCI group and the non-PSCI group [cases (%)]

项目	PSCI组(n=124)	无PSCI组(n=157)	统计量	P值
年龄(x±s，岁)	63.79±5.24	54.64±5.82	5.206^a	＜0.001
性别[例(%)]			0.958^b	0.328
男性	79(63.71)	91(57.96)
女性	45(36.29)	66(42.04)
BMI(x±s)	22.74±1.32	22.60±1.41	0.857^a	0.392
发病至入院时间(x±s，h)	9.37±2.14	9.01±2.21	1.380^a	0.169
受教育年限(x±s，年)	12.48±3.34	12.81±3.15	0.843^a	0.400
吸烟史[例(%)]	46(37.10)	62(39.49)	0.168^b	0.682
饮酒史[例(%)]	74(59.68)	86(54.78)	0.679^b	0.410
糖尿病[例(%)]	46(37.10)	51(32.48)	0.652^b	0.419
高血压[例(%)]	87(70.16)	98(62.42)	1.846^b	0.174
高脂血症[例(%)]	32(25.81)	41(26.11)	0.003^b	0.953
TC(x±s，mmol/L)	6.01±0.84	5.87±0.91	1.337^a	0.182
TG(x±s，mmol/L)	2.51±0.82	2.35±0.86	1.589^a	0.113
LDL-C(x±s，mmol/L)	3.04±0.85	2.89±0.62	1.649^a	0.101
HDL-C(x±s，mmol/L)	0.95±0.25	1.01±0.31	1.796^a	0.074
入院时收缩压(x±s，mmHg)	146.01±15.36	145.27±18.61	0.365^a	0.715
入院时舒张压(x±s，mmHg)	82.25±10.09	81.64±10.23	0.500^a	0.617
WBC(x±s，×10⁹/L)	6.02±1.31	6.14±1.25	0.778^a	0.437
RBC(x±s，×10¹²/L)	4.90±0.34	4.96±0.31	1.527^a	0.128
Hb(x±s，g/L)	132.48±25.56	141.78±23.18	3.155^a	0.002
注：^a为t值，^b为χ²值。1 mmHg=0.133 kPa。

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表 2 PSCI组和无PSCI组脑卒中患者血清铁相关指标比较(x±s)

Table 2. Comparison of serum iron-related indexes between the PSCI group and the non-PSCI grou (x±s)

组别	例数	SI(μmol/L)	SF(ng/mL)	TRF(g/L)	TIBC(μmol/L)	TSAT(%)	Hep(μg/L)
PSCI组	124	14.57±4.12	276.94±81.45	1.45±0.62	45.24±11.21	22.54±7.17	42.68±11.58
无PSCI组	157	17.14±4.28	185.12±53.41	2.01±0.81	55.73±10.98	31.18±8.25	34.91±10.51
t值		5.104	10.846	6.564	7.860	9.382	5.816
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 PSCI组和无PSCI组脑卒中患者NIHSS评分及影像学资料比较

Table 3. Comparison of NIHSS score and imaging data between the PSCI group and the non-PSCI group

组别	例数	NIHSS评分(x±s，分)	梗死体积(x±s，cm³)	病灶部位[例(%)]				血管周围间隙扩大[例(%)]
组别	例数	NIHSS评分(x±s，分)	梗死体积(x±s，cm³)	基底节区	丘脑	内囊	其他	有	无
PSCI组	124	15.04±1.26	1.85±0.57	71(57.26)	25(20.16)	21(16.94)	7(5.64)	48(38.71)	76(61.29)
无PSCI组	157	12.35±1.12	1.22±0.61	88(56.05)	32(20.38)	31(19.75)	6(3.82)	21(13.38)	136(86.62)
统计量		18.655^a	8.918^a	0.813^b				24.002^b
P值		＜0.001	＜0.001	0.846				＜0.001
注：^a为t值，^b为χ²值。

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表 4 脑卒中患者PSCI的logistic回归分析

Table 4. Logistic regression analysis of PSCI in stroke patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.003	0.003	0.637	0.425	1.003	0.996~1.009
Hb	-0.008	0.002	15.965	＜0.001	0.992	0.988~0.996
SI	-0.062	0.012	25.169	＜0.001	0.940	0.917~0.963
SF	0.009	0.001	122.504	＜0.001	1.009	1.007~1.010
TRF	-0.377	0.065	33.212	＜0.001	0.686	0.603~0.780
TIBC	-0.024	0.005	24.256	＜0.001	0.977	0.968~0.986
TSAT	-0.009	0.006	2.104	0.147	0.991	0.979~1.003
Hep	0.016	0.004	13.210	＜0.001	1.016	1.007~1.025
NIHSS评分	0.095	0.012	67.722	＜0.001	1.100	1.075~1.125
梗死体积	0.219	0.078	7.932	0.005	1.244	1.069~1.449
血管周围间隙扩大	0.952	0.113	70.843	＜0.001	2.592	2.076~3.235

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