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
计量
- 文章访问数: 117
- HTML全文浏览量: 39
- PDF下载量: 1
- 被引次数: 0
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

HTML全文

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。

下载: 导出CSV

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

下载: 导出CSV

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。

下载: 导出CSV

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

下载: 导出CSV

参考文献(26)

[1]	QUINN T J, RICHARD E, TRUSCHL Y, et al. European stroke organisation and European academy of neurology joint guidelines on post-stroke cognitive impairment[J]. Eur J Neurol, 2021, 28(12): 3883-3920. doi: 10.1111/ene.15068
[2]	章丹, 曾婷婷, 傅圣勇, 等. 铁代谢对代谢综合征患者认知功能的影响[J]. 浙江临床医学, 2021, 23(1): 72-74. ZHANG D, ZENG T T, FU S Y, et al. Effect of iron metabolism on cognitive function of patients with metabolic syndrome[J]. Zhejiang Clinical Medical Journal, 2021, 23(1): 72-74.
[3]	凡勇福, 苏凯奇, 袁洁, 等. 铁代谢与缺血性脑卒中[J]. 中国组织工程研究, 2022, 26(32): 5223-5228. FAN Y F, SU K Q, YUAN J, et al. Relationship between iron metabolism and ischemic stroke[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(32): 5223-5228.
[4]	饶政清, 梅志刚, 葛金文, 等. 脑泰方调控细胞铁转运抑制铁死亡保护脑卒中缺血损伤的机制研究[J]. 中草药, 2021, 52(21): 6552-6560. RAO Z Q, MEI Z G, GE J W, et al. Mechanism of Naotaifang on ischemic stroke through regulating cellular iron transport and inhibiting ferroptosis[J]. Chinese Traditional and Herbal Drugs, 2021, 52(21): 6552-6560.
[5]	CERASUOLO M, DI MEO I, AURIEMMA M, et al. Iron and ferroptosis more than a suspect: beyond the most common mechanisms of neurodegeneration for new therapeutic approaches to cognitive decline and dementia[J]. Int J Mol Sci, 2023, 24(11): 9637. DOI: 10.3390/ijms24119637.
[6]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 Neurology Branch of Chinese Medical Association, Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[7]	吕艳, 张增强, 王海, 等. 海南版简易智能状态检查量表和蒙特利尔认知评估量表界值划分的初步研究[J]. 中华老年心脑血管病杂志, 2020, 22(4): 352-355. LYU Y, ZHANG Z Q, WANG H, et al. Cut-off point of Chinese Hainan version of MMSE scale and MoCA scale[J]. Chinese Journal of Geriatric Heart, Brain and Vessel Diseases, 2020, 22(4): 352-355.
[8]	中国卒中学会血管性认知障碍分会. 卒中后认知障碍管理专家共识2021[J]. 中国卒中杂志, 2021, 16(4): 376-389. Expert consensus on the management of post-stroke cognitive impairment 2021. Experts Consensus on Post-stroke Cognitive Impairment Management 2021 Chinese Society of Vascular Cognitive Impairment[J]. Chinese Journal of Stroke, 2021, 16(4): 376-389.
[9]	EL HUSSEINI N, KATZAN I L, ROST N S, et al. Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association/American Stroke Association[J]. Stroke, 2023, 54(6): e272-e291.
[10]	赵紫岐, 赵科洪, 屈云. 计算机辅助认知训练治疗卒中后认知功能障碍的多中心随机对照研究[J]. 中华物理医学与康复杂志, 2022, 44(11): 978-981. ZHAO Z Q, ZHAO K H, QU Y. Computer-assisted cognition training relieves cognitive dysfunction after a stroke: a multicenter randomized and controlled study[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2022, 44(11): 978-981.
[11]	谢吐秀, 吕菁君, 张新奇, 等. 铁死亡在脑缺血-再灌注损伤过程中的研究进展[J]. 中国急救医学, 2022, 42(4): 358-363. XIE T X, LYU J J, ZHANG X Q, et al. Research progress of ferroptosis in cerebral ischemia/reperfusion injury[J]. Chinese Journal of Critical Care Medicine, 2022, 42(4): 358-363.
[12]	WANG P N, CUI Y M, LIU Y Y, et al. Mitochondrial ferritin alleviates apoptosis by enhancing mitochondrial bioenergetics and stimulating glucose metabolism in cerebral ischemia reperfusion[J]. Redox Biol, 2022, 57: 102475. DOI: 10.1016/j.redox.2022.102475.
[13]	LANE D, METSELAAR B, GREENOUGH M, et al. Ferroptosis and NRF2: an emerging battlefield in the neurodegeneration of Alzheimer's disease[J]. Essays Biochem, 2021, 65(7): 925-940. doi: 10.1042/EBC20210017
[14]	李华, 杨华, 范雪怡, 等. 脑小血管病轻度抑郁与脑内红核铁含量相关性研究[J]. 中华全科医学, 2023, 21(8): 1312-1314, 1373. LI H, YANG H, FAN X Y, et al. Correlation of mild depression in patients with cerebral small vessel disease and iron content in red nucleus[J]. Chinese Journal of General Practice, 2023, 21(8): 1312-1314, 1373.
[15]	霍永彦, 陆媛, 于德华, 等. 上海农村地区老年居民轻度认知障碍患病情况及影响因素分析[J]. 山东医药, 2020, 60(14): 67-70. HUO Y Y, LU Y, YU D H, et al. Prevalence and influencing factors of mild cognitive impairment among elderly residents in rural areas of Shanghai[J]. Shandong Medical Journal, 2020, 60(14): 67-70.
[16]	AYTON S, WANG Y, DIOUF I, et al. Brain iron is associated with accelerated cognitive decline in people with Alzheimer pathology[J]. Mol Psychiatry, 2020, 25(11): 2932-2941. doi: 10.1038/s41380-019-0375-7
[17]	谷正盛, 杜冰滢, 吴汶, 等. 中枢神经系统铁沉积与血管性认知障碍研究进展[J]. 海军军医大学学报, 2022, 43(3): 301-307. GU Z S, DU B Y, WU W, et al. Iron deposition in central nervous system and vascular cognitive impairment: research progress[J]. Academic Journal of Naval Medical University, 2022, 43(3): 301-307.
[18]	孙玙, 杨水泉, 胡朝晖, 等. 血清铁调素及铁代谢指标与脑出血早期病情及预后的相关性研究[J]. 中国临床解剖学杂志, 2021, 39(3): 355-358, 362. SUN Y, YANG S Q, HU Z H, et al. Research on the serum hepcidin and iron metabolism indicator in intracerebral hemorrhage and its application in assessment of early conditions and prognosis[J]. Chinese Journal of Clinical Anatomy, 2021, 39(3): 355-358, 362.
[19]	王琪, 李景轩, 倪丽伟, 等. 脑梗死患者血清铁代谢指标变化及其与神经功能缺损程度的关系[J]. 山东医药, 2023, 63(8): 65-67. WANG Q, LI J X, NI L W, et al. Changes of serum iron metabolism indexes in patients with cerebral infarction and their relationship with the degree of neurological deficit[J]. Shandong Medical Journal, 2023, 63(8): 65-67.
[20]	薛静, 高莹, 王舒. 铁死亡在脑卒中中作用的研究进展[J]. 河北医学, 2023, 29(3): 525-528. XUE J, GAO Y, WANG S. Research progress on the role of iron death in stroke[J]. Hebei Medicine, 2023, 29(3): 525-528.
[21]	GLEASON A, BUSH A I. Iron and ferroptosis as therapeutic targets in Alzheimer's disease[J]. Neurotherapeutics, 2021, 18(1): 252-264.
[22]	XU M J, HU Y Y, WU J X, et al. Association between the serum iron and acute cognitive impairment after stroke: a cross-sectional study[J]. J Geriatr Psychiatry Neurol, 2023, 36(2): 121-128.
[23]	黄莉, 区腾飞, 杨洁, 等. 脑卒中后认知障碍预测模型的构建与验证[J]. 西安交通大学学报(医学版), 2023, 44(2): 214-220. HUANG L, QU T F, YANG J, et al. Development and validation of predictive model for cognitive impairment after stroke[J]. Journal of Xi'an Jiaotong University(Medical Sciences), 2023, 44(2): 214-220.
[24]	GALLAGHER P G. Anemia in the pediatric patient[J]. Blood, 2022, 140(6): 571-593.
[25]	魏淑琦, 孟心怡, 阎文静, 等. 急性轻型缺血性脑卒中患者扩大的血管周围间隙与脑卒中后认知功能障碍的相关性[J]. 中华神经医学杂志, 2022, 21(1): 20-27. WEI S Q, MENG X Y, YAN W J, et al. Correlation of enlarged perivascular spaces with post-stroke cognitive impairment in patients with acute mild stroke[J]. Chinese Journal of Neuromedicine, 2022, 21(1): 20-27.
[26]	钟文娟, 张秋芳, 黄程勇, 等. 献血人群血小板数与铁代谢指标的相关性研究[J]. 中国实验血液学杂志, 2023, 31(5): 1481-1485. ZHONG W J, ZHANG Q F, HUANG C Y, et al. Relationship between iron metabolic parameters and platelet counts in blood donors[J]. Journal of Experimental Hematology, 2023, 31(5): 1481-1485.