TH及Apelin在脑小血管病致认知功能障碍患者血清中的变化及意义

Correlation of serum thyroxine and Apelin with cognitive impairment in patients with cerebral small vessel disease

摘要:

目的 探讨脑小血管疾病（cerebral small vessel disease，CSVD）患者循环血甲状腺激素（thyroxine，TH）及孤独G蛋白耦联受体配体Apelin与认知障碍（cognitive impairment，CI）的关系。方法 本研究共纳入85例CSVD患者及30例健康对照（healthy control，HC）组。依据蒙特利尔认知评估量表（Montreal cognitive assessment scale，MoCA），CSVD患者被进一步分为非认知障碍（non-cognitive impairment，NCI）组、CI组。采用酶联免疫吸附测定法检测血清TH、Apelin水平。采用MoCA对认知功能进行评估。Pearson相关分析及一元线性回归分析用于评估TH、Apelin与CI的关系。采用logistic回归分析确定CI患病的危险因素。受试者工作特征（receiver operating characteristic，ROC）曲线评价TH、Apelin水平对CSVD相关CI的诊断价值。结果 相比HC组、NCI组，CI组的游离三碘甲状腺原氨酸（free triiodothyronine，FT3）水平明显下降，而Apelin水平则明显升高。相关性分析显示，在CSVD患者中Apelin与MoCA呈弱负相关。多因素logistic回归分析对潜在影响因素（年龄、受教育年限）进行校正后的结果显示，较低水平的FT3和较高水平的Apelin是CSVD患者出现CI的独立危险因素。ROC曲线分析显示，FT3和Apelin均对CSVD患者并发CI具有较高诊断价值，而FT3/Apelin联合模型可进一步增加对CI诊断的准确性。结论 FT3降低和Apelin升高与CSVD出现CI密切相关，将FT3和Apelin纳入联合预测模型有助于识别CSVD疾病状态下处于CI风险的患者。

Abstract:

Objective To investigate whether serum thyroxine（TH） and Apelin are associated with cognitive impairment（CI） in patients with cerebral small vessel disease（CSVD）.Methods A total of 85 consecutive patients with CSVD and 30 healthy controls（HC） were recruited in this study. The patients were assessed via the Montreal cognitive assessment scale（MoCA） and further divided into non-cognitive impairment（NCI） group and CI group. The levels of serum TH and Apelin were detected by enzyme-linked immunosorbent assay. MoCA was used to assess the cognitive function. The relationship between the TH，Apelin and CI was explored through Pearson correlation analysis and univariate linear regression analysis. Logistic regression analysis was used to determine risk factors associated with CI onset. The receiver operating characteristic（ROC） curve was used to analyze the diagnostic value of TH and Apelin in CSVD associated CI.Results Compared with HC group and NCI group，patients in CI group had significantly lower free triiodothyronine（FT3） levels and higher Apelin levels. The correlation analysis revealed a negative correlation between Apelin and MoCA in CSVD patients. The logistic analysis adjusted for confounding factors showed that the increase in Apelin and decrease in FT3 significantly correlated with CI risk. ROC curve analysis suggested that FT3，Apelin，and the combination of FT3-Apelin had a significant diagnostic value for CI.Conclusion The decrease of FT3 and increase of Apelin are independently associated with CI and their combination may be useful in identifying who is at risk for CI in CSVD patients.