血清Hcy、SAA和MCP-1在脑梗死后血管性认知功能障碍患者血清中的表达及意义

目的 探讨血清同型半胱氨酸(Hcy)、淀粉样蛋白A (SAA)和单核细胞趋化蛋白-1(MCP-1)在脑梗死后血管性认知功能障碍(VCI)中的表达情况，并分析其临床价值。方法选取120例脑梗死患者作为研究对象，根据是否并发VCI分为VCI组（n=32）和无VCI组（n=88）；同期选取50例健康体检者作为对照组。分别采用循环酶法和酶联免疫吸附法检测血清Hcy和SAA、MCP-1水平；对比各组血清Hcy、SAA和MCP-1水平，并绘制ROC曲线分析三者在脑梗死后VCI中的诊断价值；对比各组中文版蒙特利尔认知评估量表(MoCA)评分；采用Pearson相关分析血清Hcy、SAA和MCP-1与MMSE和MoCA评分的关系。结果对照组、无VCI组和VCI组血清Hcy、SAA和MCP-1水平比较差异有统计学意义（P<0.05），其中对照组低于无VCI组（P<0.05），无VCI组低于VCI组（P<0.05）。绘制ROC曲线，血清Hcy、SAA和MCP-1对脑梗死后VCI具有一定诊断价值（P<0.05），三者联合诊断效能最高（P<0.05）。以脑梗死后VCI发生=1，VCI未发生=0，将血清Hcy、SAA和MCP-1水平纳入二元logistic回归分析模型发现，血清Hcy、SAA和MCP-1是脑梗死后VCI的独立危险因素（P<0.05）。对照组、无VCI组和VCI组MoCA评分比较，差异有统计学意义（P<0.05），其中对照组高于无VCI组（P<0.05），无VCI组高于VCI组（P<0.05）。经Pearson相关分析得知，血清Hcy、SAA和MCP-1与MoCA评分均呈明显负相关（P<0.05）。结论血清Hcy、SAA和MCP-1在脑梗死后VCI中高表达，具有一定诊断价值，三者联合诊断效能最高，与MoCA评分负相关，是导致脑梗死后VCI发生的独立影响因素。

The expression and clinical value of serum Hcy,SAA and MCP-1 in vascular cognitive dysfunction after cerebral infarction

Objective To investigate the expression of serum homocysteine (Hcy), amyloid A (SAA) and monocyte chemoattractant protein-1 (MCP-1) in vascular cognitive impairment (VCI) after cerebral infarction, and to analyze their clinical values. Methods A total of 120 patients with cerebral infarction were selected, and were divided into VCI group (n=32) and VCI free group (n=88), according to whether there was VCI. At the same time, 50 healthy people were selected as the control group. The levels of serum Hcy, SAA and MCP-1 were assessed by circulating enzyme method and enzyme-linked immunosorbent assay. The levels of serum Hcy, SAA and MCP-1 were compared, and the diagnostic value of the three in VCI after cerebral infarction were analyzed by using ROC curve. The scores of Chinese version of Montreal cognitive assessment scale (MoCA) were compared, and the correlations between serum Hcy, SAA and MCP-1 and MMSE and MOCA scores was analyzed by Pearson correlation. Results There were significantly differences in Hcy, SAA and MCP-1 among the control group, VCI free group and VCI group (P<0.05); and those in the control group were significantly lower than those in the VCI free group (P<0.05), which were significantly lower than those in VCI group (P<0.05). ROC curve was drawn, serum Hcy, SAA and MCP-1 had significant diagnostic values for VCI after cerebral infarction (P<0.05), and the combined diagnostic efficacy of the three was the highest (P<0.05). After cerebral infarction, serum Hcy, SAA and MCP-1 were significant independent factors of VCI after cerebral infarction (P<0.05). There were significant differences in MoCA scores among the control group, VCI free group and the VCI group (P<0.05); which was significantly highest in the control group, and followed by VCI free group and VCI group (P<0.05). According to Pearson correlation analysis, serum Hcy, SAA and MCP-1 were significantly negatively correlated with MOCA score (P<0.05). Conclusion Serum Hcy, SAA and MCP-1 are highly expressed in VCI after cerebral infarction, which has a certain diagnostic value. The combined diagnosis of the three is the most effective for VCI, which is negatively related to MOCA score; and they are independent influencing factors for VCI after cerebral infarction.