脑小血管病患者外周血Hcy，VILIP-1和UA水平与病情严重程度及认知障碍的相关性研究

目的　探究外周血同型半胱氨酸（homocysteine，Hcy）、视椎蛋白样蛋白1（visinin-like protein 1，VILIP- 1）、尿酸（uric acid，UA）与脑小血管病（cerebral small vessel disease，CSVD）患者病情程度及认知障碍相关性。方法　选取2017 年6 月～ 2019 年6 月沧州市人民医院医专院区70 例CSVD 患者作为观察组，同期选取30 例健康体检者作为对照组。统计两组及观察组不同神经功能、脑动脉搏动指数（PI）、有无认知障碍、外周血Hcy，VILIP-1 和UA 水平，通过Spearman 和多元线性回归模型分析外周血各指标与病情程度、认知障碍的关系。结果　①观察组外周血VILIP-1（671.05±201.32 pg/ml），Hcy（20.83±6.25 μmol/L），UA（352.21±78.66 μmol/L）高于对照组（475.12±142.54pg/ml，10.05±3.02 μmol/L 和241.25±40.86 μmol/L）, 差异均有统计学意义（t=4.831，8.989，7.698，均P ＜ 0.05）。②观察组PI 重度者外周血UA（449.79±134.94μmol/L），Hcy（30.43±5.89μmol/L）和VILIP-1（876.94±263.08pg/ml）水平高于PI 轻中度者（273.46±82.04μmol/L，360.18±108.05μmol/L；15.33±4.60μmol/L，20.58±6.27μmol/L；502.51±150.75pg/ml，689.84±206.95pg/ml）, 差异均有统计学意义（F=13.545~35.749，均P ＜ 0.05）。观察组NIHSS评分外周血UA（443.70±133.11μmol/L），Hcy（28.33±5.46μmol/L），VILIP-1（941.35±282.41pg/ml）水平高于NIHSS 评分轻中度者（280.25±84.08μmol/L，372.59±111.78μmol/L；16.05±4.82μmol/L，21.42±5.91μmol/L；498.88±149.65pg/ml，692.27±207.61pg/ml），差异均有统计学意义（F=12.544~23.020，均P ＜ 0.05）。③观察组认知障碍者UA（389.96±116.99μmol/L），Hcy（25.66±7.71μmol/L），VILIP-1（811.52±243.56pg/ml）水平高于无认知障碍者（301.88±90.56μmol/L，14.39±4.32μmol/L，483.76±145.13pg/ml），差异均有统计学意义（F=3.424~7.710，均P＜ 0.05）。④外周血Hcy，VILIP-1，UA与PI 呈正相关（r=0.836，0.883，0.728），与NIHSS 评分呈正相关（r=0.665，0.762，0.666），与认知障碍呈负相关（r=-0.591，0.635，0.599）；在控制年龄、性别等其他因素后，外周血Hcy（标准化偏回归系数:0.277，1.122，-0.250），VILIP-1（标准化偏回归系数:0.638，0.304，-0.319），UA（标准化偏回归系数:0.251，0.656，-0.398）与PI 和NIHSS 评分、认知障碍显著相关（均P ＜ 0.05）。结论　CSVD 患者外周血Hcy，VILIP-1 和UA 水平呈高表达，与病情程度、认知障碍密切相关。联合检测其水平变化有助于指导临床治疗。

Analysis of the Correlation between Peripheral Blood Hcy,VILIP-1, UA and the Severity of Patients with Cerebral Small Vessel Disease and Cognitive Impairment

Objective　To explore the correlation between peripheral blood homocysteine (Hcy), visinin-like protein 1 (VILIP-1), uric acid (UA) and the degree of disease and cognitive impairment in patients with cerebral small vessel disease (CSVD). Methods　From June 2017 to June 2019, 70 patients with CSVD in Cangzhou People’s Hospital, were selected as the observation group, and 30 healthy patients were selected as the control group during the same period. Counting the different disease levels neural function (NIHSS score), cerebral artery pulsatility index (PI)], peripheral blood Hcy, VILIP-1 and UA levels of cognitive impairment in the two groups and the observation group. Spearman, multiple linear regression model analyzed the relationship between peripheral blood indicators and the degree of illness, cognitive impairment. Results　① The peripheral blood VILIP-1 (671.05±201.32pg/ml), Hcy (20.83±6.25μmol/L) and UA (352.21±78.66μmol/L) of the observation group were higher than those of the control group (475.12±142.54pg/ml, 10.05±3.02 μmol/L, 241.25±40.86μmol/L)，the differences were statistically significant (t=4.831, 8.989, 7.698, all P <0.05). ② The levels of UA (449.79±134.94μmol/L), Hcy (30.43±5.89μmol/L) and VILIP-1 (876.94±263.08 pg/ml) in peripheral blood of patients with severe PI in the observation group were higher than those of patients with mild obseravation moderate PI (273.46±82.04μmol/L, 360.18±108.05μmol/L; 15.33±4.60μmol/L, 20.58±6.27μmol/L;502.51±150.75pg/ml, 689.84±206.95pg/ml), the differences were statistically significant (F=13.545~35.749, all P<0.05), the observation group NIHSS score peripheral blood UA (443.70±133.11μmol/L), Hcy (28.33±5.46μmol/L), VILIP-1 (941.35±282.41pg/ml) level was higher than NIHSS score of mild to moderate (280.25±84.08μmol/L and 372.59±111.78μmol/L, 16.05±4.82μmol/L and 21.42±5.91μmol/L, 498.88±149.65pg/ml and 692.27±207.61pg/ml), the differences were statistically significant(F=12.544~23.020, all P<0.05), respectively. ③ Observation group with cognitive impairment UA (389.96±116.99μmol/L), Hcy (25.66±7.71μmol/L) and VILIP-1 (811.52±243.56pg/ ml) level was higher than those without cognitive impairment (301.88±90.56μmol/L, 14.39±4.32μmol/L, 483.76±145.13 pg/ml), the differences were statistically significant (F=3.424~7.710, all P<0.05). ④ Peripheral blood Hcy, VILIP-1 and UA were positively correlated with PI (r=0.836, 0.883, 0.728), and positively correlated with NIHSS score (r=0.665, 0.762, 0.666), negatively correlated with cognitive impairment (r=-0.591，-0.635，-0.599).After controlling for age, gender, BMI and other factors, peripheral blood Hcy (standardized bias regression coefficient: 0.277, 1.122，-0.250), VILIP-1 (standardized partial regression coefficient: 0.638, 0.304, -0.319), UA (standardized partial regression coefficient: 0.251, 0.656，-0.398) were significantly correlated with PI, NIHSS scores, and cognitive impairment (all P<0.05). Conclusion　The levels of Hcy, VILIP-1 and UA in peripheral blood of patients with csvd were highly expressed, which were closely related to the severity of the disease and cognitive impairment. Combined detection of their levels is helpful to guide clinical treatment.