血管性痴呆患者血清MMP-9,NLRP3,Hcy水平变化及其与认知、神经功能、预后的关系

目的 探讨血管性痴呆(VD)患者血清基质金属蛋白酶(MMP)-9、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、同型半胱氨酸(Hcy)水平变化及其与认知、神经功能、预后的关系。方法 选取2018年1月-2020年4月本院82例VD患者为观察组,同期82例体检健康者为对照组,测定对照组、观察组不同认知功能、神经功能状况、预后(出院6个月后神经功能障碍程度)患者血清MMP-9,NLRP3,Hcy水平,应用Pearson相关性分析观察血清各指标水平与VD患者MMSE,NIHSS评分的关联性,Logistic回归分析探讨VD患者预后功能障碍分级为Ⅲ级的影响因素,绘制受试者工作特征(ROC)曲线探讨血清各指标水平对VD患者预后功能障碍分级为Ⅲ级的预测价值。结果 观察组血清MMP-9,NLRP3,Hcy水平高于对照组,且观察组预后功能障碍分级为Ⅲ级患者血清MMP-9,NLRP3,Hcy水平高于Ⅰ～Ⅱ级患者(P<0.05); 随观察组MMSE评分增高其血清MMP-9,NLRP3,Hcy水平逐渐降低,随NIHSS评分增高其血清各指标水平也逐渐增高(P<0.05); Pearson相关性分析显示,VD患者血清各指标水平与MMSE评分呈负相关(r=-0.600、-0.786、-0.624,P<0.05),与NIHSS评分呈正相关(r=0.588、0.633、0.476,P<0.05); Logistic回归分析显示,MMSE评分为VD患者预后功能障碍分级为Ⅲ级的重要保护因素,NIHSS评分、血清MMP-9,NLRP3,Hcy水平为VD患者预后功能障碍分级为Ⅲ级的重要危险因素(P<0.05); 绘制ROC曲线显示,血清MMP-9,NLRP3,Hcy水平联合预测VD患者预后功能障碍分级为Ⅲ级的敏感度为82.35%,特异度为83.08%。结论 VD患者血清MMP-9,NLRP3,Hcy水平可显著增高,且增高幅度与认知、神经功能有关,预测预后的价值较高。

Serum MMP-9, NLRP3 and Hcy level Changes in cerebrovascular dementia and their relationship with cognition,nerve function and prognosis

ObjectiveTo investigate serum matrix metalloproteinase(MMP)-9, nucleotide binding oligomerization domain-like receptor protein 3(NLRP3)and homocysteine(Hcy)level changes in cerebrovascular dementia(VD)and their relationship with cognition, nerve function and prognosis.Methods From January 2018 to April 2020, 82 cases of VD patients in our hospital were selected as the observation group, and 82 healthy patients in the same period were selected as the control group. The serum MMP-9, NLRP3 and Hcy levels were measured and compared in patients with different cognition, neurological function and different prognosis(degree of dysfunction after 6 months of discharge)in the observation group and the control group. Pearson correlation analysis was used to observe the correlation between serum parameter levels and MMSE and NIHSS scores in VD patients. Logistic regression analysis was used to explore the influencing factors of VD patients with prognosis of dysfunction grade Ⅲ. The receiver operating characteristic(ROC)curve was drawn to explore the predictive value of serum parameters for the prognosis of dysfunction grade Ⅲ in VD patients.Results The serum MMP-9, NLRP3 and Hcy levels in the observation group were higher than those in the control group, and serum MMP-9, NLRP3 and Hcy levels of VD patients with prognosis of dysfunction grade Ⅲin the observation group were higher than those of VD patients with prognosis of dysfunction grade I to Ⅱ(P<0.05), the serum MMP-9, NLRP3 and Hcy levels gradually decreased with the increase of the MMSE score of the observation group, and the serum parameter levels gradually increased with the increase of the NIHSS score(P<0.05). Pearson correlation analysis showed that the serum parameter levels of VD patients were negatively correlated with MMSE score(r=-0.600,-0.786,-0.624,P<0.05)and positively correlated with NIHSS score(r=0.588,0.633,0.476, P<0.05). Logistic regression analysis showed that the MMSE score was an important protective factor for the prognosis of dysfunction grade Ⅲ of VD patients, and the NIHSS score, serum MMP-9, NLRP3, and Hcy levels were the important risk factors for the prognosis of dysfunction grade Ⅲ of VD patients(P<0.05), ROC curve showed that the sensitivity and specificity of the combined use of serum MMP-9, NLRP3, and Hcy levels for predicting prognosis of dysfunction grade Ⅲ of VD patients were 82.35% and 83.08% respectively.Conclusion The serum MMP-9, NLRP3, and Hcy levels in patients with VD could be significantly increased, and the increase was related to cognitive and neurological functions, and the value of predicting prognosis and functional status was high.