中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2020, Vol. 15 ›› Issue (5): 922-928.doi: 10.4103/1673-5374.268928

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

血清胱抑素C水平与缺血性脑卒中后认知功能障碍呈负相关

  

  • 出版日期:2020-05-15 发布日期:2020-06-01
  • 基金资助:
    国家自然科学基金面上项目(81673263)，中国科学技术部项目(2016YFC1307300)，江苏省高等教育优先重点开发项目

Serum cystatin C levels are negatively correlated with post-stroke cognitive dysfunction

Dao-Xia Guo1, Zheng-Bao Zhu1, Chong-Ke Zhong1, 2, Xiao-Qing Bu1, 2, Li-Hua Chen1, Tan Xu1, Li-Bing Guo3, Jin-Tao Zhang4, Dong Li5, Jian-Hui Zhang6, Zhong Ju7, Chung-Shiuan Chen2, Jing Chen2, 8, Yong-Hong Zhang1, Jiang He2, 8#br#   

  1. 1 Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric
    Diseases, Medical College of Soochow University, Suzhou, Jiangsu Province, China
    2 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
    3 Department of Neurology, Siping Central Hospital, Siping, Jilin Province, China
    4 Department of Neurology, the 88th Hospital of People’s Liberation Army, Taian, Shandong Province, China
    5 Department of Internal Medicine, Feicheng City People’s Hospital, Feicheng, Shandong Province, China
    6 Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia Autonomous Region, China
    7 Department of Neurology, Kerqin District First People’s Hospital of Tongliao City, Inner Mongolia Autonomous Region, China
    8 Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
  • Online:2020-05-15 Published:2020-06-01
  • Contact: Yong-Hong Zhang, MD, PhD,yhzhang@suda.edu.cn.
  • Supported by:
    This study was supported by the National Natural Science Foundation of China, No. 81673263 (to YHZ), Ministry of Science and Technology of China, No. 2016YFC1307300 (to YHZ), and a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions, China (to YHZ).

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摘要：

在动物实验中，胱抑素C是一种神经保护因子，其可在肾小管被完全重吸收和分解，且随着肾功能障碍程度的增加而增加。但是既往研究中胱抑素C水平与认知功能障碍的关系，结果不一。此次前瞻性试验拟观察脑卒中发病3个月时血清胱抑素C水平与脑卒中后认知功能障碍的相关性。从中国急性缺血性脑卒中的降压试验（CATIS）中获得638例患者，检测血清胱抑素C水平，并以简易智力状态检查量表评估脑卒中后3个月时的认知功能障碍，发现308例（52.9%）存在脑卒中后认知功能障碍。在调整潜在的混杂因素后，与最低四分位数相比，血清胱抑素C水平最高四分位数患者的认知功能障碍的优势比（95％置信区间）为0.54（0.30-0.98）。血清胱抑素C与认知功能障碍之间的相关性与肾功能状态有关。其中肾功能正常的脑卒中患者血清胱抑素C水平与认知功能障碍之间存在负相关性（Plinearity = 0.044），而肾功能异常的患者则没有。较高水平的血清胱抑素C与急性缺血性脑卒中患者3个月时认知功能障碍低风险有关，特别对于肾功能正常的患者。提示胱抑素C可能是脑卒中后认知功能障碍的保护因素，且其可能用于治疗缺血性脑卒中后认知障碍。CATIS试验于2012-12-3经中国苏州大学机构审查委员会批准(批准号2012-02)，并于2013年4月25日在clinicaltrials.gov注册（NCT01840072）。

orcid: 0000-0001-6188-3490 (Yong-Hong Zhang)

关键词: 胱抑素C, 认知功能障碍, 缺血性脑卒中, 肾功能正常, 肾功能异常, 简易智力状态检查量表, 蒙特利尔认知评估量表, 神经保护作用, 神经再生

Abstract: Stroke is the leading cause of death and long-term disability worldwide, and cognitive impairment and dementia are major complications of ischemic stroke. Cystatin C (CysC) has been found to be a neuroprotective factor in animal studies. However, the relationship between CysC levels and cognitive dysfunction in previous studies has revealed different results. This prospective observational study investigated the correlation between serum CysC levels and post-stroke cognitive dysfunction at 3 months. Data from 638 patients were obtained from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Cognitive dysfunction was assessed using the Mini-Mental State Examination (MMSE) at 3 months after stroke. According to the MMSE score, 308 patients (52.9%) had post-stroke cognitive dysfunction. After adjusting for potential confounding factors, the odds ratio (95% CI) of post-stroke cognitive dysfunction for the highest quartile of serum CysC levels was 0.54 (0.30–0.98), compared with the lowest quartile. The correlation between serum CysC and cognitive dysfunction was modified by renal function status. We observed a negative linear dose-response correlation between CysC and cognitive dysfunction in patients with normal renal function (Plinearity = 0.044), but not in those with abnormal renal function. Elevated serum CysC levels were correlated with a low risk of 3-month cognitive dysfunction in patients with acute ischemic stroke, especially in those with normal renal function. The current results suggest that CysC is a protective factor for post-stroke cognitive dysfunction, and could be used to treat post-stroke cognitive dysfunction. The CATIS study was approved by the Institutional Review Boards at Soochow University from China (approval No. 2012-02) on December 30, 2012, and was registered at ClinicalTrials.gov (identifier No. NCT01840072) on April 25, 2013.

Key words: abnormal renal function, cognitive dysfunction, cystatin C, ischemic stroke, Mini-Mental State Examination, neural regeneration, neuroprotective effect, normal renal function