作者：杨超祺，陈薇，刘艳源，黎安玲，刘松梅

单位：

430071湖北省武汉市，武汉大学中南医院检验科/基因诊断中心 通信作者：黎安玲，E-mail：anling888@126.com 刘松梅，E-mail：smliu@whu.edu.cn

Units：

Department of Clinical Laboratory/Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan 430071, China Corresponding author: LI Anling, E-mail: anling888@126.com LIU Songmei, E-mail: smliu@whu.edu.cn

关键词：

脑梗死; 痴呆,血管性; 磷酸化Tau181; 血脂指标; 预测;

Keywords：

Brain infarction; Dementia, vascular; Phosphorylated Tau181; Blood lipid index; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.051

Funds：

国家自然科学基金资助项目（81972009）；武汉大学中南医院医学科技创新平台支撑项目

摘要：

背景血管性痴呆(VaD)是由脑血管疾病导致的认知功能障碍综合征,是脑梗死最常见的并发症之一。血清磷酸化Tau181(pTau181)形成纤维缠结可影响神经元功能,血脂指标在血-脑脊液屏障的损伤过程中发挥作用。目的 分析pTau181联合血脂指标对急性脑梗死患者发生VaD的预测价值。方法 选取2019年9月至2021年6月武汉大学中南医院神经内科收治住院的急性脑梗死患者114例为研究对象。根据患者是否发生VaD,将其分为VaD组(n=38)和非VaD组(n=76)。比较两组患者一般资料、pTau181及血脂指标。采用多因素Logistic回归分析探讨急性脑梗死患者发生VaD的影响因素;采用受试者工作特征(ROC)曲线评估pTau181、pTau181联合血脂指标对急性脑梗死患者发生VaD的预测价值。结果 VaD组患者pTau181、TC、LDL-C及TC、LDL-C、ApoB异常发生率高于非VaD组(P<0.05)。多因素Logistic回归分析结果显示,pTau181〔OR=1.028,95%CI(1.006,1.052)〕、TC〔OR=3.599,95%CI(1.863,6.952)〕、ApoA1〔OR=0.053,95%CI(0.009,0.962)〕、ApoB〔OR=0.008,95%CI(<0.001,0.129)〕为急性脑梗死患者发生VaD的影响因素(P<0.05)。ROC曲线分析结果显示,pTau181预测急性脑梗死患者发生VaD的曲线下面积(AUC)为0.630〔95%CI(0.526,0.734)〕,最佳截断值为18.7 ng/L,灵敏度为0.842,特异度为0.408;pTau181联合TC、ApoA1、ApoB预测急性脑梗死患者发生VaD的AUC为0.791〔95%CI(0.700,0.882)〕,最佳截断值为0.231,灵敏度为0.895,特异度为0.618。结论 pTau181、TC、ApoA1、ApoB为急性脑梗死患者发生VaD的影响因素,pTau181对急性脑梗死患者发生VaD有一定的预测价值,且其联合TC、ApoA1、ApoB的预测价值更高。

Abstract：

【Abstract】　Background Vascular dementia (VaD) is a cognitive dysfunction syndrome caused by cerebrovasculardiseases, and is one of the most common complications of cerebral infarction. Serum phosphorylated Tau181 (pTau181) formsfibrous tangles, which can affect neuronal function. Blood lipid indexes play a role in the injury of blood cerebrospinal fluid barrier.Objective To analyze the value of pTau181 combined with blood lipid indexes in predicting VaD in patients with acute cerebralinfarction. Methods A total of 114 patients with acute cerebral infarction hospitalized in the Department of Neurology, ZhongnanHospital of Wuhan University from September 2019 to June 2021 were selected as the research objects. Patients were divided intoVAD group (n=38) and non VAD group (n=76) according to whether they had VaD. The general data, pTau181 and blood lipidindexes of the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors ofVAD in patients with acute cerebral infarction; the receiver operating characteristic (ROC) curve was used to evaluate the predictivevalue of pTau181 and pTau181 combined with blood lipid index for VaD in patients with acute cerebral infarction. ResultspTau181, TC, LDL-C and the abnormal rates of TC, LDL-C and ApoB in VaD group were higher than those in non VAD group(P< 0.05) . Multivariate Logistic regression analysis showed that pTau181 [OR=1.028, 95%CI (1.006, 1.052) ] , TC [OR=3.599,95%CI (1.863, 6.952) ] , ApoA1 [OR=0.053, 95%CI (0.009, 0.962) ] , and ApoB [OR=0.008, 95%CI ( < 0.001, 0.129) ]were the influencing factors of VaD in patients with acute cerebral infarction (P < 0.05) . The results of ROC curve analysisshowed that the area under the curve (AUC) of pTau181 for predicting VaD in patients with acute cerebral infarction was 0.630[95%CI (0.526, 0.734) ] , the best cut-off value was 18.7 ng/L, the sensitivity was 0.842, and the specificity was 0.408; the AUC ofpTau181 combined with TC, ApoA1, and ApoB to predict VaD in patients with acute cerebral infarction was 0.791 [95%CI (0.700,0.882) ] , the best cut-off value was 0.231, the sensitivity was 0.895, and the specificity was 0.618.Conclusion pTau181, TC,ApoA1, and ApoB are the influencing factors of VaD in patients with acute cerebral infarction. pTau181 has a certain predictivevalue for the occurrence of VaD in patients with acute cerebral infarction, and the predictive value of pTau181 combined with TC,ApoA1, and ApoB is higher.

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