【摘要】 目的:探讨首发急性缺血性脑卒中患者认知障碍发生的危险因素及对脂蛋白相关磷脂酶A2(LP-PLA2)、可溶性CD40配体(sCD40L)的相关性。方法:选取122例首发急性缺血性脑卒中患者为研究对象，根据卒中发生后3个月蒙特利尔认知(MoCA)量表评分结果分为认知障碍组(MoCA评分<26分，n=55)和非认知障碍组(MoCA≥26分，n=67)。比较两组患者卒中发生后第3天血清Lp-PLA2、sCD40L水平；受试者特征工作曲线(ROC)分析血清Lp-PLA2、sCD40L对认知障碍发生的预测价值；Logistic回归分析影响患者认知障碍发生的危险因素。结果:认知障碍组患者血清Lp-PLA2、sCD40L水平高于非认知障碍组(P<0.05)。血清Lp-PLA2、sCD40L联合检测评估首发急性缺血性脑卒中患者认知障碍发生的ROC曲线下面积(AUC)为0.850,高于单独检测的0.740、0.730(P<0.05)。相关性分析显示，首发急性缺血性脑卒中患者血清Lp-PLA2、sCD40L水平与MoCA量表评分呈现负相关(r=-0.320、-0.309,P<0.05);不同性别、年龄、文化程度、高血压病史、房颤史、吸烟史、饮酒史患者认知障碍发生情况比较，差异均无统计学意义(P>0.05);有无合并糖尿病、高血脂，病灶是否位于关键部位患者认知障碍发生情况比较，差异有统计学意义(P<0.05)。回归分析显示，合并糖尿病、合并高血脂、病灶位于关键部位(额叶、颞叶、基底、丘脑)、血清Lp-PLA2高表达、血清sCD40L高表达是首发急性缺血性脑卒中患者认知障碍发生的独立危险因素。结论:血清Lp-PLA2、sCD40L高表达与首发急性缺血性脑卒中患者认知障碍发生相关，合并糖尿病、合并高血脂、病灶位于关键部位均是患者认知功能障碍发生的独立危险因素。更多还原

【Abstract】 Objective:To investigate the risk factors of cognitive impairment in patients with first-episode acute ischemic stroke and its correlation with lipoprotein associated phospholipase A2(Lp-PLA2) and soluble CD40 ligand(sCD40 L).Methods:122 patients with first-episode acute ischemic stroke were selected.According to the score of Montreal cognitive(MoCA) scale 3 months after stroke, those with < 26 points were included in the cognitive impairment group(n=55),and those with ≥26 points were included in the non cognitive impairment group(n=67).The levels of serum Lp-PLA2 and sCD40 L were compared on the 3 rd day after stroke.The predictive value of serum Lp-PLA2 and sCD40 L on the occurrence of cognitive impairment was evaluated by receiver operating curve(ROC),and the risk factors affecting the occurrence of cognitive impairment were screened by logistic regression analysis.Results:The levels of serum Lp-PLA2 and sCD40 L in cognitive impairment group were higher than those in non cognitive impairment group(P<0.05).The area under the ROC curve of cognitive impairment in patients with first-episode acute ischemic stroke evaluated by the combined detection of serum Lp-PLA2 and sCD40 L was 0.850,which was higher than the area under the curve detected by two serum indexes alone(0.740 & 0.730,P<0.05).Pearson correlation analysis showed that the levels of serum Lp-PLA2 and sCD40 L in patients with first-episode acute ischemic stroke were negatively correlated with the score of MoCA scale(r=-0.320,-0.309,P<0.05).There was no significant difference in the incidence of cognitive impairment among patients with different gender, age, educational level, history of hypertension, history of atrial fibrillation, history of smoking and history of drinking(P>0.05).Whether there was diabetes, hyperlipidemia, and whether the lesions were located in the key parts of the patients were significantly different in the occurrence of cognitive impairment(P<0.05).Logisitic regression analysis showed that diabetes mellitus, hyperlipidemia, lesion location in the key parts(frontal lobe, temporal lobe, basal and thalamus),high expression of Lp-PLA2 in serum and high expression of serum sCD40 L were independent risk factors for cognitive impairment in patients with acute ischemic stroke.Conclusion:The high level of serum Lp-PLA2 and sCD40 L is associated with cognitive impairment in first-episode acute ischemic stroke patients.Diabetes mellitus, hyperlipidemia and focal lesions are the independent risk factors of cognitive dysfunction.更多还原