背景:丘脑梗死患者经历多核血管异常阻塞,影响身体,从而影响丘脑。大多数丘脑梗死患者预后不良,这严重影响了他们的安全。因此,分析影响丘脑梗死患者预后的独立危险因素并制定相应的预防措施至关重要。
目的:探讨非高密度脂蛋白胆固醇(non-HDL-C)和同型半胱氨酸(Hcy)水平在丘脑梗死认知功能障碍中的作用。
方法:2019年3月至2022年3月,80例丘脑梗死患者根据MoCA评分分为认知障碍组[蒙特利尔认知评估量表(MoCA)评分<26;35例]和认知功能正常组(MoCA评分为26~30;45例)。此外,选取同期健康体检者50例作为对照组。观察到非HDL-C和Hcy水平与MoCA评分和受试者工作特征曲线之间的相关性,分析血清non-HDL-C和Hcy水平对诊断丘脑梗死患者认知功能障碍的价值。根据改良Rankin量表(MRS)评分,将80例丘脑梗死患者分为预后良好组(MRS评分≤2分)和预后不良组(MRS评分>2分)。
结果:认知障碍组的non-HDL-C和Hcy水平明显高于认知功能正常组(P<0.05)。对照组non-HDL-C水平与认知功能正常组比较,差异无统计学意义(P>0.05)。认知障碍组的MoCA评分明显低于认知功能正常组及对照组(P<0.05)。对照组与认知功能正常组比较,差异有统计学意义(P<0.05)。non-HDL-C和Hcy水平与MoCA评分相关(P<0.05),认知障碍[曲线下面积(AUC)=0.709,95%置信区间(95CI):0.599-0.816],非HDL-C水平,并可预测丘脑梗死患者的认知功能损害(AUC=0.738,95CI:0.618~0.859)。Hcy联合non-HDL-C水平可预测丘脑梗死患者认知功能损害(AUC=0.769,95CI:0.721~0.895)。预后良好组50例,预后不良组30例。与预后良好组相比,在预后不良组,美国国立卫生研究院卒中量表(NIHSS)评分,非HDL-C水平,Hcy水平,大面积脑梗塞,心房颤动,活化部分凝血酶原时间比较差异有统计学意义(P<0.05)。非HDL-C水平,Hcy水平,NIHSS得分,广泛的脑血清,房颤可能是丘脑梗死患者预后不良的独立危险因素(P<0.05)。
结论:Non-HDL-C和Hcy水平与丘脑梗死患者认知功能损害呈正相关。Non-HDL-C和Hcy水平可用于诊断丘脑梗死患者的认知障碍,联合检测效果较好。影响丘脑梗死患者预后的主要因素是non-HDL-C水平,Hcy水平,NIHSS得分,大面积脑梗塞,和心房颤动。临床上,可根据以上因素制定相应的预防措施,防止预后不良,降低死亡率。
BACKGROUND: Patients with thalamic infarction experience abnormal blockages of multinucleated vessels, affecting the body and thereby the thalamus. Most patients with thalamic infarction have an adverse prognosis, which seriously affects their safety. Therefore, it is essential to analyze the independent risk factors that influence the prognosis of patients with thalamic infarction and develop corresponding preventive measures.
OBJECTIVE: To explore the effect of non-high-density lipoprotein cholesterol (non-HDL-C) and Homocysteine (Hcy) levels in cognitive impairment in thalamic infarction.
METHODS: From March 2019 to March 2022, 80 patients with thalamic infarction were divided into a group with cognitive impairment [Montreal Cognitive Assessment (MoCA) score < 26; 35 patients] and a group with normal cognitive function (MoCA score of 26-30; 45 patients) according to the MoCA score. In addition, 50 healthy people in the same period were selected as the control group. A correlation between the non-HDL-C and Hcy levels and the MoCA score and receiver operating characteristic curve was observed, and the serum non-HDL-C and Hcy levels were analyzed for the diagnosis of cognitive impairment in patients with thalamic infarction. According to the Modified Rankin Scale (MRS) score, 80 patients with thalamic infarction were divided into a good prognosis group (MRS score ≤ 2) and a poor prognosis group (MRS score >2).
RESULTS: The non-HDL-C and Hcy levels were significantly higher in the group with cognitive impairment than in the group with normal cognitive function (P < 0.05). There was no significant difference in the non-HDL-C level between the control group and the group with normal cognitive function (P > 0.05). The MoCA scores of the group with cognitive impairment were significantly lower than those of the group with normal cognitive function and the control group (P < 0.05). There was a significant difference between the control group and the group with normal cognitive function (P < 0.05). The non-HDL-C and Hcy levels were correlated with the MoCA score (P < 0.05), cognitive impairment [areas under the curve (AUC) = 0.709, 95% confidence interval (95%CI): 0.599-0.816], the non-HDL-C level, and could predict cognitive impairment in patients with thalamic infarction (AUC = 0.738, 95%CI: 0.618-0.859). Hcy combined with non-HDL-C levels can predict cognitive impairment in patients with thalamic infarction (AUC = 0.769, 95%CI: 0.721-0.895).There were 50 patients in the good prognosis group and 30 patients in the poor prognosis group. Compared with the good prognosis group, in the poor prognosis group, the National Institutes of Health Stroke Scale (NIHSS) score, non-HDL-C level, Hcy level, large-area cerebral infarction, atrial fibrillation, and activated partial prothrombin time were statistically significant (P < 0.05). The non-HDL-C level, the Hcy level, the NIHSS score, extensive cerebral serum, and atrial fibrillation may all be independent risk factors for poor prognosis in patients with thalamic infarction (P < 0.05).
CONCLUSIONS: Non-HDL-C and Hcy levels are positively correlated with cognitive impairment in patients with thalamic infarction. Non-HDL-C and Hcy levels can be used in the diagnosis of cognitive impairment in patients with thalamic infarction, and the combined detection effect is better. The main factors affecting the prognosis of patients with thalamic infarction are the non-HDL-C level, the Hcy level, the NIHSS score, large-area cerebral infarction, and atrial fibrillation. Clinically, corresponding preventive measures can be formulated based on the above factors to prevent poor prognosis and reduce mortality.