血清γ-谷氨酰转移酶联合同型半胱氨酸预测急性脑梗死患者卒中后认知障碍的效能

Efficacy of serum gamma-glutamyl transferase combined with homocysteine in predicting post-stroke cognitive impairment in patients with acute cerebral infarction

摘要:

目的 探讨血清γ-谷氨酰转移酶（GGT）联合同型半胱氨酸（Hcy）预测急性脑梗死（ACI）患者卒中后认知障碍（PSCI）的效能。方法 纳入2021年5月至2022年5月洪湖市人民医院神经内科收治的100例ACI患者（ACI组）和50例健康体检者（对照组）作为研究对象。根据是否发生PSCI将ACI患者分为PSCI组和非PSCI组。比较各组的临床资料、蒙特利尔认知评估（MoCA）量表评分以及血清血脂指标、GGT和Hcy水平。采用多因素Logsitic回归分析确定影响ACI患者发生PSCI的危险因素，并采用受试者操作特征（ROC）曲线分析其对PSCI的预测效能。结果 100例ACI患者中73例（73.0%）发生了PSCI。ACI组患者急性期和脑梗死事件后6个月的MoCA评分无显著变化（P>0.05）；非PSCI组患者脑梗死事件后6个月的MoCA评分显著高于急性期（P<0.05）。ACI组血清GGT和Hcy水平高于对照组（P<0.05）；PSCI组血清甘油三酯（TG）、GGT和Hcy水平高于非PSCI组，高密度脂蛋白胆固醇（HDL-C）水平低于非PSCI组（P<0.05）。轻度ACI组血清GGT和Hcy水平显著低于中度组和重度组，而中度组显著低于重度组（P<0.05）。多因素Logistic回归分析显示血清GGT和Hcy是ACI患者发生PSCI的危险因素（P<0.05）。血清GGT+Hcy预测PSCI的灵敏度和阴性预测值分别为98.63%和95.24%，均显著高于单独指标检测。结论 ACI患者血清GGT和Hcy水平异常升高，二者联合对PSCI有良好的预测价值。

Abstract:

Objective To investigate the efficacy of serum gamma-glutamyl transferase （GGT） combined with homocysteine （Hcy） in predicting post-stroke cognitive impairment （PSCI） in patients with acute cerebral infarction （ACI）.Methods A total of 100 ACI patients who were admitted to Department of Neurology， Honghu People’s Hospital， from May 2021 to May 2022 were enrolled as ACI group， and 50 individuals who underwent physical examination were enrolled as control group. According to the presence or absence of PSCI， the patients with ACI were divided into PSCI group and non-PSCI group. The above groups were compared in terms of clinical data， Montreal Cognitive Assessment （MoCA） score， serum lipid parameters， and the levels of GGT and Hcy. A multivariate logistic regression analysis was used to determine the risk factors for PSCI in ACI patients， and the receiver operating characteristic （ROC） curve was used to analyze their efficacy in predicting PSCI.Results Among the 100 ACI patients， 73 （73.0%） developed PSCI. The ACI group showed no significant change in MoCA score from the acute stage to 6 months after cerebral infarction （P>0.05）， while the non-PSCI group had a significant increase in MoCA score from the acute stage to 6 months after cerebral infarction （P<0.05）. The ACI group had significantly higher levels of GGT and Hcy than the control group （P<0.05）， and compared with the non-PSCI group， the PSCI group had significantly higher levels of TG， GGT， and Hcy and a significantly lower level of HDL-C （P<0.05）. The mild ACI group had significantly lower levels of GGT and Hcy than the moderate and severe ACI groups， and the moderate group had significantly lower levels than the severe group （P<0.05）. The multivariate logistic regression analysis showed that serum GGT and Hcy were risk factors for PSCI in ACI patients （P<0.05）. GGT+Hcy had a sensitivity of 98.63% and a negative predictive value of 95.24% in predicting PSCI， which were significantly higher than those of each indicator alone.Conclusions There are abnormal increases in the serum levels of GGT and Hcy in ACI patients， and the combination of GGT and Hcy has a good value in predicting PSCI.