血清sICAM-1、VEGF在缺血性脑卒中致血管性痴呆患者中的表达及临床意义

Expression and clinical significance of serum sICAM-1 and VEGF in patients with vascular dementia caused by ischemic stroke

摘要:

目的 观察血清可溶性细胞间黏附分子-1（sICAM-1）、血管内皮生长因子（VEGF）在缺血性脑卒中致血管性痴呆（VD）患者中的表达及临床意义。方法 回顾性分析2020年1月—2021年6月南京中医药大学连云港附属医院收治的112例缺血性脑卒中患者的临床资料，发生VD的31例缺血性脑卒中患者为VD组，其余81例为非VD组。另选取该院同期体检的健康人员55例为健康组。比较3组血清sICAM-1、VEGF水平；比较VD组和非VD组的临床资料，采用多因素逐步Logistic回归分析缺血性脑卒中后发生VD的影响因素；绘制受试者工作特征（ROC）曲线分析血清sICAM-1、VEGF单独及联合检测对缺血性脑卒中后发生VD的预测价值。结果 与健康组比较，非VD组、VD组血清sICAM-1、VEGF水平升高（P <0.05）；与非VD组比较，VD组血清sICAM-1水平升高（P <0.05），血清VEGF水平降低（P <0.05）。与非VD组比较，VD组吸烟占比、高血压及NIHSS评分升高（P <0.05），两组的年龄、性别构成、BMI、饮酒、VD家族史、高盐饮食、高脂血症、糖尿病、冠心病、多发性脑梗死、脑梗死病史、脑白质疏松、脑梗死部位、梗死范围、职业类型比较，差异无统计学意义（P >0.05）。多因素逐步Logistic回归分析显示，吸烟［O^R=1.881（95% CI：1.521，2.242）］、高血压［O^R=7.043（95% CI：4.123，9.963）］、NIHSS评分［O^R=4.674（95% CI：2.379，6.969）］、额叶脑梗死［O^R=2.396（95% CI：1.985，2.808）］、血清sICAM-1水平［O^R=4.591（95% CI：2.379，6.802）］、血清VEGF水平［O^R=4.889（95% CI：2.147，7.631）］均是缺血性脑卒中后发生VD的危险因素（P <0.05）；ROC曲线结果显示，血清sICAM-1、VEGF预测缺血性脑卒中后发生VD的最佳截断值为365.41 ng/L和216.52 pg/mL，两者单独及联合检测缺血性脑卒中后发生VD的AUC分别为0.754、0.793和0.868。结论 在缺血性脑卒中致VD患者中血清sICAM-1高表达，VEGF低表达，两者单独及联合检测对缺血性脑卒中后VD的发生具有较高的预测价值。

Abstract:

Objective To observe the expression and clinical significance of serum soluble intercellular adhesion molecule-1 (sICAM-1) and vascular endothelial growth factor (VEGF) in patients with vascular dementia (VD) caused by ischemic stroke (IS).Methods The clinical data of 112 IS patients in our hospital from January 2020 to June 2021 were retrospectively analyzed. 31 IS patients with VD were assigned to the VD group, and the remaining 81 patients were assigned to the Non-VD group. In addition, 55 healthy patients who underwent physical examination in this hospital during the same period were selected as the healthy group. The levels of serum sICAM-1 and VEGF in the three groups were compared. The clinical data of the two groups were compared, and the logistic regression analysis method was used to analyze the influencing factors of VD after IS. The ROC curve was drawn to analyze the predictive value of serum sICAM-1 and VEGF alone and in combination on the occurrence of VD after IS.Results Compared with the healthy group, the serum sICAM-1 and VEGF levels in the Non-VD group and the VD group were increased (P < 0.05). Compared with the Non-VD group, the serum sICAM-1 level in the VD group was increased (P < 0.05), of which the serum VEGF level was decreased (P < 0.05). Compared with the Non-VD group, smoking, hypertension, and the NIHSS score in the VD group were increased (P < 0.05). Logistic regression analysis showed that smoking [O^R = 1.881 (95% CI: 1.521, 2.242) ], hypertension [O^R = 7.043 (95% CI: 4.123, 9.963) ], high NIHSS score [O^R = 4.674 (95% CI: 2.379, 6.969) ], frontal cerebral infarction [O^R = 2.396 (95% CI: 1.985, 2.808) ], serum sICAM-1 [O^R = 4.591 (95% CI: 2.379, 6.802) ] and VEGF levels[O^R = 4.889 (95% CI: 2.147, 7.631) ] were all risk factors for VD after IS (P < 0.05). ROC results showed that the best cut-off points for serum sICAM-1 and VEGF to predict the occurrence of VD after IS were 365.41 ng/L and 216.52 pg/mL, respectively. The AUC of VD after the detection of IS was 0.754, 0.793, and 0.793, 0.868.Conclusion In patients with VD caused by IS, there is a high expression of serum sICAM-1 and a low expression of VEGF. The detection of the two alone or in combination has a high predictive value for the occurrence of VD after IS.