肿瘤坏死因子水平及衰弱状态与老年脑卒中病人认知功能障碍的相关性

doi:10.3969/j.issn.1003-9198.2024.12.009

摘要/Abstract

摘要： 目的分析TNF-α及衰弱状态与老年脑卒中病人发生认知功能障碍的关系。方法以2022年10月至2023年10月连云港市第二人民医院收治的94例老年脑卒中病人为研究对象,所有病人均接受MoCA、Fried 衰弱量表和NIHSS评估。MoCA得分≥26分的病人为认知正常组(n=53),＜26分的病人纳入认知障碍组(n=41),检测并比较2组病人TNF-α、细胞凋亡指标[半胱天冬酶3(Caspase-3)、脂肪酸合成酶(Fas)、Fas配体(FasL)]、神经递质水平[多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)]的差异,采用多因素Logistic回归分析探讨病人认功能知障碍的影响因素,并利用ROC曲线评估相关影响因素预测老年脑卒中病人发生认知障碍的价值。结果认知障碍组病人Fried和NIHSS评分以及TNF-α、Caspase-3、Fas、FasL水平高于认知正常组,DA、5-HT、NE水平低于认知正常组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示, Fried和NIHSS评分、TNF-α、Caspase-3、Fas、FasL、DA、5-HT、NE水平均是病人发生认知障碍的独立影响因素(P均＜0.05)。ROC曲线显示,Fried评分预测认知障碍的灵敏度和特异度分别为92.7%、60.4%, TNF-α预测认知障碍的灵敏度和特异度分别为82.9%、83.0%。结论 TNF-α水平及衰弱程度更高的病人发生认知功能障碍的风险更大。

关键词: 肿瘤坏死因子-α, 衰弱, 脑卒中, 认知功能, 老年人

Abstract: Objective To analyze the relationship of tumor necrosis factor α (TNF-α) and frailty with cognitive impairment in the elderly patients with stroke. Methods Ninety-four elderly patients with stroke admitted to Lianyungang Second People’s Hospital from October 2022 to October 2023 were enrolled in this study. All patients underwent the assessment using Montreal Cognitive Assessment (MoCA) scale, Fried frailty index and National Institutes of Health Stroke Scale (NIHSS), respectively. The patients with MoCA score ≥26 were divided into the normal group (n=53), and those with score <26 were divided into the cognitive impairment group (n=41). The levels of TNF-α, apoptosis markers including cysteine-dependent aspartate-specific protease-3 (Caspase-3), fatty acid synthase (Fas), Fas ligand (FasL), and neurotransmitters including dopamine (DA), serotonin (5-HT), norepinephrine (NE) were measured and compared between the two groups. Multiple Logistic regression analysis was conducted to identify the independent factors influencing the occurrence of cognitive impairment. The predictive value of frailty and TNF-α for cognitive impairment was assessed by the receiver operating characteristic (ROC) curve. Results The scores of Fried and NIHSS, and the levels of TNF-α, Caspase-3, Fas and FasL were significantly higher, and the levels of DA, 5-HT and NE were significantly lower in the cognitive impairment group than those in the normal group. Multivariable analysis revealed that Fried and NIHSS scores, and the levels of TNF-α, Caspase-3, Fas, FasL, DA, 5-HT, and NE were independent influencing factors of cognitive impairment (all P<0.05). The sensitivity and specificity of the Fried score predicting cognitive impairment was 92.7%, 60.4%, while the sensitivity and specificity of TNF-α was 82.9%, 83.0%, respectively. Conclusions Higher levels of TNF-α and frailty are associated with an increased risk of cognitive impairment in the elderly patients with stroke.

Key words: tumor necrosis factor-α, frailty, stroke, cognitive function, aged

中图分类号:

R 749.13

汪玲玲, 申潇竹, 龚晨, 胡广云. 肿瘤坏死因子水平及衰弱状态与老年脑卒中病人认知功能障碍的相关性[J]. 实用老年医学, 2024, 38(12): 1229-1233.

WANG Lingling, SHEN Xiaozhu, GONG Chen, HU Guangyun. Relationship of tumor necrosis factor and frailty with cognitive dysfunction in elderly patients with stroke[J]. Practical Geriatrics, 2024, 38(12): 1229-1233.

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