血清Hcy、S100B水平和脑部代谢物指标与老年AIS患者认知障碍的相关性

doi:10.3969/j.issn.1673-8640.2025.11.011

摘要/Abstract

摘要：

目的探讨血清同型半胱氨酸（Hcy）、S100B蛋白水平和脑部代谢物指标[N-乙酰天门冬氨酸盐（NAA）/肌酸比值、胆碱复合物（Cho）/肌酸比值]与老年急性缺血性脑卒中（AIS）患者认知障碍的关系。方法选取2021年1月—2023年6月上海市黄浦区香山中医医院老年AIS患者92例。收集所有患者入院时的临床资料，并采用氢质子磁共振波谱检测患者脑部代谢物[N-乙酰天门冬氨酸盐（NAA）、胆碱复合物（Cho）、肌酸]，计算 NAA/肌酸比值和Cho/肌酸比值；检测Hcy、S100B蛋白、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、白细胞介素（IL）-1β、IL-6、肿瘤坏死因子-α（TNF-α）、IL-8、IL^-10。对所有患者随访6个月，根据蒙特利尔认知评估量表（MoCA）评分将患者分为认知障碍组（46例）和无认知障碍组（46例）。采用Pearson相关分析评估各项指标与MoCA评分的相关性。结果认知障碍组左、右侧大脑半球NAA/肌酸比值均显著低于无认知障碍组（P<0.001），Cho/肌酸比值均高于无认知障碍组（P<0.01）；血清Hcy、S100B蛋白水平均显著高于无认知障碍组（P<0.05）。2个组血清IL^-1β、IL-6、TNF-α、IL-8、IL^-10、TC、TG、LDL-C、HDL-C水平差异均无统计学意义（P>0.05）。AIS患者左、右侧大脑半球NAA/肌酸比值与MoCA评分均呈负相关（r值分别为-0.13、-0.20，P<0.05），左、右侧大脑半球Cho/肌酸比值与MoCA评分均呈正相关（r值分别为0.17、0.14，P<0.05），血清Hcy、S100B蛋白与MoCA评分均呈正相关（r值分别为0.47、0.21，P<0.05）。结论 AIS患者脑部NAA/肌酸比值、Cho/肌酸比值和血清Hcy、S100B蛋白水平与认知障碍密切相关，或可作为判断认知障碍发生风险的生物学指标。

关键词: 同型半胱氨酸, S100B蛋白, N-乙酰天门冬氨酸盐/肌酸比值, 胆碱复合物/肌酸比值, 急性缺血性脑卒中, 认知障碍, 老年

Abstract:

Objective To investigate the relationship between serum homocysteine（Hcy），S100B protein levels and cerebral metabolite indicators [N-acetylaspartate（NAA）/creatine ratio，choline complex（Cho）/creatine ratio] and cognitive impairment in elderly patients with acute ischemic stroke（AIS）. Methods A total of 92 elderly AIS patients from Shanghai Huangpu Xiangshan Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were enrolled. The clinical data at admission were collected，and hydrogen proton magnetic resonance spectroscopy was used to determine cerebral metabolites [NAA，Cho，creatine]，and the NAA/creatine ratio and Cho/creatine ratio were calculated. Laboratory indicators [Hcy，S100B protein，total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），interleukin （IL）-1β，IL-6，tumor necrosis factor-alpha（TNF-α），IL-8，IL^-10] were determined. All the patients were followed up for 6 months，and they were classified into cognitive impairment group（46 cases）and non-cognitive impairment group（46 cases）according to the Montreal Cognitive Assessment（MoCA）. Pearson correlation analysis was used to evaluate the correlation between each index and the MoCA score. Results The NAA/creatine ratio in the left and right hemispheres of the brain in cognitive impairment group was lower than that in non-cognitive impairment group（P<0.001），and the Cho/creatine ratio was higher（P<0.01）. The serum Hcy and S100B protein levels in cognitive impairment group were higher than those in non-cognitive impairment group（P<0.05）. There was no statistical significance in serum IL^-1β，IL-6，TNF-α，IL-8，IL^-10，TC，TG，LDL-C and HDL-C levels between the 2 groups（P>0.05）. The NAA/creatine ratio in the left and right hemispheres of the brain in AIS patients was negatively correlated with the MoCA score（r values were -0.13 and -0.20，respectively，P<0.05），and the Cho/creatine ratio was positively correlated with the MoCA score（r values were 0.17 and 0.14，respectively，P<0.05）. Serum Hcy and S100B protein were positively correlated with the MoCA score（r values were 0.47 and 0.21，respectively，P<0.05）. Conclusions The NAA/creatine ratio，Cho/creatine ratio and serum Hcy and S100B protein levels in the brain are related to cognitive impairment in AIS patients and may serve as the biological indicators for assessing the risk of cognitive impairment.

Key words: Homocysteine, S100B protein, N-acetylaspartate/creatine ratio, Choline complex/creatine ratio, Acute ischemic stroke, Cognitive impairment, Elderly

中图分类号:

R446.11

沈志瑛, 陈铭, 董悦颖. 血清Hcy、S100B水平和脑部代谢物指标与老年AIS患者认知障碍的相关性[J]. 检验医学, 2025, 40(11): 1097-1101.

SHEN Zhiying, CHEN Ming, DONG Yueying. Correlation between serum Hcy，S100B levels and cerebral metabolite indicators and cognitive impairment in elderly AIS patients[J]. Laboratory Medicine, 2025, 40(11): 1097-1101.

图/表 3

参考文献 22

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组别	例数	左侧大脑半球		右侧大脑半球
组别	例数	NAA/肌酸比值	Cho/肌酸比值	NAA/肌酸比值	Cho/肌酸比值
认知障碍组	46	1.03±0.19	1.33±0.23	1.09±0.21	1.31±0.20
无认知障碍组	46	1.28±0.39	1.10±0.12	1.30±0.18	1.16±0.24
t值		3.908	6.013	5.150	3.256
P值		<0.001	<0.001	<0.001	0.002

组别	例数	左侧大脑半球		右侧大脑半球
组别	例数	NAA/肌酸比值	Cho/肌酸比值	NAA/肌酸比值	Cho/肌酸比值
认知障碍组	46	1.03±0.19	1.33±0.23	1.09±0.21	1.31±0.20
无认知障碍组	46	1.28±0.39	1.10±0.12	1.30±0.18	1.16±0.24
t值		3.908	6.013	5.150	3.256
P值		<0.001	<0.001	<0.001	0.002

组别	例数	IL^-1β/（pg·mL^-1）	IL-6/（pg·mL^-1）	TNF-α/（ng·mL^-1）	IL-8/（μg·L^-1）	IL^-10/（μg·L^-1）
认知障碍组	46	63.32±20.44	84.13±20.66	1.31±0.21	10.36±5.16	26.17±10.43
无认知障碍组	46	65.07±18.96	90.27±19.84	1.26±0.33	9.48±7.73	24.55±11.70
t值		0.426	1.454	0.867	0.642	0.701
P值		0.671	0.149	0.388	0.522	0.485

组别	例数	IL^-1β/（pg·mL^-1）	IL-6/（pg·mL^-1）	TNF-α/（ng·mL^-1）	IL-8/（μg·L^-1）	IL^-10/（μg·L^-1）
认知障碍组	46	63.32±20.44	84.13±20.66	1.31±0.21	10.36±5.16	26.17±10.43
无认知障碍组	46	65.07±18.96	90.27±19.84	1.26±0.33	9.48±7.73	24.55±11.70
t值		0.426	1.454	0.867	0.642	0.701
P值		0.671	0.149	0.388	0.522	0.485

组别	例数	TC/ （mmol·L^-1）	TG/ （mmol·L^-1）	LDL-C/ （mmol·L^-1）	HDL-C/ （mmol·L^-1）	Hcy/ （μmol·L^-1）	S100B蛋白/ （μg·L^-1）
认知障碍组	46	4.51±0.78	1.96±1.27	2.95±1.67	1.16±0.49	13.40±3.32	0.36±0.14
无认知障碍组	46	4.79±1.01	1.79±1.12	2.64±1.26	1.25±0.37	9.76±4.30	0.29±0.12
t值		1.488	0.681	1.005	0.994	4.544	2.575
P值		0.140	0.498	0.318	0.323	<0.001	0.012