The Study Of Plasma Levels Of Et-1, VEGF And The Correlative Risk Factors In Patients With Vascular Cognitive Impairment

Objective To investigate the correlative risk factors on cognitive function impairment after cerebral infarction; To detect the changes of endothelin-1(ET-1) and vascular endothelial growth factor(VEGF) in the plasma of patients with vascular cognitive impairment(VCI), we study the correlation of ET-1, VEGF, cognitive impairment degree and the risk factors, then, the role of ET-1, VEGF in the pathogenesis of VCI and the correlation between them, In order to provide basement on prevention, early diagnosis and intervention of VCI.Methods The patients in neurology department of 117 cases of acute cerebral infarction after 3 months in the People's Hospital of Ning xia Autonomy from March 2009 to August 2010, who were in line with the 1995 Fourth National Symposiumon Cerebrovascular Diseases revised diagnostic criteria and Hachinski grade≥7. Patients were divided into No cognitive Impairment (N-VCI) group 30 cases, cognitive impairment no dementia (VCIND) group 57 cases and Vascular dementia (VD) group 30 cases by cognition assessment and corresponding standards. Recorded the smoking, alcohol using of the patients and whether they had the history of hyperlipidemia, hypertension, diabete, definited whether they had white matter lesions by CT or MRI; Radio-immunity was used to detect the concentration of ET-1 and Enzyme-linked immunosorbent assay(ELISA)was used to detect the concentration of VEGF in the plasma of the patients; Neuropsychology scale such as Montreal Cognitive Assessment(MoCA), Activities of Daily Living(ADL), Clinical Dementia Rating (CDR), Hachinski Ischemic Index(HIS), Hamilton Depression Rating Scale(HAMD) were applied to evaluate of patients. Case-control study was used to analyze ET-1 and VEGF. Results (1)MoCA in VD group, VCIND group and group were respectively (15.57±2.92), (21.75±2.14) and (26.60±0.89), ADL were respectively (50.60±4.34), (39.35±5.16) and(30.70±3.74), MoCA in VD group was lower than that of CIND group and N-VCI group, CIND group was lower than that of N-VCI group, there were significantly Statistical differences (P<0.01); ADL in VaD group was significantly higher than that of CIND group and N-VCI group, CIND group was higher than that of N-VCI group(P<0.01).(2)Single factor analysis showed that the incidence rate of hypertension, diabete history and white matter lesions in VCI group were high than N-VCI group(P<0.05 or P<0.01), but smoking, alcohol using of the patients and history of hyperlipidemia in the two groups had no significantly statistical difference(P>0.05).(3)Logistic regression analysis showed that hypertension and white matter lesions were positively correlated with VCI, the regression coefficient were respectively 1.817, 1.351, and the OR were respectively1.146, 0.875, 6.154, 3.863.(4)The plasma of ET-1 in VD group, VCIND group and N-VCI group were respectively (73.07±7.77)pg/ml, (82.67±8.57)pg/ml and(91.98±5.92)pg/ml; VEGF in VD group, VCIND group and N-VCI group were respectively (196.14±5.36)pg/ml, (200.18±6.56)pg/ml and (207.88±6.84)pg/ml. ET-1 in VD group were significantly higher than that of CIND and N-VCI group, but VEGF in VD group were lower than that of CIND and N-VCI group, there were significantly Statistical differences(P<0.01); ET-1 in CIND group higher than that of N-VCI group, but VEGF in CIND group lower than that of N-VCI group, there were significantly Statistical differences (P<0.01).(5)The Spearman correlation analyses revealed the plasma of ET-1 and VEGF were neg- ative correlation (r=-0.724, P<0.01); The plasma of ET-1 showed negative correlation with MoCA(r=-0.655, P<0.01); The plasma of VEGF in VD was significantly positively correlated with MoCA (r=0.505, P<0.01).(6)Cerebral infarction size and location had certain relevance with VCI, MoCA in TACI/ PACI, POCI and LACI patients were significantly different (P<0.01); but ET-1 and VEGF had no significantly statistical differences in different types of cerebral infarction(P>0.05).(7)White matter lesions had certain relevance with VCI, MoCA in White matter lesions and no white matter lesions were significantly Statistical differences (P<0.01);The plasma of ET-1 in white matter lesions was higher than no white matter lesions, and VEGF was lower, there were significantly Statistical differences (P<0.01).Conclusions (1)Hypertension, diabete and white matter lesions are the occurrence risk factors of VCI.(2)The level of plasma ET-1 was increased in VCI patients and VEGF was reduced in VCI patients, the heavier of the cognitive dysfunction, the higher of plasma ET-1 and the lower of plasma VEGF. Indicating that ET-1, VEGF are closely related with VCI, High ET-1 and low VEGF maybe take part in the process of VCI.(3)Cerebral infarction size and location had certain relevance with VCI but ET-1and VEGF are not affected by the size and location.(4)White matter lesion is important risk of VCI, ET-1 maybe take part in the process of WML.