Study On The Correlation Between The Levels Of Hcy,FIB,UACR,CysC And Cognitive Function In Patients With Cerebral Small Vessel Disease

Objective: To analyze the correlation bwtween the levels of homocysteine(Hcy),fibrinogen(FIB),urinary albumin creatinine ratio(UACR),cystatin C(CysC)and cognitive function in patients with cerebral small vessel disease(CSVD),and explore the possible risk factors and predictors of cognitive impairment(CI)in CSVD,which could provide clinical reference for early detection,treatment and prevention of CI caused by CSVD.Methods: A total of 184 patients with CSVD admitted to the Department of Neurology in the Second Hospital of Lanzhou University from December 2018 to October 2019 were collected as the CSVD group continuously.According to the brain MRI imaging biomarkers include white matter hyperintensities/ white matter lesions/leukoaraiosis,lacunar infarction,cerebral microbleeds,enlarged perivascular spaces and brain atrophy,these patients were classified as single group(patients with any one biomarker,n=81)and mixed group(patients with two or more biomarkers,n=103).The hamilton depression scale(HAMD)was used to exclude the patients with depression,at the same time,the montreal cognitive assessment(MoCA)was used for cognitive function examination.The paitients were divided into CSVD with cognitive impairment(CI)group and CSVD without cognitive impairment(non-CI)group(control group)by the results of MoCA.The general clinical data in all subjects such as gender,age,education,hypertension and diabetes were recorded.Renal function indicators such as CysC,UACR,urinary microalbumin(UMALB),urinary glycoglo bulin(B2MGU),uric acid(UA),blood urea nitrogen(BUN),creatinine(Cr)and other biochemical indicators such as Hcy,FIB,fasting blood glucose(GLU),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),lipoprotein a(LPa),D-dimer were detected.All of the data were analyzed bySPSS 22.0 software.The 21 demographic parameters,hematological and urinary indicators were compared among the three groups.The logistic regression was used to screen the independent risk factors for CI,the spearman rank correlation was performed to analyze the correlation between the MoCA score with risk factors,the predictive value of risk factors was analyzed by receiver operating characteristic curve(ROC curve).Results: 1.The differences between CI patients and non-CI patients in CSVD group,single group and mixed group: In the CSVD group,the levels of CysC,UACR,Hcy and FIB in the CI patients were higher than those in the non-CI patients,and the differences were statistically significant(P<0.05).In the single group,the levels of CysC,Hcy between CI patients and non-CI patients showed statistically signifcant differences(P<0.05).In the mixed group,the levels of Hcy,FIB,UACR,B2 MGU and age in the two groups showed statistically significant differences(P<0.05).2.The multivariate logistic regression analysis revealed that: in the CSVD group,Hcy(OR=1.122,95%CI 1.041~1.210,P=0.003),FIB(OR=1.927,95%CI 1.192~3.116,P=0.007)and UACR(OR=1.012,95%CI 1.002~1.022,P=0.025)were independently correlated with CI(P<0.05),while CysC(OR=7.264,95%CI 0.981~53.768,P=0.052)was not correlated with CI(P>0.05);Hcy(OR=1.156,95%CI 1.013~1.319,P=0.031)was an independent risk factor for CI in patients of the single group(P<0.05);FIB(OR=2.989,95%CI 1.485~6.015,P=0.002)was independent risk factor for CI in patients of the mixed group(P<0.05).3.The Spearman correlation analysis presented a negative correlation between Hcy(r=-0.346,P=0.000),FIB(r=-0.367,P=0.000),UACR(r=-0.196,P=0.008)and MoCA score of patients with CSVD.4.ROC curve analysis of Hcy,FIB and UACR: Hcy(AUC=0.668,P=0.000),FIB(AUC=0.660,P=0.000)and UACR(AUC=0.592,P=0.032)had certain predictive value for CI in patients with CSVD,and there was higher predictive value for CI when three indicators were combined(AUC=0.729,P=0.000)(AUC>0.5,P<0.05).Conclusions: 1.Hcy,FIB and UACR may be the independent risk factors for CI in patients with CSVD,while CysC may be not correlated with CI.And there were differences in independent risk factor for CI in patients with different MRI burden of CSVD.Hcy was significantly associated with CI in patients which had only one brain imaging biomarker,while FIB was independent risk factor for CI in patients with greater MRI burden of CSVD.2.Hcy,FIB and UACR may have certain predictivevalue for CI in patients with CSVD,and there was higher predictive value for CI when the three indicators were combined.