| Purpose Cholinesterase(CHE)is a kind of enzyme that catalyzes the hydrolysis of acylcholine,which is divided into two categories: acetylcholinesterase(ACh E)and butyrylcholinesterase(Bu Ch E).Studies have shown that serum CHE activity level is related to the degree and prognosis of patients with cerebral infarction,but whether serum CHE activity level can accurately predict cognitive dysfunction in patients with acute cerebral infarction,and the damage of each cognitive domain has rarely been reported.In this study,the serum CHE activity level in patients with acute cerebral infarction was detected,and the correlation between serum CHE activity level and cognitive dysfunction and cognitive domain impairment in patients with acute cerebral infarction was observed.To explore its predictive value for cognitive dysfunction in patients with acute cerebral infarction,and provide reliable basis for accurate prediction of cognitive dysfunction in patients with clinical acute cerebral infarction.Methods We continuously choose 142 cases of patients with first acute cerebral infarct received treatment in Department of Neurology of Subei People's Hospital of Jiangsu Province.Hospital from June,2018 to August,and their ages ranged from 18 to 80;we collect general clinical characteristics,risk factors of stroke,area of cerebral infarction of them;then examine activity level of CHE in serum of peripheral veins by colorimetry at admission.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological deficits in patients with acute cerebral infarction;90 days after discharge,the Barthe index(BI)was used to assess the ability of daily life,the Hamilton Depression Scale(HAMD)to assess patients' depression and Hamilton anxiety Table(HAMA)to assess the anxiety of patients;the Montreal Cognitive Assessment Scale(MoCA,a face-to-face follow-up of patients)was used to evaluate the 90 days cognitive function status of patients;the modified Rankin scale(mRS)was used to assess the motor function of patients at 90 days(by face-to-face follow-up).MoCA score ? 26 was set as normal cognitive function,and MoCA score < 26 was set as cognitive dysfunction(patients with less than 12 years of education can get 1 point);mRS 2was identified as having good motor function and mRS>2 as having motor dysfunction.At first,we use the single factor analysis method to compare the baseline data and the activity level of CHE in serum of patients with acute cerebral infarct in cognitive disorder group and non-cognitive disorder group,then apply Spearman's correlation coefficient analysis method to analyze the relevance among the activity level of CHE in serum,90 days MoCA scores,and evaluation of other cognitive domains of patients with acute cerebral infarct;through the binary class logistic regression equation analysis of patients with acute cerebral infarctcongitive disorder risk factors;Secondly,the Receiver Operating Characteristic Curve(ROC)test was used to analyze the predictive value of serum CHE activity in 90 d cognitive dysfunction.Finally,the optimal serum CHE cutoff values of normal cognition and cognitive disorder at 90 days were analyzed by the Youden index.According to the optimal point to patients with acute cerebral infarct is divided into high CHE in serum CHE and low serum in two groups,Differences in clinical data characteristics,90 days MoCA total score,cognitive domain score and mRS score are compared between the two groups.Results1.Comparing with patients with acute cerebral infarct in cognitive disorder group and non-cognitive disorder group,activity level of CHE in serum of patients in cognitive disorder group is lower(P<0.05).2.To patients with acute cerebral infarct,activity level of CHE in serum is positively correlated with 90 days MoCAtotal score,naming,language,memory,attention,abstraction,orientation,visual space are all positively correlated with performance score(P:<0.001,0.034,0.039,0.029,0.004,0.030,0.021,<0.001).3.Serum CHE activity level and the trend change of cognitive impairment rate in patients with acute cerebral infarction: according to the CHE activity in serum three digits can be divided into three groups,the median activity of CHE in serum in the three groups is 9043,7492,5644 IU/L,respectively.The ratio of patients with 90 days congitive disorder is25.50%,47.90%,and 89.40%,respectively.The differences between the three groups are statistically significant(P < 0.001).4.Logistic regression analysis showed that serum CHE activity was a protective factor for cognitive impairment in patients with acute cerebral infarction(OR value is 0.444,95%CI0.325-0.607,P<0.001).5.The area under the ROC curve between the 90-day prognosis of cognitive impairment and serum CHE in patients was 0.801(95% CI 0.729-0.874,P<0.05);The best critical point of normal cognition and cognitive impairment was 7288IU/L(sensitivity 0.701 and specificity 0.815)by Youden index.According to the best critical point,patients with acute cerebral infarction were divided into two groups: serum CHE ?7288IU/L and serum CHE >7288IU/L,two groups of patients with MoCAscores and the cognitive domain scores,mRS score have significant statistical significance at 90 days(P<0.05).Conclusion1.The level of serum CHE activity was significantly correlated with cognitive impairment in patients with acute cerebral infarction.The lower the level of serum CHE activity,the higher the incidence of cognitive impairment in patients,and vice versa,the lower the incidence of cognitive impairment in patients.2.To patients with acute cerebral infarct,activity level of CHE in serum is positively correlated with 90 days MoCA total score,naming,language,memory,attention,abstraction,orientation,visual space are all positively correlated with performance score.3.Activity level of CHE in serum of patients with acute cerebral infarct can become one of clinical evaluation indexes of predicting cognitive disorder,harm of various cognitive domains,and motor dysfunction on 90 days. |
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