Risk Factors Of Post-stroke Fatigue And Cognitive Impairment And The Correlation With TNF-α And Lipid Levels

Objective: To investigate the correlation of TNF-α,blood lipid levels with post-stroke fatigue(PSF)and post-stroke cognitive impairment(PSCI)in acute ischemic stroke(AIS)patients,and to understand the effects of other risk factors on PSF and PSCI in order to evaluate,screen and intervene in time and provide a theoretical basis for clinical diagnosis and treatment.Methods: A total of 203 cases with first-episode acute cerebral infarction admitted in the Neurology Department of our hospital were selected from August 2019 to October 2020.The clinical data of all patients were collected.Fasting blood samples were collected from the morning of the second day after admission for blood lipid test and serum preparation.And the TNF-α was detected by Elisa.The fatigue severity scale(FSS)and Montreal Cognitive Scale(Mo CA)were used to evaluate fatigue and cognitive function of all patients on the tenth day after onset,then they were divided into fatigue group and non-fatigue group,cognitive impairment group and non-cognitive impairment group.Among them,patients with both fatigue and cognitive impairment were in the PSF+PSCI group,only fatigue patients were in the O-PSF group,only cognitive impairment patients were in the O-PSCI group and no fatigue and cognitive impairment patients were in the control group.The data were analyzed and processed by SPSS22.0 statistical software.Results:(1)A total of 203 patients with first-onset acute cerebral infarction were included in this study.The average FSS score was(35.41±4.89)points,the average Mo CA score was(26.14±1.93)points.There were 76 patients with fatigue,accounting for 37.44%;There were 79 patients with cognitive impairment,accounting for 38.92%.There were 37 patients in the PSF+PSCI group,accounting for 18.23%;39 patients in the O-PSF group,accounting for 19.21%;42 patients were in the O-PSCI group,accounting for 20.69%;85 patients in the control group,accounting for 41.87%.(2)Single factor analysis showed that there were significant differences in hypertension,diabetes,NIHSS score,cognitive impairment,TNF-α,TG,TC,LDL-C and HDL-C between fatigue group and non-fatigue group(P<0.05).Logistic regression analysis showed that NIHSS score >3 points(OR=3.916,95%CI: 1.663～9.218),higher TNF-αlevel(OR=1.077,95%CI: 1.027～1.129)or higher LDL-C level(OR=2.530,95%CI:1.401～4.569)were independent risk factors of PSF in the acute phase(P< 0.05).Correlation analysis showed that FSS scores was positively correlated with TNF-α,LDL-C and NIHSS score(r: 0.381,0.210,0.236,P<0.05).(3)Single factor analysis showed that there were significant differences in education degree,hypertension,diabetes,NIHSS score,fatigue,TNF-α,TG,TC and LDL-C between cognitive impairment group and non-cognitive impairment group(P<0.05).Logistic regression analysis showed hypertension(OR=6.890,95%CI: 2.511～18.910),NIHSS score >3points(OR=3.969,95%CI: 1.532～10.278),higher TNF-α level(OR=1.108,95%CI:1.052～1.167),higher TC level(OR=1.689,95%CI: 1.021～2.794),higher LDL-C level(OR=2.319,95%CI: 1.278～4.208)were independent risk factors of PSCI in the acute stage(P<0.05);Correlation analysis showed that Mo CA score was negatively correlated with TNF-α,LDL-C,TC and NIHSS score in PSCI patients(r:-0.407,-0.281,-0.237,-0.339,P<0.05).(4)The levels of TNF-α,TC and LDL-C in the PSF+PSCI group were higher than those in the O-PSF group,the O-PSCI group and the control group(P<0.05);The levels of TNF-α and LDL-C in the O-PSCI group and the O-PSF group had no statistical significance(P>0.05),but were higher than those in the control group(P<0.05);There was no significant difference in TC level among the O-PSF group,the O-PSCI group and the control group(P>0.05).Conclusions:(1)PSF in acute stage is related to hypertension,diabetes,NIHSS score,TNF-α,TG,TC,LDL-C and HDL-C levels,in which NIHSS score >3 points,higher TNF-α level and higher LDL-C level are independent risk factors of PSF,and FSS score is positively correlated with NIHSS score,TNF-α and LDL-C levels.(2)PSCI in acute stage is related to education degree,hypertension,diabetes,NIHSS score,TNF-α,TG,TC and LDL-C levels.Among them,hypertension,NIHSS score >3 points,higher TNF-α level,higher TC level and higher LDL-C level are independent risk factors of PSCI,and Mo CA score is negatively correlated with NIHSS score,TNF-α,LDL-C and TC levels.(3)There may be a certain correlation between PSF and PSCI,but the specific causality and pathogenesis still need further study and verification.