急性脑梗死患者血清BDNF、IL-18、hs-CRP水平与血管性认知障碍的相关性

doi:10.19723/j.issn.1671-167X.2024.04.026

Abstract

Abstract:

Objective: To explore the correlations between serum levels of brain-derived neurotrophic factor (BDNF), interleukin-18 (IL-18) and hypersensitivity C-reactive protein (hs-CRP) in patients with acute cerebral infarction and vascular cognitive impairment (VCI), and to provide some clinical bases for early prevention of VCI. Methods: A total of 160 patients with acute cerebral infarction admitted in Department of Neurology of Jincheng People' s Hospital from May 2019 to April 2020 were enrolled in this study and were devided into three groups according to whether or not combined with cognitive impairment, including no cognitive impairment group (NCI, 57 cases), vascular cognitive impairment no dementia group (VCIND, 56 cases) and vascular dementia group (VaD, 47 cases). The cognitive function of all the patients were evaluated by Montreal cognitive assessment (MoCA). The National Institute of Health stroke scale (NIHSS) was used to assess the degree of neurological deficit (mild-, moderate-, severe-neurologic deficit group). The infarct size was calculated by Pullicino' s method (small-, middle-, large-infarct group). The levels of serum BDNF and IL-18 were measured by enzyme-linked immunosorbent assay (ELISA), and serum levels of hs-CRP were measured by immunoturbidimetry during the acute phase (0-7 d), recovery period (15-30 d) and 6 months after cerebral infarction. The effects of varying degrees of neurological deficits and different size of infarction on BDNF, IL-18 and hs-CRP were observed. The levels of serum BDNF, IL-18 and hs-CRP in the patients of the three groups with acute, convalescent and six-month cerebral infarction were compared, and their correlations with VCI were analyzed. Results: Serum BDNF level and MoCA scores in mild-neurologic deficit group and small-infarct group were significantly higher than those in moderate- and severe-deficit group, middle- and large-infarct group, respectively (P < 0.05). Their levels of IL-18 and hs-CRP were significantly lower than those in moderate- and severe-deficit group, middle- and large-infarct group, respectively (P < 0.05). The levels of serum BDNF in NCI group, VCIND group and VaD group during the acute phase, convalescence and 6 months after cerebral infarction were in a significant decline, and the differences during the acute phase and recovery period were statistically significant (P < 0.05). The levels of IL-18 and hs-CRP during the acute phase, recovery period and 6 months after cerebral infarction showed a significant increasing trend with significance (P < 0.05). Correlation analysis revealed that the levels of BDNF was positively correlated with MoCA scores but negatively correlated with the severity of cognitive impairment while the expression levels of IL-18 and hs-CRP were negatively correlated with MoCA scores but positively correlated with the severity of cognitive impairment. Conclusion: Serum BDNF, IL-18 and hs-CRP are involved in the pathological process of occurrence and development of VCI in the patients with acute cerebral infarction. BDNF has a protective effect on VCI while IL-18 and hs-CRP cause severe cognitive impairment. The levels of serum BDNF、IL-18 and hs-CRP in the patients with acute ischemic cerebral infarction are closely related to the severity of cognitive impairment and can be used as biomarkers of early diagnosis of VCI.

Key words: Brain infarction, Vascular cognitive impairment, Brain-derived neurotrophic factor, Interleukin-18, Hypersensitivity C-reactive protein

CLC Number:

R749.13

Jinna LI,Li' na XU,Min LI,Yi SONG,Jing ZHANG,Longbin JIA. Correlations between serum BDNF, IL-18 and hs-CRP levels in patients with acute cerebral infarction and vascular cognitive impairment[J].Journal of Peking University (Health Sciences), 2024, 56(4): 708-714.

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References 27

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Research indexes	NCI group (n=57)	VCIND group (n=56)	VaD group (n=47)	χ²/F	P
Gender (male), n (%)	35 (61.4)	32 (57.1)	28 (59.6)	0.214	0.899
Age/ years, $\bar x \pm s$	62.93±7.54	64.33±7.78	65.02±8.86	2.170	0.446
Years of education, $\bar x \pm s$	8.62±3.04	8.41±3.17	7.97±2.88	1.684	0.831
Smoking, n (%)	11 (19.3)	18 (32.1)	19 (40.4)	5.164	0.059
Drinking, n (%)	14 (24.6)	12 (21.4)	14 (29.8)	0.961	0.618
Hypertension, n (%)	16 (28.1)	19 (33.9)	19 (40.4)	1.402	0.496
Diabetes, n (%)	10 (17.5)	11 (19.6)	13 (27.7)	1.708	0.426
Hyperlipemia, n (%)	11 (19.3)	13 (23.2)	15 (31.9)	2.287	0.319
History of stroke, n (%)	12 (21.1)	16 (28.6)	17 (36.2)	2.230	0.328
NIHSS, M (P₂₅, P₇₅)	1 (1, 4)	1 (1, 4)	2 (1, 4)	2.228	0.033
Classification of cerebral infarction, n (%)
Partial anterior Circulation infarction	16 (28.07)	16 (28.57)	12 (25.53)	0.237	0.751
Subcortical infarction	29 (50.88)	27 (48.21)	23 (48.94)	0.316	0.584
Posterior circulation infarction	12 (21.05)	13 (23.21)	12 (25.53)	0.441	0.528
Infarct area, n (%)
Large infarct	0 (0)	8 (14.29)	20 (42.55)	7.153	0.014
Middle infarct	3 (8.77)	34 (60.71)	18 (38.30)	6.278	0.026
Small infarct	54 (94.74)	14 (25.00)	9 (19.15)	7.144	0.034

Items	Neurologic deficit group					Infarct area group
Items	Mild (n=82)	Moderate (n=52)	Severe (n=26)	F	P	Small (n=77)	Middle (n=55)	Large (n=28)	F	P
BDNF/(μg/L)	5.66±2.48^ab	4.89±2.33^a	3.71±2.62	14.152	0.031	5.78±1.61^cd	5.02±2.07^c	3.55±1.43	14.761	0.028
IL-18/(ng/L)	27.57±2.94^ab	43.57±3.45^a	64.57±4.83	15.184	0.024	23.57±1.94^cd	38.87±4.65^c	68.50±5.39	16.214	0.019
hs-CRP/(mg/L)	5.95±2.63^ab	11.73±4.04^a	24.32±6.76	18.393	0.013	5.67±1.48^cd	13.16±3.54^c	26.08±7.79	23.545	0.009
MoCA scores	24.57±1.94^ab	15.44±2.11^a	10.35±3.25	11.267	0.037	25.70±2.26^cd	16.73±2.48^c	9.89±3.16	13.376	0.033

Groups	n	Acute phase			Convalescence period			At 6 months
Groups	n	BDNF/(μg/L)	IL-18/(ng/L)	hs-CRP/(mg/L)	BDNF/(μg/L)	IL-18/(ng/L)	hs-CRP/(mg/L)	BDNF/(μg/L)	IL-18/(ng/L)	hs-CRP/(mg/L)
NCI group	57	5.74±2.52^a	27.92±4.84^ab	3.02±0.88^ab	6.62±2.46^a	13.25±2.13^ab	2.84±0.55^ab	4.36±1.37	8.67±2.25^ab	2.53±0.62^ab
VCIND group	56	5.03±2.11^a	56.85±6.61^a	9.23±2.14^a	5.47±2.19^a	38.16±4.24^a	6.19±2.02^a	4.03±1.45	14.19±1.97^a	4.47±1.29^a
VaD group	47	3.67±0.79	76.68±5.89	18.14±7.52	3.81±0.56	49.38±3.77	13.46±6.20	3.14±0.37	20.66±3.46	9.92±5.77
F		15.045	16.757	19.884	24.671	15.466	13.881	1.664	8.787	10.176
P		0.033	0.027	0.019	0.001	0.029	0.020	0.173	0.041	0.026

Items	NCI group		VCIND group		VaD group
Items	r	P	r	P	r	P
BDNF	0.822	＜0.01	0.796	＜0.01	0.842	＜0.01
IL-18	-0.741	＜0.01	-0.761	＜0.01	-0.713	＜0.01
hs-CRP	-0.778	＜0.01	-0.729	＜0.01	-0.686	＜0.01

Items	Standard error	Wald	P	Odds ratio	95%CI
Infarct area	0.075	4.52	0.033	2.830	0.982-3.428
NIHSS	0.042	7.66	0.010	3.437	1.226-4.271
BDNF	0.029	5.71	0.067	1.826	1.698-2.567
IL-18	0.061	6.13	0.016	1.171	0.977-3.685
hs-CRP	0.016	4.42	0.004	1.357	2.446-6.997

Correlations between serum BDNF, IL-18 and hs-CRP levels in patients with acute cerebral infarction and vascular cognitive impairment

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