血清CLU、NRG-1水平与血管性痴呆患者认知功能障碍严重程度的关系及对预后的价值分析

摘要 目的：探讨血清簇集素（CLU）、神经调节蛋白-1（NRG-1）水平与血管性痴呆（VD）患者认知功能障碍严重程度的关系及对预后的价值。方法：选择2020年1月到2022年11月新疆医科大学第一附属医院收治的150例VD患者作为VD组。按照认知功能评分将血管性痴呆患者分为轻度痴呆组60例、中度痴呆组48例以及重度痴呆组42例。随访6个月，根据随访结果将VD患者分为预后良好组与预后不良组。另选同期在我院体检的健康志愿者150例作为对照组。比较VD组与对照组的血清CLU、NRG-1水平；对比不同痴呆程度组血清CLU、NRG-1水平。单因素及多因素Logistic分析VD患者预后不良的影响因素；采用受试者工作特征（ROC）曲线分析血清NRG-1、CLU预测VD患者预后不良的价值。结果：VD组血清CLU水平明显高于对照组，而NRG-1水平明显低于对照组（P＜0.05）。中度及重度痴呆组的血清CLU比轻度痴呆组更高，而NRG-1比轻度痴呆组更低（P＜0.05）。重度痴呆组的血清CLU比中度组更高，而NRG-1比中度组更低（P＜0.05）。随访6个月，无失访病例，预后良好组105例，预后不良组45例。单因素分析显示，预后不良组的年龄、CLU、吸烟及合并高脂血症比例均相比预后良好组更高，而NRG-1、MMSE评分、MoCA评分及NIHSS评分均相比预后良好组更低（P＜0.05）。多因素Logistic回归分析显示，血清CLU升高、合并高脂血症和年龄偏大为患者预后不良的危险因素（P＜0.05），而血清NRG-1升高为患者预后不良的保护因素（P＜0.05）。ROC曲线分析发现，血清NRG-1联合CLU对预后不良预测价值最高。结论：VD患者血清CLU升高，而血清NRG-1明显降低，与痴呆程度有关。血清NRG-1联合CLU对VD患者预后不良具有较高的预测价值，值得临床关注。

Relationship between Serum CLU and NRG-1 Levels and the Severity of Cognitive Impairment in Patients with Vascular Dementia and Their Prognostic Value Analysis

ABSTRACT Objective: To investigate the relationship between serum levels of clusterin (CLU) and neuromodulin-1 (NRG-1) and the severity of cognitive dysfunction in patients with vascular dementia (VD) and their prognostic value. Methods: 150 VD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2020 to November 2022 were selected as the study group. According to the cognitive function score, patients with vascular dementia were divided into mild dementia group of 60 cases, moderate dementia group of 48 cases, and severe dementia group of 42 cases. Follow-up for 6 months, and VD patients were divided into good prognosis group and poor prognosis group based on the follow-up results. During the same period, another 150 healthy volunteers who underwent physical examination at our hospital were selected as the control group. The levels of serum CLU and NRG-1 in the VD group and control group were compared, and the levels of serum CLU and NRG-1 in the different degrees of dementia groups were compared. The factors affecting poor prognosis in VD patients were analysed by univariate and multifactor logistic, the value of serum NRG-1 and CLU in predicting poor prognosis of VD patients was analyzed by receiver operating characteristic (ROC) curve. Results: Serum CLU levels in VD group were significantly higher than those in controls, while NRG-1 levels were significantly lower than those in controls (P<0.05). Serum CLU was higher in the moderate and severe dementia groups than in the mild dementia group, while NRG-1 was lower than in the mild dementia group (P<0.05). The serum CLU was higher in the severe dementia group than in the moderate group, and the NRG-1 was lower than in the moderate group (P<0.05). There were no lost cases after follow-up for 6 months, with 105 patients in the good prognosis group and 45 patients in the poor prognosis group. Univariate analysis showed that the proportions of age, CLU, smoking, and hyperlipidemia in the poor prognosis group were higher than those in the good prognosis group, while NRG-1, MMSE scores, MoCA scores, and NIHSS scores were lower than those in the good prognosis group (P<0.05). Multifactor logistic regression analysis showed that elevated serum CLU levels, hyperlipidemia and older age were risk factors for poor prognosis in patients(P<0.05), while elevated serum NRG-1 levels were protective factors for poor prognosis(P<0.05). ROC curve analysis found that combined detection of serum NRG-1 and CLU had the highest predictive value for poor prognosis. Conclusion: Serum CLU is elevated in VD patients, while serum NRG-1 is significantly reduced, which is related to cognitive dysfunction. The combination of serum NRG-1 and CLU has a high predictive value for poor prognosis in VD patients, and deserves clinical attention.