[1]郭晓敏a,雷向宇,刘宗伟,等.脑小血管病患者基于血液eGFR 和中性粒细胞/ 淋巴细胞比值水平构建发生认知功能障碍的列线图预测模型及评价[J].现代检验医学杂志,2024,39(05):85-91.[doi:10.3969/j.issn.1671-7414.2024.05.016]
　GUO Xiaomina,LEI Xiangyu,LIU Zongwei,et al.Construction and Evaluation of A Nomogram Prediction Model for Cognitive Impairment Based on Blood eGFR Levels and Neutrophil/Lymphocyte Ratio in Patients with Cerebral Small Vessel Disease[J].Journal of Modern Laboratory Medicine,2024,39(05):85-91.[doi:10.3969/j.issn.1671-7414.2024.05.016]
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脑小血管病患者基于血液eGFR 和中性粒细胞/ 淋巴细胞比值水平构建发生认知功能障碍的列线图预测模型及评价()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年05期
页码:
85-91
栏目:
论著
出版日期:
2024-09-15

文章信息/Info

Title:
Construction and Evaluation of A Nomogram Prediction Model for Cognitive Impairment Based on Blood eGFR Levels and Neutrophil/Lymphocyte Ratio in Patients with Cerebral Small Vessel Disease
文章编号:
1671-7414（2024）05-085-07
作者:
郭晓敏1a; 雷向宇2; 刘宗伟3; 袁维帅3; 魏爱琴1a; 朱 娜1b
（1. 陕西省人民医院 a. 神经内科；b. 科研处，西安 710068；2. 西安交通大学第一附属医院神经内科，西安 710061；3. 自然资源部第一海洋研究所，山东青岛 266061）
Author(s):
GUO Xiaomin1a; LEI Xiangyu2; LIU Zongwei3; YUAN Weishuai3; WEI Aiqin1a; ZHU Na1b
（1a. Department of Neurology；1b. Research Office, Shaanxi Provincial People’s Hospital, Xi’an 710068, China；2. Department of Neurology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China；3. the First Institute of Oceanography,
关键词:
脑小血管病; 认知障碍; 中性粒细胞/ 淋巴细胞比值; 估测肾小球滤过率; 临床预测模型
分类号:
R743；R446.11
DOI:
10.3969/j.issn.1671-7414.2024.05.016
文献标志码:
A
摘要:
目的 明确脑小血管病（cerebral small vessel disease，CSVD）患者认知障碍（cognitive impairment，CI）的独立危险因素并构建列线图临床预测模型。方法 回顾性纳入2017 年1 月1 日～ 2022 年12 月31 日于西安交通大学第一附属医院住院诊断为脑小血管病的患者共247 例，依据简易认知状态量表（mini-mental state examination，MMSE）分为伴有认知障碍组（CSVD-CI 组，n=83）及无认知障碍组（CSVD-NCI 组，n=164），通过Logistic 回归筛选其发生认知障碍的影响因素，基于筛选的影响因素建立列线图临床预测模型并检验该模型效能。结果 与CSVD-NCI 组相比，CSVD-CI 组患者中性粒细胞/ 淋巴细胞比值（neutrophil/lymphocyte ratio，NLR）（3.03±2.56 vs 2.33±1.34）和清蛋白/ 球蛋白比值（1.58 ± 0.27 vs 1.49 ± 0.28）显著增高、估测肾小球滤过率（estimated glomerular filtration rate，eGFR）[88.59±16.59 ml/（min·1.73m2） vs 94.02±12.45 ml/（min·1.73m2）] 显著减低，差异具有统计学意义（t=2.282，2.426，2.689，均P <0.05）。与CSVD-NCI 组比较，CSVD-CI 组患者男性比例更低（43.4% vs 67.7%），且受教育程度更低（2.13±1.50 vs 2.86±1.12），差异具有统计学意义（χ2=13.516，t=4.283，均P <0.001）。NLR（OR：1.20, 95%CI：1.01 ～ 1.43），性别（OR：0.43, 95%CI：0.24 ～ 0.79），eGFR（OR：0.97，95%CI：0.95 ～ 0.99）及受教育程度（OR：0.72，95%CI：0.57 ～ 0.91）为CSVD 患者发生认知障碍的影响因素。基于此四项影响因素建立列线图预测模型具有良好的认知障碍预测效能（AUC=0.704，95%C：0.633 ～ 0.766）。结论 构建的列线图在预测 CSVD 患者认知功能障碍的发生方面具有较高的准确度和临床实用性。
Abstract:
Objective To identify the independent risk factors of cognitive impairment (CI) in patients with cerebral small vessel disease (CSVD) and construct a clinical prediction model. Methods Patients with CSVD who were hospitalized in the First Affiliated Hospital of Xi’an Jiaotong University from January 1, 2017 to December 31, 2022 were retrospectively enrolled, and were divided into a group with cognitive impairment (CSVD-CI group, n=83) and a group without cognitive impairment (CSVD-NCI group, n=164) according to the mini-mental state examination (MMSE). The influence factors of cognitive impairment were screened by logistic regression. The clinical prediction model of the nomogram was further developed based on the screened factors, and the efficacy of the model was tested. Results Compared with patients in the CSVD-NCI group, patients in the CSVD-CI group had higher neutrophil/lymphocyte ratio (NLR) (3.03±2.56 vs 2.33±1.34) and (1.58 ± 0.27 vs 1.49 ± 0.28), and a lower estimated glomerular filtration rate [eGFR: 88.59±16.59 ml/(min·1.73m2) vs 94.02±12.45 ml/ (min·1.73m2)], with significant differences (t=2.282, 2.426, 2.689, all P ＜ 0.05). Compared with patients in the CSVD-NCI group, patients in the CSVD-CI group had lower proportion of males (43.4% vs 67.7%) and level of education (2.13±1.50 vs 2.86), and the differences were significant (χ2=13.516, t=4.283, all P ＜ 0.05). NLR (OR：1.20, 95%CI：1.01 ～ 1.43), sex (OR： 0.43, 95%CI：0.24 ～ 0.79), eGFR (OR：0.97, 95%CI：0.95 ～ 0.99) and education degree (OR：0.72, 95%CI：0.57 ～ 0.91) were the impact factors for cognitive impairment in CSVD patients. The nomogram prediction model based on these four factors had good efficacy in predicting cognitive impairment (AUC=0.704, 95%CI: 0.633 ～ 0.766). Conclusion The nomogram constructed in this study has moderate accuracy and clinical utility in predicting the occurrence of cognitive impairment in CSVD patients.

参考文献/References:

[1] WARDLAW J M, SMITH C, DICHGANS M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging[J]. Lancet Neurolog, 2013, 12(5)：483-497.
[2] CANNISTRARO R J, BADI M, EIDELMAN B H, et al. CNS small vessel disease: a clinical review[J]. Neurology, 2019, 92(24)：1146-1156.
[3] KAPASI A, DECARLI C, SCHNEIDER J A. Impact of multiple pathologies on the threshold for clinically overt dementia[J]. Acta Neuropathologica, 2017,134(2)：171-186.
[4] 张春丽, 张颖, 李璐, 等. 脑小血管病患者血清CTRP1 和同型半胱氨酸水平对血管性轻度认知障碍预测价值的研究[J]. 现代检验医学杂志, 2022,37(1): 182-185, 194. ZHANG Chunli, ZHANG Ying, LI Lu, et al. Study on the predictive value of serum CTRP1 and homocysteine levels in patients with cerebral small vessel diseases in vascular mild cognitive impairment [J]. Journal of Modern Laboratory Medicine, 2022, 37(1): 182-185, 194.
[5] 刘玥, 刘西玲, 张欣, 等.Lp-PLA2, Hcy, HbA1c 和LDL-C 水平与脑微出血相关性研究[J]. 现代检验医学杂志,2017,32(6):35-38. LIU Yue, LIU Xiling, ZHANG Xin, et al. Study on the relationship between lipoprotein-related phospholipase A2, homocysteine, beta-N-1-deoxy fructosyl component of hemoglobin and cerebral microbleeds [J][J]. Journal of Modern Laboratory Medicine, 2017, 32(6): 35-38.
[6] XIAO Chuyun, MA Yahui, OU Yanan, et al. Association between kidney function and the burden of cerebral small vessel disease: an updated meta-analysis and systematic review[J]. Cerebrovascular Diseases (Basel, Switzerland), 2023, 52(4): 376-386.
[7] YAO Tingting, SONG Guoping, LI Yuehua, et al. Chronic kidney disease correlates with MRI findings of cerebral small vessel disease[J]. Renal Failure, 2021,43(1): 255-263.
[8] JIANG Lingling, CAI Xueli, YAO Dongxiao, et al. Association of inflammatory markers with cerebral small vessel disease in community-based population[J]. Journal of Neuroinflammation, 2022, 19(1): 106.
[9] WANG Yuan, MA Lidan, ZHANG Meng, et al. Blood neutrophil-to-lymphocyte ratio as a predictor of cerebral small-vessel disease [J]. Medical Science Monitor, 2022, 28: e935516.
[10] CHUANG Shaoyuan, HSU Y C, CHOU Kuangwei, et al. Neutrophil-Lymphocyte ratio as a predictor of cerebral small vessel disease in a geriatric community: the I-Lan longitudinal aging study[J]. Brain Sciences, 2023, 13(7): 1087.
[11] GONG P, ZHANG X, GONG Y, et al. A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke[J]. European Journal of Neurology, 2020, 27(10): 1996-2005.
[12] GITTLEMAN H, LIM D, KATTAN M W, et al. An independently validated nomogram for individualized estimation of survival among patients with newly diagnosed glioblastoma: NRG oncology RTOG 0525 and 0825[J]. Neuro-Oncology, 2017, 19(5): 669-677.
[13] 吴丹, 曹凡, 王勋, 等. 脑小血管病的研究进展[J].中国临床神经科学, 2017, 25(5):573-580 WU Dan, CAO Fan, WANG Xun, et al. Research progress of cerebral small vessel disease [J]. Chinese Journal of Clinical Neurosciences, 2017, 25(5)：573- 580.
[14] PINTER D, ENZINGER C, FAZEKAS F. Cerebral small vessel disease, cognitive reserve and cognitive dysfunction[J]. Journal of Neurology, 2015, 262(11): 2411-2419.
[15] RENSMA S P, STEHOUWER C D A, VAN BOXTEL M P J, et al. Associations of arterial stiffness with cognitive performance, and the role of microvascular dysfunction: the maastricht study[J]. Hypertension, 2020, 75(6): 1607-1614.
[16] CLIMIE R E, VAN SLOTEN T T, BRUNO R M, et al. Macrovasculature and microvasculature at the crossroads between type 2 diabetes mellitus and hypertension[J]. Hypertension, 2019, 73(6): 1138-1149.
[17] 李建伟, 张婕, 王曼, 等. 高血压前期人群血压昼夜节律与中性粒细胞淋巴细胞比值的关系研究[J]. 陕西医学杂志, 2020, 49(10): 1283-1287. LI Jianwei, ZHANG Jie, WANG Man, et al. Study on the relationship between circadian rhythm of blood pressure and neutrophil-lymphocyte ratio in prehypertensive population [J]. Shaanxi Medical Journal, 2020, 49(10): 1283-1287.
[18] 朱志坚, 孙丽芳, 陆志刚. 外周血中性粒细胞/淋巴细胞比值对急性心肌梗死患者预后的预测价值[J].陕西医学杂志, 2019, 48(10): 1326-1329. ZHU Zhijian, SUN Lifang, LU Zhigang. Prognostic value of peripheral blood neutrophil/lymphocyte ratio for long-term prognosis in patients with acute myocardial infarction [J]. Shaanxi Medical Journal, 2019, 48(10): 1326-1329.
[19] 杨凯祥, 牛玉军. 冠心病斑块易损性及预后与血小板/ 淋巴细胞比值及中性粒细胞/ 淋巴细胞比值相关性研究[J]. 陕西医学杂志, 2021, 50(1): 44-47. YANG Kaixiang, NIU Yujun. Correlation between plaque vulnerability, prognosis of coronary heart disease and PLR and NLR [J]. Shaanxi Medical Journal, 2021, 50(1): 44-47.
[20] NEUEN B L, LEATHER N, GREENWOOD A M, et al. Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients[J]. Renal Failure, 2016, 38(1)：70-76.
[21] EVANS L E, TAYLOR J L, SMITH C J, et al. Cardiovascular comorbidities, inflammation, and cerebral small vessel disease[J]. Cardiovascular Research, 2021, 117(13): 2575-2588.
[22] 王阳斌, 夏茂, 夏永泉. 血浆vWF, D- 二聚体水平与外周血中性粒细胞/ 淋巴细胞比值联合检测在血栓性疾病中的临床诊断价值[J]. 现代检验医学杂志,2019, 34(6): 86-89. WANG Yangbin, XIA Mao, XIA Yongquan. Diagnostic value of vWF combined with D-Dimer and peripheral blood NLR in the diagnosis of thrombotic disease [J]. Journal of Modern Laboratory Medicine, 2019, 34(6):86-89.
[23] 刘海颖, 孟爱国, 曾小芳, 等 . 脑梗死和短暂性脑缺血患者外周血RDW 与NLR 变化及相关性研究[J].现代检验医学杂志, 2019, 34(2): 83-87. LIU Haiying, MENG Aiguo, ZENG Xiaofang, et al. Analysis of relationship between RDW and inflammation index in patients with cerebral infarction [J]. Journal of Modern Laboratory Medicine, 2019,34(2): 83-87.
[24] 刘高雯, 段颖. 急性缺血性脑卒中小鼠模型脑组织中miR-21 表达对炎症反应和细胞凋亡的影响及相关机制研究[J]. 现代检验医学杂志, 2023, 8(3): 86-91, 96. LIU Gaowen, DUAN Ying. Effects of miR-21 expression on inflammatory response and apoptosis in brain tissue of mice with acute ischemic stroke and related mechanisms [J]. Journal of Modern Laboratory Medicine, 2023, 38(3)：86-91, 96.
[25] LEE M, LIM J S, KIM C H, et al. High neutrophillymphocyte ratio predicts post-stroke cognitive impairment in acute ischemic stroke patients[J]. Front Neurol, 2021, 12：693318.
[26] SHANG Tianling, MA Bo, SHEN Yanxin, et al. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: a single-center retrospective study in China [J]. Frontiers in Neurology, 2022, 13: 907486.
[27] HOU Lan, ZHANG Shuhan, QI Dandan, et al. Correlation between neutrophil/lymphocyte ratio and cognitive impairment in cerebral small vessel disease patients: a retrospective study [J]. Frontiers in Neurology, 2022, 13: 925218.
[28] D?NESCU S A, SZOLGA B, GEORGIU C, et al. Unusual manifestations of secondary syphilis: case presentations[J]. Acta Dermatovenerologica Croatica, 2018, 26(2)：186-188.
[29] TANG Xingyao, HAN Yipeng, CHAI Yinhe, et al.Association of kidney function and brain health: a systematic review and meta-analysis of cohort studies [J]. Ageing Research Reviews, 2022, 82：101762.
[30] CLOUSTON S A P, SMITH D M, MUKHERJEE S, et al. Education and cognitive decline: an integrative analysis of global longitudinal studies of cognitive aging[J]. The Journals of Gerontology?. Series B, 2020, 75(7)： e151-e160.
[31] YAHIRUN J J, VASIREDDY S, HAYWARD M D. The education of multiple family members and the life-Course pathways to cognitive impairment[J]. The Journals of Gerontology?. Series B, 2020, 75(7): e113-e128.
[32] LANGA K M. Is the risk of Alzheimer’s disease and dementia declining? [J]. Alzheimer’s Research & Therapy, 2015, 7(1)：34.
[33] AU B, DALE-MCGRATH S, TIERNEY M C. Sex differences in the prevalence and incidence of mild cognitive impairment：a meta-analysis [J]. Ageing Research Reviews, 2017, 35：176-199.
[34] GAN Jinghuan, CHEN Zhichao, SHI Zhihong, et al. Sex differences in clinical cognitive impairment with Lewy bodies: a Chinese multicenter study[J]. Biology of Sex Differences, 2022, 13(1): 55.
[35] BARUS R, BERGERON S, AUGER F, et al. Sex differences in cognitive impairment induced by cerebral microhemorrhage[J]. Translational Stroke Research, 2021, 12(2): 316-330.

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备注/Memo

备注/Memo:
基金项目：陕西省重点研发项目（2023-ZDLSF-20）。
作者简介： 郭晓敏（1982-），女，副主任医师，主要研究方向为脑血管病及认知障碍的病理生理机制研究，E-mail: guoxiaomin@xjtu.edu.cn。
通讯作者：朱娜(1982-)，女，副研究员，主要研究方向为免疫学检验的研究，E-mail：happybabyegg@163.com。
更新日期/Last Update: 2024-09-15