1.Habitat model based on lung CT for predicting brain metastasis of lung adenocarcinoma with epidermal growth factor receptor mutation
Lijuan LIN ; Ying LIN ; Yanqing WU ; Xiang LIN ; Wei GUO ; Yang SONG ; Dehua CHEN
Chinese Journal of Interventional Imaging and Therapy 2024;21(7):408-413
Objective To observe the value of habitat model based on lung CT for predicting brain metastasis(BM)of lung adenocarcinoma with epidermal growth factor receptor(EGFR)mutation.Methods Data of plain lung CT of 198 lung adenocarcinoma patients with EGFR-mutant were retrospectively analyzed.The patients were divided into training set(n=138)and test set(n=60)at the ratio of 7∶3,and further divided into BM subgroup and non-BM subgroup in each set.Then a logistic regression(LR)clinical model was constructed using variables being statistically different between subgroups in training set.For features extracted from tumor and subregion of tumor,radiomics models and habitat models were constructed based on random forest,Gaussian process(GP)and support vector machine(SVM)algorithms,and the best radiomics and habitat models with generalization ability were screened.LR combined model was constructed based on the predicted values of the best radiomics and habitat models with generalization ability,as well as the clinical model.Then receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for predicting BM of lung adenocarcinoma with EGFR-mutant.Spearman correlation analysis was performed to observe the correlations between Ki-67 and habitat features of lung adenocarcinoma with EGFR-mutant.Results AUC of LR clinical model,GP radiomics model,SVM habitat model and LR combined model for predicting BM of lung adenocarcinoma with EGFR-mutant was 0.700,0.726,0.801 and 0.834 in training set,0.754,0.600,0.715 and 0.848 in test set,respectively.AUC of LR combined model was higher than that of LR clinical model in training set(P<0.001),also higher than that of GP radiomics model in test set(P=0.010).Compared with GP radiomics model and SVM habitat model,the performance of LR combined model was significantly and positively improved in training set(integrated discrimination improvement index[IDI]=8.60%,8.55%,both P<0.001).Ki-67 level of EGFR-mutant lung adenocarcinoma was lowly and positively correlated with habitatmap_original_glszm_lalgle extracted from habitat map(│rs│=0.201,P=0.004).Conclusion The habitat model based on lung CT could be used to predict BM of lung adenocarcinoma with EGFR-mutant effectively.
2.Panax notoginseng extracts regulate inflammatory response of immune-stressed broilers through IL-6,CASP3 and STAT3
Lin DU ; Pingrui YANG ; Hanlin ZHOU ; Lijuan QIU ; Weidong HU ; Liting CAO ; Shicheng BI
Chinese Journal of Veterinary Science 2024;44(8):1755-1764
This study aims to observe the effect of Panax notoginseng extracts on inflammatory re-sponse in immunosuppressed broilers and to investigate the mechanism through network pharma-cology and molecular docking combined with in vivo animal tests.Based on the TCMSP database and GeneCard and other disease databases,we searched for targets related to Panax notoginseng and broiler inflammation,screened key compounds and targets by applying Cytoscape 3.7.1 and String databases,respectively,and constructed a network relationship diagram of traditional Chi-nese medicine(TCM)-key components-targets,and carried out GO functional enrichment and KEGG pathway enrichment analyses by using the DAVID platform.The GO functional enrichment analysis and KEGG pathway enrichment analysis were carried out by the DAVID platform,visual-ized by the Chiplot online website,and finally,the core clustered proteins were analyzed by Pymol software to obtain the core targets,and molecular docking technology was used to predict the de-gree of matching between the active ingredients and the core targets as well as the animal experi-ments to further explore the pharmacological mechanism of Panax notoginseng extracts.Sixty 1-day-old red-feathered broilers were randomly divided into three groups(LPS group,CON group,and PN group),and the test period was 35 days.The LPS and PN groups were injected intraperito-neally with 250 μg/kg body weight of LPS,and the CON group was injected with an equal amount of sterile physiological saline on the 12,14,33,and 35 d.The LPS and PN groups were injected with 250 μg/kg body weight of LPS,and the CON group was injected with an equal amount of sterile physiological saline.The effect of Panax notoginseng extract on inflammatory cytokines in serum was detected by ELISA,and the hormone content in serum was also detected in each group,and fluorescence quantitative PCR was used to detect the effect of each group on the mRNA ex-pression levels of STAT3,IL-6,and CASP3.The results showed that the serum levels of IFN-γ,IL-6,iNOS,TNF-α,and TNF-β were significantly increased(P<0.05),while the level of IL-10 was significantly decreased(P<0.05)after LPS tapping at weeks 2 and 5.The serum levels of IFN-y,IL-6,iNOS,TNF-α,and TNF-β were significantly decreased(P<0.05)and IL-10 was sig-nificantly increased(P<0.05)by the addition of Panax ginseng extracts to the basal diet com-pared with the LPS group.Panax notoginseng extracts significantly decreased the serum levels of adrenocorticotropic hormone(ACTH)and corticosterone(CORT)(P<0.05)and increased the levels of growth hormone(GH)(P<0.05).A total of 8 active ingredients and 123 potential tar-gets for broiler inflammation were predicted by network pharmacology.The protective mechanism of Panax notoginseng against broiler inflammation may be related to the C-type lectin receptor(CLR)signaling pathway,Toll-like receptor(TLR)signaling pathway,MAPK signaling pathway,NOD-like receptor(NLR)signaling pathway,and FoxO signaling pathway.According to the pre-diction,the alleviation of inflammatory response in broiler chickens by Panax notoginseng may be related to the action on 12 key targets.Fluorescence quantitative PCR showed that Panax notogin-seng extract down-regulated the mRNA expression of IL-6 and CASP3(P<0.05)and up-regula-ted that of STAT3(P<0.05),and molecular docking results also showed that the active ingredi-ents in Panax notoginseng extracts could exert anti-inflammatory effects through IL-6 and CASP3.The results suggested that Panax quinquefolium extracts might alleviate the inflammatory response of immune-stressed broilers through multi-components,multi-targets,and multi-path-ways,and this study helps propose new therapeutic strategies and provides a theoretical basis for the development of feed additives based on Penthorum chinense Pursh extract.
3.Biological role and related mechanism of autophagy in acute lung injury of hemorrhagic shock mice
Xuerong LIN ; Jia WANG ; Zhibin ZHANG ; Lijuan ZHU
Chinese Critical Care Medicine 2024;36(8):848-852
Objective:To study the biological role and related mechanism of autophagy in acute lung injury (ALI) of hemorrhagic shock mice.Methods:According to random number table method, wild-type male C57BL/6 mice were divided into control group, ALI group, rapamycin group and 3-methyladenine (3-MA) group, with 8 mice in each group. Light chain 3 (LC3) gene knockout mice with C57BL/6 background were divided into LC3 knockout group and LC3 knockout+ALI group, with 8 mice in each group. Control group, ALI group, LC3 knockout group, LC3 knockout+ALI group were intraperitoneally injected with 2 mL/kg normal saline, rapamycin group was intraperitoneally injected with 3 mg/kg autophagy activator rapamycin, 3-MA group was intraperitoneally injected with 15 mg/kg autophagy inhibitor 3-MA, all of which were given for 3 consecutive days. 2 hours after the last administration, the hemorrhagic shock induced ALI model was established. 24 hours after modeling, the lung index was calculated. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of lung tissue and lung injury score was performed. The expressions of autophagy genes LC3-Ⅱ/LC3-Ⅰ and Beclin-1 in lung tissue were detected by Western blotting. The contents of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and malondialdehyde (MDA) in lung tissue were detected according to the steps of the kit.Results:Compared with the control group, the lung tissue structure was destroyed and exudation increased, lung index, lung injury score, the expressions of LC3-Ⅱ/LC3-Ⅰ, Beclin-1, and the contents of TNF-α, IL-6 and MDA in lung tissue significantly increased in the ALI group. Compared with the ALI group, the structural damage and exudation of lung tissue were reduced in the rapamycin group, lung index, lung injury score and the contents of TNF-α, IL-6 and MDA in lung tissue decreased, while the expressions of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 in lung tissue increased [lung index: (7.56±0.39)% vs. (9.12±0.59)%, lung injury score: 3.04±0.58 vs. 9.32±2.14, TNF-α (ng/mg): 1.85±0.32 vs. 3.51±0.62, IL-6 (ng/mg): 1.61±0.32 vs. 2.52±0.44, MDA (nmol/mg): 1.03±0.16 vs. 1.88±0.24, LC3-Ⅱ/LC3-Ⅰ: 1.21±0.12 vs. 0.39±0.05, Beclin-1/β-actin: 1.10±0.12 vs. 0.58±0.06, all P < 0.05], while lung tissue structure damage was aggravated and exudation was further increased in the 3-MA group, lung index, lung injury score and the contents of TNF-α, IL-6 and MDA in lung tissue increased, the expressions of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 in lung tissue decreased [lung index: (10.44±0.62)% vs. (9.12±0.59)%, lung injury score: 11.59±2.28 vs. 9.32±2.14, TNF-α (ng/mg): 4.77±0.71 vs. 3.51±0.62, IL-6 (ng/mg): 3.44±0.52 vs. 2.52±0.44, MDA (nmol/mg): 2.71±0.42 vs. 1.88±0.24, LC3-Ⅱ/LC3-Ⅰ: 0.25±0.04 vs. 0.39±0.05, Beclin-1/β-actin: 0.21±0.03 vs. 0.58±0.06, all P < 0.05]. Lung index, lung injury score and the contents of TNF-α, IL-6 and MDA in lung tissue of LC3 knockout ALI mice were higher than those of wild-type ALI mice [lung index: (10.44±0.75)% vs. (9.12±0.59)%, lung injury score: 12.41±2.86 vs. 9.32±2.14, TNF-α (ng/mg): 4.85±0.72 vs. 3.51±0.62, IL-6 (ng/mg): 3.28±0.51 vs. 2.52±0.44, MDA (nmol/mg): 2.75±0.41 vs. 1.88±0.24, all P < 0.05]. Conclusion:Autophagy plays a protective role in ALI of hemorrhagic shock mice, and the related molecular mechanism is the inhibition of inflammatory response and oxidative stress response.
4.Development and reliability and validity test of patient admission nursing assessment sheet of integrated Chinese and western medicine ward
Fanhua ZHOU ; Lin GAN ; Yanli MEI ; Fen DU ; Ye YAN ; Lijuan XIONG
Chinese Journal of Nursing 2024;59(7):802-807
Objective To design and test the reliability and validity of patient admission nursing assessment sheet of integrated Chinese and westem medicine ward.Methods On the basis of literature research,with traditional Chinese medicine"look,hear,ask and pulse-taking"as the basic framework,physical discrimination as the evaluation outcome,combined with the general nursing evaluation points of patients admitted to hospital,we designed the patient admission nursing assessment sheet of integrated Chinese and westem medicine ward,and then we adopted the Delphi method to conduct an inquiry on the draft of the admission sheet.In April 2022,3 clinical nurses were selected to evaluate 160 admitted patients from Integrated Traditional Chinese and Western Medicine Department of a tertiary A comprehensive hospital in Hubei Province,and Fleiss'Kappa coefficient and content validity coefficient were used to test the reliability and validity.Results The recovery rates of the 2 rounds of expert correspondence questionnaires were 95.45%and 100%.The authority coefficients were 0.931 and 0.957;the Kendall harmony coefficients were 0.101 and 0.106(P<0.01);the importance scores of articles were 4.13~4.82;the coefficient of variation was 0.07~0.19 in 2nd round of expert correspondence.The final nursing assessment list for inpatients in the integrated Chinese and Western medicine ward included 3 parts:general demographic data assessment,four-Chinese medicine diagnosis assessment/physical discrimination,and nursing risk assessment,and there are 32 evaluation contents in the assessment sheet.The Fleiss'Kappa coefficient of this assessment sheet was 0.602(P<0.001);the item content validity index was 0.857~1.000,and the overall content validity index was 0.920.Conclusion The admission nursing assessment sheet for inpatients in integrated Chinese and Westem medicine wards has good reliability and validity,and it is suitable for the integrated Chinese and Westem medicine wards.
5.Construction and verification of a risk prediction model for postoperative malnutrition in infants with congenital heart disease
Lin HAN ; Minmin LI ; Yuxin LI ; Liuyi LU ; Qi ZHANG ; Xueting WANG ; Ping JU ; Lijuan YANG
Chinese Journal of Nursing 2024;59(19):2396-2403
Objective To develop a risk prediction model for postoperative malnutrition in children with congenital heart disease(CHD)and to verify it both internally and externally.Methods By a convenience sampling method,300 CHD children treated at a tertiary hospital in Shandong Province from January 2018 to December 2021 were selected as a modeling group,and 129 children from January 2022 to June 2023 were selected as a validation group.Data on patient demographics,disease-specific variables,therapeutic interventions,and nursing care parameters were collected.Single factor and logistic regression were employed to construct a risk prediction model for postoperative malnutrition in CHD children,and the nomogram was drawn and its prediction effect was evaluated.Results The incidence of postoperative malnutrition among CHD children was 33.10%.Logistic regression analysis revealed that risk factors for malnutrition in children included birth weight<2.5 kg,preoperative malnutrition,negative fluid balance 1 week after surgery,and long duration of cardiopulmonary bypass(P<0.05).The area under the receiver operating characteristic curve of the modeling group was 0.933;the sensitivity was 83.30%;the specificity was 90.90%.The Hosmer-Lemeshow test showed that x2=7.765(P=0.457).The AUC of the validation group was 0.918;the sensitivity was 87.20%;the specificity was 90.00%.The Hosmer-Lemeshow test showed that x2=4.947(P=0.763).Calibration curves for both groups indicated good calibration of the model,and the clinical decision curves demonstrated its practical clinical utility.Conclusion The risk prediction model developed in this study exhibits good predictive ability,which can provide a reference for medical staff to early identify high-risk infants for postoperative malnutrition following CHD surgery and to formulate targeted intervention measures.
6.Analysis of differentially expressed genes in visceral adipose tissue of patients with type 2 diabetes mellitus based on bioinformatics
Ying LI ; Jiaxiang LU ; Lu HE ; Xiaojie XIE ; Ren LIN ; Shiqi TANG ; Lijuan XU
Chinese Journal of Health Management 2024;18(12):910-915
Objective:To analyze the differentially expressed genes (DEGs) in visceral adipose tissue of patients with type 2 diabetes mellitus (T2DM) based on bioinformatics.Methods:The microarray dataset GSE78721 was downloaded from the Gene Expression Omnibus (GEO) database, including visceral fat samples data from 19 T2DM patients and 16 non-diabetic subjects. The analysis of transcriptomic profiling results from tissue samples was conducted, and a comparison between different groups of samples based on gender was performed. The online Xintao Academic Database was utilized for the analysis, employing the "limma" package in R language to filter DEGs. Subsequently, the DEGs were visualized, and Gene Ontology (GO) functional annotation along with Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out and visualized. Based on the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, a protein-protein interaction network (PPI) of DEGs was constructed and key differentially expressed genes were identified and visualized using Cytoscape software.Results:Analysis of visceral adipose tissue gene expression profiles revealed 168 DEGs (|log 2FC|≥1, P<0.05). In females, 42 mRNAs were up-regulated, 3 were down-regulated; in males, 105 were up-regulated, 37 were down-regulated, 19 genes were shared by the two groups. GO analysis linked DEGs to insulin-like growth factor receptor signaling and regulation, nutrient response, and leukocyte migration. KEGG analysis implicated extracellular matrix receptor interactions and leukocyte transendothelial migration. The PPI network unveiled 10 key genes, including COL1A1, COL1A2, TGFB3, PCOLCE, TIMP1, COL6A2, COMP, COL14A1, VCAM1 and THY1. Conclusion:Bioinformatics technology can effectively analyze and screen DEGs in visceral adipose tissue of T2DM patients, providing useful clues for further exploring its molecular mechanism and finding therapeutic targets.
7.Safety and efficacy of donor-derived chimeric antigen receptor T-cell therapy in patients with relapsed B-cell acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation
Yaqi ZHUO ; Sanfang TU ; Xuan ZHOU ; Jilong YANG ; Lijuan ZHOU ; Rui HUANG ; Yuxian HUANG ; Meifang LI ; Bo JIN ; Bo WANG ; Shiqi LI ; Zhongtao YUAN ; Lihua ZHANG ; Lin LIU ; Sanbin WANG ; Yuhua LI
Chinese Journal of Hematology 2024;45(1):74-81
Objective:To investigated the safety and efficacy of donor-derived CD19+ or sequential CD19+ CD22+ chimeric antigen receptor T-cell (CAR-T) therapy in patients with B-cell acute lymphoblastic leukemia (B-ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:The data of 22 patients with B-ALL who relapsed after allo-HSCT and who underwent donor-derived CAR-T therapy at the Zhujiang Hospital of Southern Medical University and the 920th Hospital of Joint Logistics Support Force of the People’s Liberation Army of China from September 2015 to December 2022 were retrospectively analyzed. The primary endpoint was overall survival (OS), and the secondary endpoints were event-free survival (EFS), complete remission (CR) rate, and Grade 3-4 adverse events.Results:A total of 81.82% ( n=18) of the 22 patients achieved minimal residual disease-negative CR after CAR-T infusion. The median follow-up time was 1037 (95% CI 546–1509) days, and the median OS and EFS were 287 (95% CI 132-441) days and 212 (95% CI 120-303) days, respectively. The 6-month OS and EFS rates were 67.90% (95% CI 48.30%-84.50%) and 58.70% (95% CI 37.92%-79.48%), respectively, and the 1-year OS and EFS rates were 41.10% (95% CI 19.15%-63.05%) and 34.30% (95% CI 13.92%-54.68%), respectively. Grade 1-2 cytokine release syndrome occurred in 36.36% ( n=8) of the patients, and grade 3-4 occurred in 13.64% of the patients ( n=3). Grade 2 and 4 graft-versus-host disease occurred in two patients. Conclusion:Donor-derived CAR-T therapy is safe and effective in patients with relapsed B-ALL after allo-HSCT.
8.Efficacy and safety of eltrombopag in the treatment of primary immune thrombocytopenia: real-world data from a single medical center
Xifeng DONG ; Yalan LI ; Nianbin LI ; Weinan LIN ; Ting WANG ; Huaquan WANG ; Lijuan LI ; Wen QU ; Limin XING ; Hong LIU ; Yuhong WU ; Guojin WANG ; Jia SONG ; Jing GUAN ; Xiaoming WANG ; Zonghong SHAO ; Rong FU
Chinese Journal of Hematology 2024;45(3):271-276
Objective:This study aimed at investigating the efficacy and safety of eltrombopag in the treatment of adult primary immune thrombocytopenia (ITP) and evaluated the factors influencing its efficacy and side effects.Methods:A total of 198 patients with adult ITP who were admitted to Tianjin Medical University General Hospital between January 2018 and March 2022 were retrospectively analyzed. The efficacy of each starting dose of eltrombopag was evaluated, and adverse events were analyzed. The factors influencing efficacy were investigated, including sex, age, adult ITP type, platelet antibodies, and combined drug treatments.Results:Of the 198 patients, 70 males and 128 females with a median age of 45 years (18-88 years) were included; 130 (65.7%) had newly diagnosed adult ITP, 25 (12.6%) had persistent adult ITP, and 43 (21.7%) had chronic adult ITP. The bleeding event scores at baseline were assessed; 84.3% had scores of<4 and 15.7% had scores of ≥4. The eltrombopag response rate (initial response) at 6 weeks was 78.8% (complete response [CR]: 49.0%; CR1: 14.6%; CR2: 15.2%). The median response time to eltrombopag was 7 (7, 14) days. The initial response rates to 25, 50, and 75 mg eltrombopag were 74.1%, 85.9%, and 60.0%, respectively ( P=0.031). The initial response rate to the 50 mg dose was significantly higher than that of the 25-mg and 75-mg doses. Two patients received 100 mg as the starting dose, and their initial response was 0. Regarding dose adjustment, 70.7% of the patients remained on the starting dose, 8.6% underwent dose adjustment to 50 mg, and 6.1% underwent dose adjustment to 75 mg. Another two patients underwent dose adjustment to 100 mg. After dose adjustment, the persistent response rates were 83.6%, 85.3%, and 85.7% for the 25-, 50-, and 75-mg doses, respectively, with no significant difference. After dose adjustment, the sustained efficacy rate for the 100-mg dose (4 patients) was 100.0%. After 6 weeks of treatment with eltrombopag, the overall bleeding score of patients with ITP decreased. The number of patients with a score of ≥4 decreased to 0, the number of patients with a score of<4 decreased, and there was no significant change in the number of patients with a score of 1-2. The most common adverse event associated with eltrombopag was impaired liver function (7.7%). No thrombosis events or other adverse events were observed. ITP type and number of megakaryocytes significantly affected the initial response to eltrombopag. The initial response rates to eltrombopag for newly diagnosed adult ITP, persistent adult ITP, and chronic adult ITP were 85.3%, 56.0%, and 76.2%, respectively ( P=0.003). For megakaryocytes, the initial response rates were 61.8%, 87.1%, and 84.3% ( P=0.009) for the decreased, normal, and increased megakaryocyte groups, respectively. Conclusion:Eltrombopag, as a second-line or higher treatment for adult ITP, has a rapid onset of action and good safety. The initial response rate is significantly higher with a dose of 50 mg than with a dose of 25 mg. Patients with newly diagnosed ITP and those with normal or increased megakaryocyte numbers have a higher initial response rate to eltrombopag.
9.Effect of granulocyte colony-stimulating factor combined with tadalafil on endometrial receptivity and pregnancy outcomes in patients with thin endometrium
Hongzhen SHI ; Lijuan SUN ; Lin WANG ; Qian WANG ; Shuang ZHANG ; Lin LIN
China Pharmacist 2024;27(6):984-991
Objective To investigate the effects of granulocyte colony-stimulating factor(G-CSF)combined with tadalafil(TD)on endometrial receptivity and pregnancy outcomes in patients with thin endometrium(TE).Methods Patients with TE in the department of reproductive medicine of the First Hospital of Qinhuangdao from May 2020 to March 2023 were selected as the study subjects.They were divided into a experimental group(G-GSF combined with TD)and a control group(G-GSF)according to the different treatment regimens.The endometrial receptivity[endometrial thickness(EMT),endometrial volume(EMV),endometrial blood flow peak systolic flow rate/end diastolic flow rate(EBF-S/D),endometrial fractionation,endometrial blood flow fractionation,uterine artery pulsatility index(AUPI),uterine artery resistance index(AURI)and uterine arterial peak systolic flow rate/end diastolic flow rate(AU-S/D)]of the TE patients before and after treatment(the endometrial transition day)were compared;the endometrial receptivity on endometrial transformation day,post-treatment pregnancy outcomes[embryo implantation rate(EIR),clinical pregnancy rate(CPR),and early miscarriage rate(ABR)],and the incidence of adverse reactions during treatment were compared between the two groups.Results A total of 60 patients were included in the study,with 30 in each group.Before treatment,the difference in endometrial receptivity between the two groups was not statistically significant(P>0.05).Compared with the pre-treatment period,the EMT,EMV,the proportion of type A endometrium and the proportion of type Ⅱ+Ⅲ endometrial blood flow significantly increased in the two groups after treatment on the endometrial transformation day increased significantly(P<0.05),while the EBF-S/D,AUPI,AURI and AU-S/D significantly decreased(P<0.05).EMT and EMV were greater in the experimental group than in the control group(P<0.05),whereas EBF-S/D,AUPI,AURI and AU-S/D were less than those in the control group(P<0.05).Compared with the control group,the differences in the proportion of endometrium,the proportion of endometrial blood flow,EIR,CPR and ABR in the experimental group were not statistically significant(P>0.05).No adverse reactions occurred during treatment in both groups.Conclusion G-CSF combined with TD can improve endometrial receptivity in TE patients with high safety,but there is no effect on pregnancy outcome.
10.Correlation between serum albumin, urea nitrogen and Fazekas scores and cognitive function in patients with mild and medium ischemic stroke
Ying GUI ; Lijuan LI ; Xian LI ; Ting LIU ; Xiaopeng GUO ; Dandan JIA ; Lin MA
Clinical Medicine of China 2024;40(3):161-168
Objective:To investigate the correlation between serum albumin, urea nitrogen and Fazekas scores and cognitive function scores in patients with mild and medium ischemic stroke.Methods:Clinical data of 160 patients with acute ischemic stroke with the National Institutes of Health Stroke Scale (NIHSS)≤7 scores admitted to the Department of Neurology of the First Affiliated Hospital of Hainan Medical College from June 2021 to April 2023 were selected for a cross-sectional study. According to the Montreal Cognitive Assessment (MoCA) score, they were divided into normal cognitive group (28 cases) (MoCA≥26 scores), mild to moderate cognitive impairment group (74 cases) (MoCA 15-<26 scores), and severe cognitive impairment group (58 cases) (MoCA<15 scores). Demographic characteristics, serological indicators and imaging data of patients were collected, and the correlation between serum albumin, urea nitrogen and Fazekas scores and the total score of MoCA and the scores of each cognitive domain was analyzed. One-way ANOVA was used for comparison between the normal distribution and homogeneous variance data sets, LSD analysis was used for pairwise comparison, Kruskal-Wallis H test was used between the skew distribution or heterogeneous variance data sets. Bonferroni correction analysis was used for pairwise comparison. Chi-square test or Fisher exact probability method was used after the comparison between the count data sets. Spearman Spearman correlation analysis was performed on serum albumin, urea nitrogen and Fazekas scores with MoCA scores and cognitive domain scores. Multivariate ordered Logistic regression was used to analyze the independent risk factors of cognitive function in acute stage of mild and medium ischemic stroke patients. Results:The incidence of cognitive impairment in patients with acute mild and medium ischemic stroke was 82.50% (132/160). Comparison of age ((56.71±7.35), (60.32±10.20), (66.40±11.88) years old), sex (male/female: (23/5, 58/16, 33/25)), the proportion of education level above high school (25.0%(7/28), 16.2%(12/74), 6.9%(4/58)), hemoglobin ((149.26±14.91), (144.85±16.85), (137.63±17.22) g/L), albumin (39.5 (37.0, 41.2), 38.6(35.6, 40.8), 37.4 (34.5, 39.8) g/L), urea nitrogen (5.30 (4.00, 6.60), 4.81 (4.00, 6.32), 5.86 (4.55, 6.97) mmol/L), Hamilton Anxiety Scale (HAMA) score (5.0 (2.0, 10.0), 7.5 (5.0, 11.0), 10.0 (6.0, 14.3) scores),Hamilton Depression Scale (HAMA) score (5.5 (3.0, 12.5), 7.0 (4.0, 11.0), 9.5 (5.0, 14.0) scores), and Fazekas score (2.00 (1.25, 3.00), 2.00 (1.00, 4.00), 3.00 (2.00, 5.00) scores) among cognitive normal group, mild to moderate cognitive impairment group, and severe cognitive impairment group of patients, the difference were statistically significant (the statistical values were F=9.68, χ 2=9.29, χ 2=30.77, F=5.31, H=7.06, H=6.71, H=12.37, H=8.91, and H=10.96, respectively;the P values were <0.001, 0.010, <0.001, 0.006, 0.029, 0.035, 0.002, 0.012, and 0.004, respectively ). The total score of MoCA was negatively correlated with Fazekas score and serum urea nitrogen, but positively correlated with serum albumin ( r s values were -0.250, -0.168, and 0.212, respectively; P values were 0.001, 0.036, and 0.009, respectively). Serum albumin was positively correlated with scores in visual space and execution, naming, attention and orientation, serum urea nitrogen was negatively correlated with scores in language and orientation, and Fazekas score was negatively correlated with scores in visual space and execution, orientation, attention and language ( r s values were 0.291, 0.196, 0.191, 0.209, -0.205, -0.180, -0.248, -0.193, -0.188, and -0.183, respectively; P values were <0.001, 0.017, 0.020, 0.011, 0.012, 0.027, 0.002, 0.016, 0.020, and 0.023, respectively). Multiple Logistic regression analysis showed that low albumin ( OR=0.884, 95% CI: 0.813-0.963, P=0.005) and high urea nitrogen ( OR=1.195, 95% CI: 1.003-1.425, P=0.047) and high Fazekas scores ( OR=1.401, 95% CI: 1.132-1.733, P=0.002) were independent risk factors for cognitive function, while high education level was a protective factor ( OR=0.062, 95% CI: 0.019-0.202, P<0.001). Conclusion:The incidence of acute cognitive impairment is high in patients with mild and medium ischemic stroke. Higher education level is a protective factor for cognitive function. Low albumin, high urea nitrogen and high Fazekas score are independent risk factors for cognitive function.

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