Study On The Correlation Between Blood Biomarkers And Post-stroke Cognitive Impairment

objective The mechanism of post-stroke cognitive impairment(PSCI) is not clear,and the clinical diagnosis is lack of clear and reliable evaluation criteria and treatment means.This study analyzed the clinical risk factors of PSCI by retrospective cohort study.and to explore the correlation between serum neurofilament light chain(NFL) and other peripheral blood biomarkers and PSCI and its clinical significance.Methods(1)487 patients with ischemic stroke who were admitted to the Department of Neurology of our hospital from January 2013 to December 2016 were enrolled,all meeting the inclusion criteria six months after stroke.The cognitive function of the enrolled patients were evaluated using DSM-IV and Mo CA.During admission and follow-up period,National Institutes of Health Stroke Scale(NIHSS),clinical dementia rating(CDR),and daily living ability scale(BI) of patients were evaluated.Biochemical indexes,blood routine,clotting time,CT or MRI examination of the head were carried out.The correlation between various clinical risk factors and PSCI was studied by multivariate logistic regression analysis and ROC curve.Biochemical indexes and blood routine were analyzed.And the correlation between coagulation time and PSCI was analyzed;(2)the serum NFL was divided into three groups: normal subjects,patients with acute ischemic stroke and patients with cognitive impairment after ischemic stroke.Each group had 60 subjects,and the peripheral serum neurofilament light(NFL) was detected by electrochemiluminescence(ECL).Spearman rank correlation was used to test the correlation between serum NFL and neural evaluation.ROC curve was used to test the specificity of diagnosis.Results(1)Among the 487 patients in the study,128 of them were diagnosed with PSCI,and the prevalence of PSCI was 26.3%.(2)Multivariate analysis showed that age,smooking,drinking,grade 2 hypertension,moderate and severe brain atrophy and whiter matter lesions(WMLs),moderate and severe carotid atheromatous plaque,and stroke history were the clinical risk factors of PSCI.The Mo CA and IB scores of PSCI group were significantly lower than those of cognitive normal group,and NIHSS scores of PSCI group were higher than those of cognitive normal group.After adjusting for age and hypertension,PSCI and drinking(OR: 5.138,95% CI: 1.014～26.041),smooking(OR:2.761,95%CI:2.098～3.634),brain atrophy(OR: 2.280,95% CI: 1.299～4.001),whiter matter lesions(WMLs)(OR: 3.155,95% CI: 1.868～5.328),systolic blood pressure(≥ 170 mm Hg)(OR: 12.171,95% CI: 3.339～44.363),carotid atheromatous plaque(OR: 1.692,95% CI: 1.023～2.796),history of stroke(OR: 2.18,95% CI: 1.15～1.42)were positively correlated,and PSCI increased with age(OR: 2.502,95% CI: 1.553～4.033).The area under curve ROC was 0.821.In this study,a prediction model of PSCI is proposed based on the above risk factors for the first time.(3)We detected and analyzed 27 peripheral blood indexes,and found that Hcy(OR: 1.028,95% CI: 1.007～1.049),UA(OR: 1.002,95% CI: 1.00～1.004),LDL(OR: 1.631,95% CI: 1.343～1.98)were significantly correlated with PSCI,others was without significantly correlated with PSCI.(4)We found that there were significant differences in the levels of serum NFL in HC group,AIS group,and PSCI group.The more severe the nervous system injury was,the higher the NIHSS score was and the higher the NFL content was(r = 0.724,P < 0.001).The lower the ability of self-care,the higher the level of BI(r =-0.67,P < 0.001).The worse the cognitive function,the lower the Mo CA score,and the higher the NFL content(r =-0.707,P < 0.001).The NFL content of mild cognitive impairment was lower than that of moderate and severe cognitive impairment.There was also a positive correlation between serum NFL and m RS(r = 0.501,P<0.001)—the higher the NFL content,the worse the neurological recovery function.Therefore,NFL content can be used as an indicator to reflect the severity of AIS and PSCI.In three groups,there were significant differences in hyperlipidemia,hypertension history,and stroke history,and the biochemical indicators were of moderate and high homotype.The area under receiver operator curve(ROC)curve about NFL of PSCI was 0.804(95% CI: 0.78-0.89,P < 0.001).Therefore,NFL content can also be used as a biomarker for early diagnosis of PSCI and an indicator for prognosis of disease severity.Conclusions This study further confirmed that PSCI is a multi-factorial outcome.Lifestyle and vascular factors play important role in the development of PSCI.It was found that the increased homocysteine,serum uric acid,LDL were related to PSCI.NFL could be used as a biomarker for the early diagnosis of PSCI as well as a new biomarker for predicting the severity of PSCI.It has positive clinical significance for the early detection and prevention of PSCI by clarifying these related risk factors and providing an biomarkers of peripheral blood.