血清IGF-1 VEGF TSH指数表达水平与脑小血管病认知障碍进展至痴呆的相关性分析

doi:10.3969/j.issn.1006-6233.2025.05.015

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摘要 目的: 探讨血清胰岛素样生长因子-1(IGF-1)、血管内皮生长因子(VEGF)、促甲状腺激素(TSH)指数表达水平与脑小血管病(CSVD)认知障碍进展至痴呆的相关性,以期为临床开展防治工作提供参考依据。方法: 选取2020年5月至2023年5月CSVD认知障碍患者210例,均给予对症治疗,随访1年,根据认知障碍是否进展至痴呆分为痴呆组与非痴呆组。收集所有患者临床资料,于所有患者入院次日清晨采集5mL空腹静脉血检测血清IGF-1、VEGF、TSH指数水平,比较两组临床资料、血清IGF-1、VEGF、TSH指数水平,分析血清IGF-1、VEGF、TSH指数与认知障碍严重程度和痴呆的相关性,评价各血清指标对CSVD认知障碍进展至痴呆的预测价值。结果: 与非痴呆组比较,痴呆组饮酒比例、家族痴呆史比例、基线时CSVD影像学总负荷评分较高,基线时MoCA评分、规律抗认知障碍治疗比例较低(均P<0.05);与非痴呆组(97.28±14.15)ng/mL、(248.77±40.61)ng/L、(133.27±13.58)mIU/L比较,痴呆组血清IGF-1、VEGF水平(83.65±10.40)ng/mL、(210.49±35.23)ng/L较低,TSH指数水平(151.45±18.72)mIU/L较高(t=5.471、5.762、6.791,均P<0.05);血清IGF-1、VEGF与基线时CSVD影像学总负荷评分呈负相关,与MoCA评分呈正相关,TSH指数与基线时CSVD影像学总负荷评分呈正相关,与MoCA评分呈负相关(P<0.05);在校正其他因素前后,血清IGF-1、VEGF、TSH指数仍与CSVD认知障碍进展至痴呆独立相关(P<0.05);血清IGF-1、VEGF、TSH指数预测CSVD认知障碍进展至痴呆的AUC分别为0.776(95%CI:0.713~0.831)、0.812(95%CI:0.752~0.863)、0.821(95%CI:0.762~0.871);三者联合预测CSVD认知障碍进展至痴呆的AUC为0.932(95%CI:0.888~0.962),敏感度为88.89%,特异度为84.71%,预测价值显著高于各指标单独预测价值(P<0.05)。结论: 血清IGF-1、VEGF、TSH指数与CSVD认知障碍患者病情显著相关,是进展至痴呆的独立影响因素,且联合预测价值可靠。

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	白彦昌
	陈善鹏
	孙倩玉
	张亚杰

关键词 ：脑小血管病, 认知障碍, 痴呆, 胰岛素样生长因子-1, 血管内皮生长因子, 促甲状腺激素指数

Abstract：Objective: To explore the correlation between the expression levels of serum insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), and thyroid-stimulating hormone (TSH) index, and the progression of cognitive impairment to dementia in cerebral small vessel disease (CSVD), to provide a reference for clinical prevention and treatment. Methods: A total of 210 CSVD patients with cognitive impairment admitted to the hospital from May 2020 to May 2023 were selected and treated with symptomatic treatment. They were followed up for 1 year and assigned to a dementia group and a non-dementia group based on whether their cognitive impairment progressed to dementia. Clinical data were collected from all patients, and 5 mL of fasting venous blood was collected early in the morning of the day following the admission of all patients to detect the levels of serum IGF-1, VEGF, and TSH indices. The clinical data, serum levels of IGF-1, VEGF, and TSH indices were compared between the two groups, the correlation between serum levels of IGF-1, VEGF, and TSH indices and the severity of cognitive impairment and dementia was analyzed, the predictive value of each serum marker for the progression of CSVD cognitive impairment to dementia was evaluated. Results: Compared with the non-dementia group, the dementia group had higher proportions of alcohol consumption, family history of dementia, and total CSVD imaging burden scores at baseline, as well as lower MoCA scores and proportions of regular anti-cognitive impairment treatment at baseline (all P<0.05). Compared with the non-dementia group (97.28±14.15) ng/mL, (248.77±40.61) ng/L, and (133.27±13.58) mIU/L, the dementia group had lower serum IGF-1 and VEGF levels [(83.65±10.40) ng/mL and (210.49±35.23) ng/L, respectively], and a higher TSH index level (151.45±18.72) mIU/L (t=5.471, 5.762, 6.791, all P<0.05); serum IGF-1 and VEGF were negatively correlated with the total burden score of CSVD imaging at baseline, and positively correlated with MoCA score; the TSH index was positively correlated with the total burden score of CSVD imaging at baseline, and negatively correlated with MoCA score (P<0.05). Before and after correcting other factors, serum IGF-1, VEGF, and TSH indices were still independently associated with the progression of CSVD cognitive impairment to dementia (P<0.05). The AUCs of serum IGF-1, VEGF, and TSH index for predicting the progression of CSVD cognitive impairment to dementia were 0.776 (95%CI: 0.713~0.831), 0.812 (95%CI: 0.752~0.863), and 0.821 (95%CI: 0.762~0.871), respectively; the AUC of the three combined predictors for the progression of CSVD cognitive impairment to dementia was 0.932 (95%CI: 0.888~0.962), with a sensitivity of 88.89% and a specificity of 84.71%; the predictive value was significantly higher than that of each predictor (P<0.05). Conclusion: The serum levels of IGF-1, VEGF, and TSH indices are significantly correlated with the condition of patients with CSVD cognitive impairment, which are independent factors contributing to the progression to dementia, and their combined predictive value is reliable.

Key words： Cerebral small vessel disease Cognitive impairment Dementia Insulin-like growth factor-1 Vascular endothelial growth factor Thyroid stimulating hormone index

基金资助:河北省重点研发计划项目,(编号:20019702813D)

通讯作者: 张亚杰

引用本文:

白彦昌, 陈善鹏, 孙倩玉, 张亚杰. 血清IGF-1 VEGF TSH指数表达水平与脑小血管病认知障碍进展至痴呆的相关性分析[J]. 河北医学, 2025, 31(5): 788-793.
BAI Yanchang, CHEN Shanpeng, SUN Qianyu, et al. Correlation Analysis of Serum IGF-1 VEGF and TSH Index Expression Levels with the Progression of Cognitive Impairment to Dementia in Patients with Cerebral Small Vessel Disease. HeBei Med, 2025, 31(5): 788-793.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.05.015 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I5/788

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