The predictive value of lipoprotein-associated phospholipase A2 combined with the total burden of MRI scores on cognitive impairment in patients with cerebral small vessel disease

doi:10.11958/20252966

Abstract

Abstract:

Objective To investigate the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) combined with the total burden of magnetic resonance imaging (MRI) scores on cognitive impairment in patients with cerebral small vessel disease (CSVD). Methods A total of 178 CSVD patients admitted to Gansu Wuwei Tumour Hospital (Gansu Province Wuwei Academy of Medical Sciences) from January 2023 to June 2024 were divided into the normal cognition group (n= 89, MoCA≥26) and the cognitive impairment group (n=89, MoCA<26 points). The CSVD total burden of MRI scores was evaluated by 3.0T MRI. The baseline data, Lp-PLA2 level and the total burden of MRI scores were compared between the two groups. Logistic regression was applied to analyze influencing factors of cognitive impairment in CSVD patients. The predictive value of Lp-PLA2 level combined with the total burden of MRI scores on cognitive impairment in CSVD patients were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the normal cognition group, Lp-PLA2 levels, the total burden of MRI scores and IL-6 were significantly increased in the cognitive impairment group (P<0.05). Results of multivariate Logistic regression analysis showed that increased Lp-PLA2 and the total burden of MRI scores were risk factors for cognitive impairment in patients with CSVD (P<0.05). The area under curve (AUC) of Lp-PLA2 levels combined with the total burden of MRI scores for predicting cognitive impairment in patients with CSVD was 0.905 (95%CI：0.861-0.948), the sensitivity was 86.5% and the specificity was 79.8%. Conclusion Lp-PLA2 levels and the total burden of MRI scores are increased in patients with cognitive impairment, and the combination of both can serve as an early predictor of cognitive impairment in patients with CSVD.

Key words: cerebral small vessel diseases, cognition disorders, 1-alkyl-2-acetylglycerophosphocholine esterase, lipoprotein-associated phospholipase A2, the total burden of MRI scores

CLC Number:

R743

Figures/Tables 5

References 20

[1]	ZANON ZOTIN M C, SVEIKATA L, VISWANATHAN A, et al. Cerebral small vessel disease and vascular cognitive impairment:from diagnosis to management[J]. Curr Opin Neurol, 2021, 34(2):246-257. doi:10.1097/WCO.0000000000000913.
[2]	MOK V, CAI Y, MARKUS H S. Vascular cognitive impairment and dementia:Mechanisms,treatment,and future directions[J]. Int J Stroke, 2024, 19(8):838-856. doi:10.1177/17474930241279888.
[3]	DUPRÉ N, DRIEU A, JOUTEL A. Pathophysiology of cerebral small vessel disease:a journey through recent discoveries[J]. J Clin Invest, 2024, 134(10):10. doi:10.1172/JCI172841.
[4]	CAO Y, ZHU X, SHANG J, et al. Correlation between lipoprotein-associated phospholipase A2 and poststroke mild cognitive impairment[J]. Expert Rev Mol Diagn, 2024, 24(6):541-547. doi:10.1080/14737159.2024.2370410.
[5]	张晓倩, 有慧, 冯逢. MRI脑小血管病总负荷评分的临床应用进展[J]. 国际医学放射学杂志, 2023, 46(2):163-167.
	ZHANG X Q, YOU H, FENG F. Clinical application advances of MRI total load score for cerebral small vascular diseases[J]. International Journal of Medical Radiology, 2023, 46(2):163-167. doi:10.19300/j.2023.Z20032.
[6]	CHUNG C P, IHARA M, HILAL S, et al. Targeting cerebral small vessel disease to promote healthy aging:preserving physical and cognitive functions in the elderly[J]. Arch Gerontol Geriatr, 2023, 110:104982. doi:10.1016/j.archger.2023.104982.
[7]	YANG Q, WEI X, DENG B, et al. Cerebral small vessel disease alters neurovascular unit regulation of microcirculation integrity involved in vascular cognitive impairment[J]. Neurobiol Dis, 2022, 170:105750. doi:10.1016/j.nbd.2022.105750.
[8]	ZULIANI G, MARSILLACH J, TRENTINI A, et al. Lipoprotein-associated phospholipase A2 activity as potential biomarker of vascular dementia[J]. Antioxidants (Basel), 2023, 12(3):597. doi:10.3390/antiox12030597.
[9]	ZHANG D D, CAO Y, MU J Y, et al. Inflammatory biomarkers and cerebral small vessel disease:a community-based cohort study[J]. Stroke Vasc Neurol, 2022, 7(4):302-309. doi:10.1136/svn-2021-001102.
[10]	LIU L, ZHANG X, JIANG N, et al. Plasma lipoprotein-associated phospholipase A2 affects cognitive impairment in patients with cerebral microbleeds[J]. Neuropsychiatr Dis Treat, 2023, 19:635-646. doi:10.2147/dnt.s401603.
[11]	HUANG C J, ZHOU X, YUAN X, et al. Contribution of inflammation and hypoperfusion to white matter hyperintensities-related cognitive impairment[J]. Front Neurol, 2021, 12:786840. doi:10.3389/fneur.2021.786840.
[12]	QIAO S, LI H, GUO F, et al. Research progress on cognitive impairment and the expression of serum inflammatory markers in patients with white matter hyperintensities:a narrative review[J]. Ann Transl Med, 2022, 10(7):421. doi:10.21037/atm-22-1016.
[13]	焦爱菊, 朱若兰, 张春花, 等. 血清Lp-PLA2、Hcy联合WMH对脑小血管病患者认知障碍的预测价值[J]. 天津医药, 2025(8), 53(8):846-850.
	JIAO A J, ZHU R L, ZHANG C H, et al. The predictive value of lipoprotein associated-phospholipase A2 and homocysteine combined with white matter hyperintensities on cognitive impairment in patients with cerebral small vessel disease[J]. Tianjin Med J, 2025, 53(8):846-850. doi:10.11958/20251084.
[14]	刘发伟, 吉维忠. 不同影像学类型脑小血管病及其MRI总负荷与认知功能障碍的研究进展[J]. 中风与神经疾病杂志, 2024, 41(2):179-184.
	LIU F W, JI W Z. Advances in research on different imaging types of cerebral small vascular diseases,their total MRI load,and cognitive dysfunction[J]. Stroke and Neurological Disorders Journal, 2024, 41(2):179-184. doi:10.19845/j.cnki.zfysjjbzz.2024.0035.
[15]	FAN Y, XU Y, SHEN M, et al. Total cerebral small vessel disease burden on MRI correlates with cognitive impairment in outpatients with amnestic disorders[J]. Front Neurol, 2021, 12:747115. doi:10.3389/fneur.2021.747115.
[16]	JANSEN M G, GRIFFANTI L, MACKAY C E, et al. Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life[J]. J Cereb Blood Flow Metab, 2022, 42(4):600-612. doi:10.1177/0271678X211048411.
[17]	LI X, YUAN J, QIN W, et al. Higher total cerebral small vessel disease burden was associated with mild cognitive impairment and overall cognitive dysfunction:a propensity score-matched case-control study[J]. Front Aging Neurosci, 2021, 13:695732. doi:10.3389/fnagi.2021.695732.
[18]	INOUE Y, SHUE F, BU G, et al. Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease[J]. Mol Neurodegener, 2023, 18(1):46. doi:10.1186/s13024-023-00640-5.
[19]	HAINSWORTH A H, MARKUS H S, SCHNEIDER J A. Cerebral small vessel disease,hypertension,and vascular contributions to cognitive impairment and dementia[J]. Hypertension, 2024, 81(1):75-86. doi:10.1161/HYPERTENSIONAHA.123.19943.
[20]	王阳, 李扬, 矫树生, 等. 脑小血管病患者发生认知障碍的影响因素及其风险预测列线图模型构建[J]. 实用心脑肺血管病杂志, 2024, 32(2):57-62.
	WANG Y, LI Y, JIAO S S, et al. Factors influencing cognitive impairment in patients with cerebral small vascular disease and construction of a risk prediction line graph model[J]. Journal of Cardiovascular Diseases of the Heart and Brain, 2024, 32(2):57-62. doi:10.12114/j.issn.1008-5971.2024.00.020.

组别	性别（男/女）	年龄/ 岁		受教育年限/年	高血压病		糖尿病
认知正常组	44/45	65.5±7.5		8（5.5，12.0）	44（49.4）		22（24.7）
认知障碍组	48/41	67.7±9.5		6（5.0，12.0）	49（55.1）		28（31.5）
χ²、t或Z	0.360	1.709		1.483	0.563		1.001
组别		TG/（mmol/L）	TC/（mmol/L）			HDL-C/（mmol/L）
认知正常组		1.6（1.2，1.8）	4.2±1.1			1.2（1.0，1.7）
认知障碍组		1.5（1.1，1.9）	4.4±1.1			1.2（1.0，2.3）
Z或t		0.546	1.395			0.209
组别	LDL-C/（mmol/L）		Hcy/（μmol/L）			IL-6/（μg/L）
认知正常组	2.3±0.8		13.3（11.5，17.9）			7.9（5.2，12.5）
认知障碍组	2.4±0.7		16.0（12.0，20.0）			12.5（10.2，14.6）
Z或t	0.466		1.394			4.866^＊

组别	性别（男/女）	年龄/ 岁		受教育年限/年	高血压病		糖尿病
认知正常组	44/45	65.5±7.5		8（5.5，12.0）	44（49.4）		22（24.7）
认知障碍组	48/41	67.7±9.5		6（5.0，12.0）	49（55.1）		28（31.5）
χ²、t或Z	0.360	1.709		1.483	0.563		1.001
组别		TG/（mmol/L）	TC/（mmol/L）			HDL-C/（mmol/L）
认知正常组		1.6（1.2，1.8）	4.2±1.1			1.2（1.0，1.7）
认知障碍组		1.5（1.1，1.9）	4.4±1.1			1.2（1.0，2.3）
Z或t		0.546	1.395			0.209
组别	LDL-C/（mmol/L）		Hcy/（μmol/L）			IL-6/（μg/L）
认知正常组	2.3±0.8		13.3（11.5，17.9）			7.9（5.2，12.5）
认知障碍组	2.4±0.7		16.0（12.0，20.0）			12.5（10.2，14.6）
Z或t	0.466		1.394			4.866^＊

组别	Lp-PLA2/ （μg/L）	MRI总负荷/分	MRI总负荷分值分布
组别	Lp-PLA2/ （μg/L）	MRI总负荷/分	1分	2分	3分	4分
认知正常组	163（133，222）	1（1，2）	50（56.2）	30（33.7）	8（9.0）	1（1.1）
认知障碍组	254（161，350）	3（2，3）	2（2.2）	27（30.3）	51（57.3）	9（10.1）
Z或P	4.644^＊＊	8.942^＊＊	<0.001^▲

组别	Lp-PLA2/ （μg/L）	MRI总负荷/分	MRI总负荷分值分布
组别	Lp-PLA2/ （μg/L）	MRI总负荷/分	1分	2分	3分	4分
认知正常组	163（133，222）	1（1，2）	50（56.2）	30（33.7）	8（9.0）	1（1.1）
认知障碍组	254（161，350）	3（2，3）	2（2.2）	27（30.3）	51（57.3）	9（10.1）
Z或P	4.644^＊＊	8.942^＊＊	<0.001^▲

变量	β	SE	Wald χ²	P	OR	OR 95%CI
Lp-PLA2	0.005	0.002	9.927	0.002	1.005	1.002~1.008
MRI总负荷评分	2.286	0.327	48.995	<0.001	9.835	5.185~18.653
IL-6	0.023	0.019	1.422	0.233	1.023	0.985~1.062
常数项	-6.325	0.956	43.788	<0.001	0.002	-