Zhang Ming-Si, Liang Jian-Hai, Yang Meng-Jia, Ren Yue-Ran, Cheng Dai-Hong, Wu Qi-Heng, He Yan, Yin Jia
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medicine University, Guangzhou, China.
Front Aging Neurosci. 2022 Feb 28;14:834114. doi: 10.3389/fnagi.2022.834114. eCollection 2022.
BACKGROUND: Post-stroke cognitive impairment (PSCI) is a common complication after stroke, but effective therapy is limited. Identifying potential risk factors for effective intervention is warranted. We investigated whether serum superoxide dismutase (SOD) levels were related to cognitive impairment after mild acute ischemic stroke (AIS) by using a prospective cohort design. METHODS: A total of 187 patients diagnosed with mild AIS (National Institutes of Health Stroke Scale ≤ 8) were recruited. Serum SOD, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were measured, and cognitive assessments (Mini-Mental State Examination, MMSE; Montreal Cognitive Assessment, MoCA) were performed in the early phase (within 2 weeks). These indexes and assessments were repeated at 3 months after onset. MoCA < 22 was defined as early cognitive impairment (CI-E) within 2 weeks and late cognitive impairment (CI-L) at 3 months after stroke. RESULTS: In a survey, 105 of 187 (56.1%) patients were identified as CI-E after mild AIS. Lower serum SOD associated with higher inflammatory biomarkers (ESR, CRP, and IL-6) and worse cognitive scores was observed in CI-E patients. In a survey, 39 of 103 (37.9%) stroke patients who completed the 3-month follow-up were identified as CI-L. Serum SOD was consistently lower in CI-L patients at baseline and 3 months and positively associated with cognitive scores. In adjusted analyses, low serum SOD at baseline was independently associated with high risks of CI-E and CI-L, with odds ratios (ORs) of 0.64 and 0.33 per standard deviation increase in serum SOD, respectively. Multiple-adjusted spline regression models showed linear associations between serum SOD and CI-E ( = 0.044 for linearity) and CI-L ( = 0.006 for linearity). Moreover, 35.2% (19/54) of CI-E patients cognitively recovered during the 3-month follow-up. In multivariable analysis, SOD was identified as a protective factor for cognitive recovery after stroke (OR 1.04, 95% CI: 1.01-1.08, = 0.024). CONCLUSION: We demonstrate that low serum SOD is associated with a high risk of cognitive impairment after mild AIS, indicating SOD may be a potential modifiable factor for PSCI.
背景：卒中后认知障碍（PSCI）是卒中后常见的并发症，但有效的治疗方法有限。确定潜在的风险因素以进行有效干预是很有必要的。我们采用前瞻性队列设计，研究血清超氧化物歧化酶（SOD）水平是否与轻度急性缺血性卒中（AIS）后的认知障碍相关。 方法：共招募了187例诊断为轻度AIS（美国国立卫生研究院卒中量表≤8）的患者。在早期阶段（2周内）测量血清SOD、红细胞沉降率（ESR）、C反应蛋白（CRP）和白细胞介素-6（IL-6）水平，并进行认知评估（简易精神状态检查表，MMSE；蒙特利尔认知评估量表，MoCA）。在发病后3个月重复这些指标和评估。MoCA<22被定义为卒中后2周内的早期认知障碍（CI-E）和3个月时的晚期认知障碍（CI-L）。 结果：在一项调查中，187例患者中有105例（56.1%）在轻度AIS后被确定为CI-E。在CI-E患者中，观察到较低的血清SOD与较高的炎症生物标志物（ESR、CRP和IL-6）以及较差的认知评分相关。在一项调查中，103例完成3个月随访的卒中患者中有39例（37.9%）被确定为CI-L。CI-L患者在基线和3个月时血清SOD一直较低，且与认知评分呈正相关。在调整分析中，基线时低血清SOD与CI-E和CI-L的高风险独立相关，血清SOD每增加一个标准差，比值比（OR）分别为0.64和0.33。多重调整样条回归模型显示血清SOD与CI-E（线性 = 0.044）和CI-L（线性 = 0.006）之间存在线性关系。此外，35.2%（19/54）的CI-E患者在3个月随访期间认知功能恢复。在多变量分析中，SOD被确定为卒中后认知恢复的保护因素（OR 1.04，95%CI：1.01-1.08， = 0.024）。 结论：我们证明低血清SOD与轻度AIS后认知障碍的高风险相关，表明SOD可能是PSCI的一个潜在可改变因素。
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