Li Hong, Yang Deyu, Liu Shudong, Zhu Zhengbao, Shi Mengyao, Xu Tan, Chen Jing, Zhang Yonghong, He Jiang, Zhong Chongke, Bu Xiaoqing
Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, PR China.
Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, PR China.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108206. doi: 10.1016/j.jstrokecerebrovasdis.2024.108206. Epub 2024 Dec 19.
It is unclear whether the extent of neuroaxonal damage, as measured by circulating levels of neurofilament light chain (NfL), would modify the effects of early antihypertensive therapy on cognitive performance following stroke. This study aimed to investigate the effects of early blood pressure reduction on the risk of post-stroke cognitive impairment (PSCI) among patients with different plasma NfL levels.
A total of 622 eligible patients from a pre-planned ancillary study of CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were included in this study. The electrochemiluminescence immunoassay technique was used to evaluate Plasma NfL levels at baseline, and the Mini-Mental State Examination (MMSE) in Chinese was used to assess cognition at the 3-month follow-up. An MMSE score of less than 27 was considered as PSCI.
The effect of antihypertensive therapy on PSCI differed according to NfL levels at the 3-month follow-up. In the low NfL group, compared with the control group, antihypertensive treatment reduced the risk of PSCI [adjusted odds ratio (OR), 95 % confidence interval (CI): 0.50 (0.31-0.81)]. However, in the high NfL group, antihypertensive treatment increased the risk of PSCI compared with the control group [adjusted OR, 95 % CI: 1.93 (1.16-3.20)].
Antihypertensive therapy in the acute phase reduced the risk of PSCI in patients with low plasma NfL levels, but increased the risk in patients with high NfL levels.
目前尚不清楚，通过神经丝轻链（NfL）循环水平所衡量的神经轴突损伤程度是否会改变早期降压治疗对卒中后认知功能的影响。本研究旨在探讨早期血压降低对不同血浆NfL水平患者发生卒中后认知障碍（PSCI）风险的影响。
本研究纳入了来自CATIS（中国急性缺血性卒中降压试验）一项预先计划的辅助研究中的622例符合条件的患者。采用电化学发光免疫分析技术评估基线时的血浆NfL水平，并在3个月随访时使用中文版简易精神状态检查表（MMSE）评估认知功能。MMSE评分低于27分被视为PSCI。
在3个月随访时，降压治疗对PSCI的影响因NfL水平而异。在低NfL组中，与对照组相比，降压治疗降低了PSCI的风险[调整后的比值比（OR），95%置信区间（CI）：0.50（0.31-0.81）]。然而，在高NfL组中，与对照组相比，降压治疗增加了PSCI的风险[调整后的OR，95%CI：1.93（1.16-3.20）]。
急性期降压治疗降低了低血浆NfL水平患者发生PSCI的风险，但增加了高NfL水平患者的风险。
