Association of lipoprotein a, fibrinogen and D-dimer with vascular cognitive impairment in patients with ischemic cerebral small vessel diseases

Abstract

Objective To explore the correlation between lipoprotein a (Lpa), fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD). Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology, Affiliated Hospital of North China University of Science and Technology were selected as the research objects, and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination(MMSE). According to the results of MMSE, patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (100 cases), moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases). Lpa level was detected by latex immunoturbidimetry, FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed. Results (1) Compared with the control group (Lpa: (101.67±37.37)mg/L, FIB: (3.02±0.67) g/L, D-D: (231.49±95.00) mg/L), the levels of Lpa, FIB and D-D in normal group(Lpa: (150.58±89.55) mg/L, FIB: (3.48±0.80) g/L, D-D: (287.79±125.25)mg/L)and cognitive impairment group(Lpa: (257.98±189.23)mg/L , FIB: (3.86±0.97) g/L, D-D: (347.23±120.69) mg/L)increased significantly (all P<0.01). Compared with the cognitive normal group, the levels of Lpa, FIB and D-D in cognitive impairment group increased significantly (all P<0.01). (2) Compared with mild cognitive impairment group (Lpa: 169.08±51.63 mg/L, FIB: (3.10±0.69)g/L, D-D: (288.91±92.58)mg/L), the levels of Lpa, FIB and D-D of in moderate cognitive impairment group (Lpa: (236.78±107.15) mg/L, FIB: (3.52±0.67) g/L, D-D: (345.03±132.68) mg/L), severe cognitive impairment group (Lpa: (292.65±108.19) mg/L, FIB: (4.04±1.08) g/L, D-D: (401.58±84.87) mg/L) increased significantly (all P<0.01). Compared with the moderate cognitive impairment group, the levels of Lpa, FIB and D-D in the severe cognitive impairment group increased significantly (all P<0.01). (3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706, P<0.01, 95% CI was (0.646-0.766), the area under the ROC curve of FIB was 0.613, P=0.001, 95% CI was (0.548-0.679), and the area under the ROC curve of D-D was 0.670, P<0.01, 95% CI was (0.604-0.736). (4) Lpa, FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa=0.522, P<0.01; rFIB=0.410, P<0.01; rD-D=0.488, P<0.01). Conclusion Serum Lpa, FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD, which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa, FIB and D-D is of great clinical value in the early diagnosis, assessment and treatment of cognitive impairment in ischemic CSVD. Key words: Ischemic cerebral small vessel diseases; Vascular cognitive impairment; Lipoprotein a; Fibrinogen; D-dimer