【摘要】 目的 观察合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的脑梗死患者脑微出血（CMBs）情况、认知功能、过度磷酸化Tau(P-Tau)蛋白表达水平情况，分析其在合并OSAHS脑梗死组与对照组之间的差异性，并进一步探讨合并OSAHS的脑梗患者的认知功能损害程度及过度磷酸化Tau(P-Tau)蛋白表达水平与脑微出血的相关性。方法 前瞻性分析2019年12月―2022年12月期间我院卒中中心收治的脑梗死患者199例，其中94例为合并OSAHS的脑梗死患者，105例为未合并OSAHS脑梗死患者，评估两组CMBs和MoCA评分情况；比较两组患者在治疗前、治疗7 d后及治疗14 d后，其P-Tau蛋白水平变化；以受试者工作特征（ROC）曲线描述合并OSAHS的脑梗死CMBs患者治疗前P-Tau蛋白水平对其认知功能的预测效能，经Pearson相关系数分析合并OSAHS的脑梗死CMBs患者MoCA量表各维度评分结果与治疗前P-Tau蛋白水平的相关性；以MoCA量表得分为认知功能障碍程度评估依据，将94例患者分为轻度障碍组、中度障碍组与重度障碍组，比较3亚组患者治疗前P-Tau蛋白水平差异。结果 合并OSAHS的脑梗死患者MoCA评分较对照组患者低（P<0.05）,CMBs出现率更高，尤其是轻度分级。治疗前，合并OSAHS组P-Tau蛋白水平较对照组高（P<0.05），治疗7 d后及治疗14 d后，合并OSAHS组P-Tau蛋白水平较治疗前比较无显著差异（P>0.05），而对照组P-Tau蛋白水平较治疗前降低（P<0.05）。治疗前P-Tau蛋白水平对合并OSAHS的脑梗死CMBs患者认知功能障碍诊断的敏感度、特异度分别67.31%、90.48%；经Pearson相关分析显示，合并OSAHS的脑梗死CMBs患者MoCA量表中的视空间与执行、注意力和计算力、语言能力、抽象能力、延迟记忆评分结果与治疗前P-Tau蛋白水平均呈负相关（P<0.05）。轻度障碍组、中度障碍组及重度障碍组患者治疗前P-Tau蛋白水平比较存在统计学差异（P<0.05）。结论 合并OSAHS的脑梗死CMBs患者治疗前P-Tau蛋白水平与认知功能障碍存在相关性，能够指导临床对其诊断与严重程度的评估。更多还原

【Abstract】 Objective To observe cerebral microbleeds(CMBs), cognitive function, and the protein expression level of hyperphosphorylated Tau(P-Tau) in patients with cerebral infarction and obstructive sleep apnea-hypopnea syndrome(OSAHS), to analyze their differences between the cerebral infarction+OSAHS group and the control group, and to further investigate the degree of cognitive impairment in patients with cerebral infarction and OSAHS and the association between the protein expression level of P-Tau and CMBs.Methods A prospective analysis was performed for 199 patients with cerebral infarction who were admitted to Stroke Center in our hospital from December 2019 to December 2022, among whom there were 94 patients with OSAHS(cerebral infarction+OSAHS group) and 105 patients without OSAHS(control group), and CMBs and Montreal Cognitive Assessment(MoCA) score were assessed for the two groups. The two groups were compared in terms of changes in the protein expression level of P-Tau before treatment and after 7 and 14 days of treatment. The receiver operating characteristic(ROC) curve was used to describe the predictive efficacy of P-Tau protein level before treatment for the cognitive function of patients with cerebral infarction CMBs and OSAHS, and the Pearson correlation coefficient was used to investigate the correlation of the scores of each dimension of MoCA scale with P-Tau protein level before treatment. With the score of MoCA scale as the basis for assessing the degree of cognitive impairment, 94 patients were divided into mild impairment group, moderate impairment group, and severe impairment group, and P-Tau protein level before treatment was compared between the three groups.Results Compared with the patients in the control group, the patients with cerebral infarction and OSAHS had a significantly lower MoCA score(P<0. 05) and a higher occurrence rate of CMBs, especially in those with mild grade. Before treatment, the cerebral infarction+OSAHS group had a significantly higher P-Tau protein level than the control group(P<0. 05), and after 7 and 14 days of treatment, the cerebral infarction+OSAHS group had no significant change in P-Tau protein level( P>0. 05), while the control group had a significant reduction in P-Tau protein level( P<0. 05). P-Tau protein level before treatment showed a sensitivity of 67. 31% and a specificity of 90. 48% in the diagnosis of cognitive impairment in the patients with cerebral infarction CMBs and OSAHS, and the Pearson correlation analysis showed that the scores of visuospatial/executive, attention and computational ability, language, abstraction, and delayed memory in MoCA scale were negatively correlated with P-Tau protein level before treatment in these patients( P<0. 05). There was a significant difference in P-Tau protein level before treatment between the mild impairment group, the moderate impairment group, and the severe impairment group( P<0. 05).Conclusion P-Tau protein level before treatment is associated with cognitive impairment in patients with cerebral infarction CMBs and OSAHS, which can guide the diagnosis and severity assessment of the disease in clinical practice.更多还原