2026 年第 5 期 第 21 卷

血清核苷酸结合寡聚化结构域样受体蛋白3与热休克蛋白70的交互作用对老年轻型缺血性脑卒中患者认知障碍的影响

Effects of the interaction between serum nucleotide-binding oligomerization domain-like receptor protein 3 and heat shock protein 70 on cognitive impairment in elderly patients with minor ischemic stroke

作者：张志伟1王洁青2高新茹3张帆3宋爱霞3

英文作者：Zhang Zhiwei1 Wang Jieqing2 Gao Xinru3 Zhang Fan3 Song Aixia3

单位：1河北北方学院附属第一医院神经内科重症监护病房，张家口075000；2陆军第八十一集团军医院神经内科，张家口075000；3河北北方学院附属第一医院神经内科，张家口075000

英文单位：1Intensive Care Unit Department of Neurology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 2Department of Neurology the Hospital of 81st Group Army PLA Zhangjiakou 075000 China; 3Department of Neurology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：轻型缺血性脑卒中；认知障碍；核苷酸结合寡聚化结构域样受体蛋白3；热休克蛋白70

英文关键词：Minorischemicstroke;Cognitiveimpairment;Nucleotide-bindingoligomerizationdomain-likereceptorprotein3;Heatshockprotein70

• 摘要：

• 目的 分析血清核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）与热休克蛋白70（Hsp70）的交互作用对老年轻型缺血性脑卒中（MIS）患者认知障碍的影响。方法 选取2024年12月至2025年5月河北北方学院附属第一医院收治的219例老年MIS患者，发病后3个月采用蒙特利尔认知评估量表评估患者认知功能，根据是否发生认知障碍分为发生组与未发生组。比较2组血清NLRP3、Hsp70水平，采用Pearson相关性方法分析血清NLRP3与Hsp70相关性，Logistic回归分析血清NLRP3、Hsp70与认知障碍的关系，通过交互作用分析二者对认知障碍的交互作用，受试者工作特征（ROC）曲线、决策曲线分析血清NLRP3、Hsp70对老年MIS患者认知障碍的预测价值。结果 发生组血清NLRP3水平显著高于未发生组［（137±13）ng/L比（109±9）ng/L］，Hsp70显著低于未发生组［（22±4）μg/L比（30±6）μg/L］（均P＜0.05）。Pearson相关性分析显示，血清NLRP3水平与血清Hsp70水平呈负相关（r=-0.843，P＜0.05）。Logistic回归分析显示，年龄、血清NLRP3均为老年MIS患者认知障碍的危险因素，受教育年限、Hsp70为其保护因素（均P＜0.05）。交互作用分析显示，调控混杂因素后，与NLRP3低水平+Hsp70高水平相比，NLRP3高水平+Hsp70低水平时老年MIS患者发生认知障碍风险升高为10.326倍，血清NLRP3、Hsp70水平对老年MIS患者认知障碍风险具有协同交互效应（P＜0.05）。ROC曲线显示，血清NLRP3、Hsp70联合预测的曲线下面积为0.895，高于单一指标（均P＜0.05）。决策曲线显示，在风险阈值（0.01～0.99）时，血清NLRP3、Hsp70联合对老年MIS患者认知障碍风险净获益率高于单一检测。结论 血清NLRP3为老年MIS患者认知障碍的危险因素，Hsp70为其保护因素，二者对认知障碍具有协同交互效应，联合检测能提高对认知障碍风险的预测价值。

• Objective To analyze the effects of the interaction between serum nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) and heat shock protein 70 (Hsp70) on cognitive impairment in elderly patients with minor ischemic stroke (MIS). Methods A total of 219 elderly MIS patients admitted to the First Affiliated Hospital of Hebei North University from December 2024 to May 2025 were enrolled. Cognitive function was assessed using the Montreal cognitive assessment scale 3 months after onset. Patients were divided into cognitive impairment group and non-cognitive impairment group. Serum NLRP3 and Hsp70 levels were compared between the two groups. Pearson correlation was used to analyze the correlation between serum NLRP3 and Hsp70. Logistic regression was used to analyze the relationship between serum NLRP3, Hsp70 and cognitive impairment. The interaction between NLRP3 and Hsp70 on cognitive impairment was analyzed. Receiver operating characteristic (ROC) curve and decision curve analysis were used to evaluate the predictive value of serum NLRP3 and Hsp70 for cognitive impairment in elderly MIS patients. Results Serum NLRP3 level in the cognitive impairment group was significantly higher than that in the non-cognitive impairment group ［(137±13)ng/L vs (109±9)ng/L］, and Hsp70 level was significantly lower ［(22±4)μg/L vs (30±6)μg/L］(both P<0.05). Pearson correlation analysis showed that serum NLRP3 level was negatively correlated with serum Hsp70 level (r=-0.843, P＜0.05). Logistic regression analysis showed that age and serum NLRP3 were risk factors for cognitive impairment in elderly MIS patients, while education years and Hsp70 were protective factors (all P<0.05). Interaction analysis showed that after adjusting for confounding factors, compared with low NLRP3+high Hsp70 group, the risk of cognitive impairment in high NLRP3+low Hsp70 group increased to 10.326 times. Serum NLRP3 and Hsp70 had a synergistic interaction effect on the risk of cognitive impairment (P<0.05). ROC curve showed that the area under the curve of combined serum NLRP3 and Hsp70 prediction was 0.895, which was higher than that of single indicator (all P<0.05). Decision curve showed that within the risk threshold of 0.01-0.99, the net benefit rate of combined detection of serum NLRP3 and Hsp70 was higher than that of single detection. Conclusion Serum NLRP3 is a risk factor and Hsp70 is a protective factor for cognitive impairment in elderly MIS patients. They have a synergistic interaction effect on cognitive impairment, and combined detection can improve the predictive value for the risk of cognitive impairment.