Correlation between serum peroxisome proliferator-activated receptor γ coactivator 1α and soluble CD40 ligand levels with cognitive impairment and their predictive value in patients with acute cerebral infarction complicated with cerebral microbleeds

Song Xiaozheng; He Jia; Tang Yizhi

doi:10.3760/j.issn.1673-4777.2026.03.011

Abstract：Objective To investigate the correlation between serum peroxisome proliferator-activated receptor γ coactivator 1α(PGC-1α)and soluble CD40 ligand(sCD40L)levels with cognitive impairment and their predictive value in patients with acute cerebral infarction(ACI)complicated with cerebral microbleeds.Methods A total of 291 patients with ACI complicated with cerebral microbleeds admitted to the Department of Neurology,363 Hospital from June 2021 to March 2025 were enrolled as research subjects.According to the presence or absence of cognitive impairment,the patients were divided into the cognitive impairment group(124 cases)and non-cognitive impairment group(167 cases).Serum levels of PGC-1α and sCD40L were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to identify the influencing factors for cognitive impairment in patients with ACI complicated with cerebral microbleeds.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the combined prediction model constructed based on PGC-1α and sCD40L for cognitive impairment in patients with ACI complicated with cerebral microb-leeds.Results The serum PGC-1α level in the cognitive impairment group was significantly lower than that in the non-cognitive impairment group[(0.58±0.12)μg/L vs(0.85±0.10)μg/L],while the serum sCD40L level was significantly higher than that in the non-cognitive impairment group[(330±59)ng/L vs(226±21)ng/L](both P＜0.001).Multivariate Logistic regression analysis showed that high National Institutes of Health Stroke Scale(NIHSS)score and high sCD40L level were risk factors for cognitive impairment in patients with ACI complicated with cerebral microbleeds,while high PGC-1α level was a protective factor(all P＜0.05).A combined prediction model for cognitive impairment in patients with ACI complicated with cerebral microbleeds was constructed based on the probability risk model derived from the above multivariate regression:Logit[P/(1-P)]=-0.166+0.141 × NIHSS score-0.536 × PGC-1α+0.716 × sCD40L.ROC analysis with the model value as the predictive effect size showed that the area under the curve of the combined prediction model was 0.828(95％confidence interval:0.673-0.988),with a sensitivity of 84.7％and specificity of 82.0％.Conclusion Decreased serum PGC-1α level and increased sCD40L level are associated with cognitive impairment in patients with ACI complicated with cerebral microbleeds.The combined prediction model constructed based on PGC-1α and sCD40L can well evaluate the risk of cognitive impairment in these patients.