血清同型半胱氨酸和半胱氨酸天冬酶-3水平与慢性阻塞性肺疾病患者认知障碍的关系研究  

Relations of Serum Levels of Homocysteine and Caspase-3 to Cognitive Disorder in Patients with Chronic Obstructive Pulmonary Disease

作　　者：苗玲 王敏[1] 秦景云[1] 张向民[2] MIAO Ling;WANG Min;QIN Jingyun;ZHANG Xiangmin(Department of Thoracic Surgery,the Central Hospital of Handan,Handan 056000,China;Department of Respiratory Medicine,the Second Hospital of Handan,Handan 056000,China)

机构地区：[1]河北省邯郸市中心医院胸外科,056000 [2]河北省邯郸市第二医院呼吸内科,056000

出　　处：《实用心脑肺血管病杂志》2020年第2期53-57,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省医学科学研究课题计划项目(20191792)。

摘　　要：背景血清同型半胱氨酸(Hcy)和半胱氨酸天冬酶-3(caspase-3)水平与神经退行性病变有关,但二者与慢性阻塞性肺疾病(COPD)患者认知障碍的关系尚未明确。目的分析血清Hcy和caspase-3水平与COPD患者认知障碍的关系。方法选取2016年1月—2019年6月邯郸市中心医院呼吸内科收治的COPD患者156例作为病例组,根据蒙特利尔认知评估量表(MoCA)评分将其分为A组58例(认知功能正常)、B组65例(轻度认知障碍)及C组33例(中重度认知障碍);另选取同期体检健康者150例作为对照组。比较病例组和对照组受试者动脉血气分析指标〔包括动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及pH值〕、肺功能指标〔包括第1秒用力呼气容积(FEV1)、呼气峰值流速(PEF)、最大呼气中段流量(MMEF)及用力肺活量(FVC)〕、MoCA评分,对照组、A组、B组、C组受试者血清Hcy、caspase-3水平;血清Hcy和caspase-3水平与COPD患者MoCA评分的相关性分析采用Pearson相关分析;绘制受试者工作特征曲线(ROC曲线)以评价血清Hcy和caspase-3水平对COPD患者认知障碍的预测价值。结果(1)病例组患者PaO2、pH值低于对照组,PaCO2高于对照组,FEV1和FVC小于对照组,PEF和MMEF慢于对照组(P<0.05)。(2)病例组患者视空间与执行功能、命名、记忆、注意、语言、抽象思维、延时回忆、定向评分及MoCA总分均低于对照组(P<0.05)。(3)A组、B组、C组患者血清Hcy和caspase-3水平高于对照组,B组和C组患者血清Hcy和caspase-3水平高于A组,C组患者血清Hcy和caspase-3水平高于B组(P<0.05)。(4)Pearson相关分析结果显示,血清Hcy、caspase-3水平与COPD患者MoCA评分呈负相关(r值分别为-0.553、-0.567,P<0.01)。(5)ROC曲线显示,血清Hcy水平预测COPD患者认知障碍的曲线下面积(AUC)为0.781〔95%CI(0.695,0.886)〕,最佳截断值为13.56 ng/L,灵敏度、特异度分别为70.75%、92.62%;血清caspase-3水平预测COPD患者认知障碍的AUC为0.77Background Serum levels of homocysteine(Hcy)and caspase-3 are related to neurodegenerative disorders,however relations of the above two to cognitive disorder in patients with chronic obstructive pulmonary disease(COPD)is not unclear.Objective To investigate the relation of serum levels of Hcy and caspase-3 to cognitive disorder in patients with COPD.Methods From January 2016 to June 2019,a total of 156 patients with COPD were selected as case group in the Department of Respiratory Medicine,the Central Hospital of Handan,and they were divided into A group(with normal cognitive function,n=58),B group(with mild cognitive disorder,n=65)and C group(with moderate to severe cognitive disorder,n=33)according to MoCA score,meanwhile a total 150 healthy people admitted to this hospital for physical examination were selected as control group.Arterial blood-gas analysis results(including PaO2,PaCO2 and pH value),index of pulmonary function(including FEV1,PEF,MMEF and FVC)and MoCA score were compared between case group and control group,moreover serum levels of Hcy and caspase-3 were compared in control group and groups A,B,C;Pearson correlation analysis was used to analyze the correlations of serum levels of Hcy and caspase-3 with MoCA in patients with COPD;ROC curve was drawn to evaluate the predictive value of serum levels of Hcy and caspase-3 on cognitive disorder in patients with COPD.Results(1)PaO2 and pH value in case group were statistically significantly lower than those in control group,PaCO2 in case group was statistically significantly higher than that in control group,FEV1 and FVC in case group were statistically significantly less than those in control group,PEF and MMEF in case group were statistically significantly slower than those in control group(P<0.05).(2)Visual space and executive function score,naming score,memory score,attention score,language score,abstract thinking score,delayed memory score,orientation score and total MoCA score in case group were statistically significantly less than those in contr

关 键 词：慢性阻塞性肺疾病 认知障碍 同型半胱氨酸 半胱氨酸天冬酶-3 预测 

分 类 号：R563.9[医药卫生—呼吸系统]