脑白质高信号患者血浆脂蛋白磷脂酶A2水平及其与认知功能障碍的关系  

Correlation of plasma lipoprotein phospholipase A2 level with cognitive impairment in patients with white matter hyperintensity

作　　者：邓小莹[1] 范永祥[1] 莫志铭[1] 张志新[1] 张斌[1] DENG Xiaoying;FAN Yongxiang;MO Zhiming;ZHANG Zhixin;ZHANG Bin(Department of Neurology,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510700,China)

机构地区：[1]广州医科大学附属第五医院神经内科,广州510700

出　　处：《实用医学杂志》2021年第7期884-888,共5页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2017ZC0235)。

摘　　要：目的探讨脑白质高信号(WMH)患者血浆脂蛋白磷脂酶A2(Lp-PLA2)水平及其与认知功能障碍的关系。方法选取WMH患者97例为病例组(WMH组),以MoCA量表23分为界分为认知障碍组(CI组)37例和非认知障碍组(NCI组)60例,同期健康体检者52例为对照组(HC组)。采用t检验分析WMH组与HC组血浆Lp-PLA2水平及MoCA得分,应用logistic回归分析WMH伴认知障碍的相关危险因素,并进一步分析Lp-PLA2与WMH患者认知障碍的关系及其诊断应用。结果 (1)WMH组血浆Lp-PLA2水平比对照组明显增高,MoCA评分显著降低(P<0.05);CI组与NCI组相比,性别、年龄、文化程度、饮酒史、尿酸、总胆固醇、甘油三酯、高密度脂蛋白胆固醇差异无统计学意义(P>0.05),高血压史、糖尿病史、吸烟史、空腹血糖、同型半胱氨酸、低密度脂蛋白胆固醇、Lp-PLA2差异具有统计学意义(P<0.05);(2)logistic回归显示:空腹血糖、低密度脂蛋白、同型半胱氨酸、Lp-PLA2等4个指标是WMH伴认知障碍的危险影响因素(P<0.05);(3)同型半胱氨酸、Lp-PLA2两指标指标对WMH伴认知障碍有较高的诊断价值(AUC=0.703,95%CI:0.508~0.973;AUC=0.751,95%CI:0.611~0.923)。联合应用价值更高,AUC为0.806(95%CI:0.677~0.960)。结论 WMH患者具有较高的血浆Lp-PLA2水平,血浆Lp-PLA2水平升高可能为WMH伴发认知障碍的危险因素,也对其有较高的诊断评估价值。Objective To investigate the level of plasma lipoprotein phospholipase A2(Lp-PLA2)and its relationship with cognitive impairment in patients with white matter hyperintensity(WMH).Methods A total of 97patients with WMH were selected as case group(WMH group).According to the MoCA scale,the WMH group was divided into cognitive impairment group(CI group)and non-cognitive impairment group(NCI group).A group of 52healthy subjects in the same period were selected as healthy control group(HC group).The plasma Lp-PLA2 levels and MoCA scores of patients with WMH were compared with those of HC group.Plasma Lp-PLA2 level and MOCA score were analyzed by t-test.Logistic regression was used to analyze the risk factors of WMH with cognitive impairment,and the relationship between LP-PLA2 and cognitive impairment was further analyzed.Results(1)The level of plasma Lp-PLA2 in the WMH group was significantly higher than that in the control group,and the MoCA score was significantly lower(P<0.05).There were no statistically significant differences between the CI and NCI groups in terms of gender,age,education level,drinking history,uric acid and high-density lipoprotein,total cholesterol,glycerol(P>0.05),but the differences were statistically significant in terms of history of hypertension,diabetes,smoking,fasting blood glucose,homocysteine,low-density lipoprotein cholesterol,and Lp-PLA2(P<0.05).(2)Logistic regression showed that the four indexes of Fasting blood glucose,low-density lipoprotein,homocysteine and Lp-PLA2 were the risk factors of WMH with cognitive impairment(P<0.05);(3)The two indicators of homocysteine,Lp-PLA2 had high diagnostic value for WMH with cognitive impairment(AUC=0.703,95%CI:0.508~0.973;AUC=0.751,95%CI:0.611~0.923).The combined application value was higher(AUC=0.806,95%CI:0.677~0.960).Conclusion WMH patients have higher plasma Lp-PLA2 levels.Increased plasma Lp-PLA2 levels may be a risk factor for WMH associated with cognitive impairment,and it also has a higher diagnostic and evaluation value.

关 键 词：脑白质高信号 血浆脂蛋白磷脂酶A2 认知障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]