载脂蛋白E基因及白质高信号与阿尔茨海默病脑白质完整性的关系  

Relationship between apolipoprotein E gene,white matter hyperintensities and white matter integrity in Alzheimer′s disease

作　　者：刘晓宇 李春[1] 王晓洁 王晓放 张怡琳 田雨 赵莘瑜[1] LIU Xiaoyu;LI Chun;WANG Xiaojie;WANG Xiaofang;ZHANG Yilin;TIAN Yu;ZHAO Xinyu(Department of Neurology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Department of Neurology,Zhengzhou People′s Hospital,Zhengzhou 450053)

机构地区：[1]郑州大学第一附属医院神经内科,郑州450052 [2]郑州人民医院神经内科,郑州450053

出　　处：《郑州大学学报（医学版）》2022年第1期92-96,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划项目(2018010008,LHGJ20190079)。

摘　　要：目的:探究阿尔茨海默病(AD)中载脂蛋白E(ApoE)ε4、白质高信号(WMH)、血清神经丝蛋白轻链(NFL)水平与脑白质完整性的关系。方法:收集38例AD患者临床资料并检测ApoE基因型及血清NFL水平,采用Fazekas量表评估WMH严重程度,通过弥散张量成像序列参数各向异性分数(FA)和平均扩散率(MD)评估白质完整性。结果:双侧扣带回扣带束、右侧钩束FA值与简易智能精神状态检查量表评分呈正相关(r=0.471~0.663,P<0.05),胼胝体辐射线额部、左侧下纵束、双侧钩束FA值与听觉词语学习测验华山版(AVLT-H)即刻回忆评分呈正相关(r=0.647~0.768,P<0.05),左侧扣带回扣带束、右侧钩束FA值与AVLT-H短延时回忆评分呈正相关(r=0.611、0.588,P<0.05),左侧扣带回扣带束、胼胝体辐射线额部FA值与AVLT-H长延时回忆评分呈正相关(rs=0.620、0.561,P<0.05)。ApoEε4是双侧钩束FA值影响因素(β=-0.005、-0.007,P<0.05),WMH是广泛白质FA值影响因素(β=-0.026~-0.009,P<0.05)。在AD女性患者中ApoEε4是左侧扣带回扣带束、左侧海马部扣带束、右侧钩束FA值影响因素(β=-0.009、-0.017、-0.009,P<0.05)。血清NFL水平与双侧扣带回扣带束、双侧海马部扣带束、双侧上纵束颞部及右侧钩束FA值呈负相关(rs=-0.837~-0.709,P<0.05),与双侧扣带回扣带束、左侧海马部扣带束、左侧上纵束颞部、双侧钩束MD值呈正相关(rs=0.600~0.847,P<0.05)。结论:女性、ApoEε4、WMH是AD患者白质纤维束损伤的危险因素,早期积极管理血管危险因素在AD预防中具有重要意义。Aim:To explore relationship between apolipoprotein E(ApoE)ε4,white matter hyperintensities(WMH),serum neurofilament light(NFL)level and white matter integrity in Alzheimer′s disease(AD).Methods:The clinical data of 38 AD patients were collected,and blood samples were used to measure ApoE genotype and serum NFL level.The Fazekas scale and parameters of fractional anisotropy(FA)and mean diffusivity(MD)of diffusion tensor imaging sequence were used to evaluate the severity of WMH and the white matter integrity,respectively.Results:FA values of bilateral cingulum(cingulate gyrus)and the right uncinate fasciculus were positively correlated with mini mental state examination score(r=0.471-0.663,P<0.05).FA values of forceps minor,the left inferior longitudinal fasciculus and the bilateral uncinate fasciculus were positively correlated with the score of immediate recall of auditory verbal learning test-Huashan version(AVLT-H)(r=0.647-0.768,P<0.05).FA values of the left cingulum(cingulate gyrus)and the right uncinate fasciculus were positively correlated with the score of short-term recall of AVLT-H(r=0.611,0.588,P<0.05).FA values of the left cingulum(cingulate gyrus)and forceps minor were positively correlated with the score of long-term recall of AVLT-H(rs=0.620,0.561,P<0.05).ApoEε4 was a influencing factor of FA values of bilateral uncinate fasciculus(β=-0.005,-0.007,P<0.05),and WMH was a influencing factor of FA values of widespread white matter(β=-0.026--0.009,P<0.05).ApoEε4 was a influencing factor of FA values of the left cingulum(cingulate gyrus),the left hippocampal cingulum and the right uncinate fasciculus only in the female group(β=-0.009,-0.017,-0.009,P<0.05).Serum NFL level was negatively correlated with FA values of bilateral cingulum(cingulate gyrus),bilateral hippocampal cingulum,bilateral superior longitudinal fasciculus(temporal part)and the right uncinate fasciculus(rs=-0.837--0.709,P<0.05),and positively correlated with MD values of bilateral cingulum(cingulate gyrus),the left hippocampal cing

关 键 词：阿尔茨海默病 脑白质完整性 载脂蛋白E基因 白质高信号 神经丝蛋白轻链 

分 类 号：R741.02[医药卫生—神经病学与精神病学]