血清1,25(OH)_(2)D_(3)水平与脑小血管病患者认知功能损害程度的相关性分析  

Correlation analysis of serum 1,25(OH)_(2)D_(3)level with cognitive impairment in patients with small cerebral vascular disease

作　　者：孔祥增[1] 李艳敏[1] 孟莉[1] 刘娜[1] 邱会卿[1] 王晓[1] Kong Xiangzeng;Li Yanmin;Meng Li;Liu Na;Qiu Huiqing;Wang Xiao(Department of Neurology,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院神经内科,石家庄050031

出　　处：《脑与神经疾病杂志》2023年第4期199-204,共6页Journal of Brain and Nervous Diseases

基　　金：河北省2017年度医学科学研究重点课题计划项目(20170491)。

摘　　要：目的研究1,25-二羟基维生素D3[1,25(OH)_(2)D_(3)]水平与脑小血管病(CSVD)患者认知功能损害(CI)程度的相关性.方法选取2020年7月-2021年8月河北医科大学第一医院神经内科收治的126例CSVD患者,入院后参照简易智能状态检查量表(MMSE)分为CSVD并发CI组(MMSE<27分,n=89)及CSVD无并发CI组(MMSE≥27分,n=37).比较两组同型半胱氨酸(Hcy)、1,25(OH)_(2)D_(3)、3-硝基酪氨酸(3-NT)、超敏C反应蛋白(hs-CRP)、高密度脂蛋白胆固醇(HDL-C)水平,通过ROC分析Hcy、1,25(OH)_(2)D_(3)、3-NT、hs-CRP、HDL-C预测CSVD并发CI的价值.根据MMSE量表评分评估患者认知功能,将89例CSVD并发CI患者分为轻度组(21分≤MMSE量表评分<27分,n=46)、中度组(10分≤MMSE量表评分<21分,n=28)、重度组(MMSE量表评分<10分,n=15),比较三组患者Hcy、1,25(OH)_(2)D_(3)、3-NT、hs-CRP、HDL-C水平差异,通过Spearman相关系数分析血清Hcy、1,25(OH)_(2)D_(3)、3-NT、hs-CRP、HDL-C与CI严重程度的相关性.结果CSVD并发CI组血清Hcy、3-NT、hs-CRP显著高于CSVD无并发CI组,1,25(OH)_(2)D_(3)、HDL-C水平显著低于CSVD无并发CI组,差异有统计学意义(P<0.05);经ROC分析,Hcy≥14.516μmol·L^(-1)、1,25(OH)_(2)D_(3)≤0.325ng·mL^(-1)、3-NT≥5.741ng·mL^(-1)、hs-CRP≥3.149mg·L^(-1)、HDL-C≤1.160mmol·L^(-1)是预测CSVD并发CI的最佳截断值,曲线下面积分别为0.901、0.894、0.899、0.916、0.904,敏感度为0.932、0.838、0.932、0.943、0.865,特异性为0.865、0.932、0.892、0.865、0.920,且P<0.05;不同CI程度患者血清Hcy、3-NT、hs-CRP比较,轻度组<中度组<重度组;1,25(OH)_(2)D_(3)、HDL-C水平比较,轻度组>中度组>重度组,差异有统计学意义(P<0.05);经相关性分析,CI程度与血清Hcy、3-NT、hs-CRP呈正相关,与1,25(OH)_(2)D_(3)、HDL-C呈负相关,差异有统计学意义(P<0.05).结论血清Hcy、1,25(OH)_(2)D_(3)、3-NT、hs-CRP、HDL-C与CSVD并发CI发病机制相关,且CI程度与血清Hcy、3-NT、hs-CRP呈正相关,与1,25(OH)_(2)DObjective To investigate the correlation between the level of 1,25-dihydroxyvitamin D3[1,25(OH)_(2)D_(3)]and the degree of cognitive impairment(CI)in patients with small cerebral vascular disease(CSVD).Methods A total of 126 CSVD patients admitted to the Department of Neurology,the First Hospital of Hebei Medical University from July 2020 to August 2021 were selected.After admission,they were divided into CSVD complicated CI group(MMSE<27 points,n=89)and CSVD non-complicated CI group(MMSE≥27 points,n=37)according to the simple Mental state Examination Scale(MMSE).The levels of homocysteine(Hcy),1,25(OH)_(2)D_(3),3-nitrotyrosine(3-NT),high-sensitivity C-reactive protein(hs-CRP)and high-density lipoprotein cholesterol(HDL-C)were compared between the two groups.The predictive value of Hcy,1,25(OH),D,3-NT,hs-CRP and HDL-C in CSVD concurrent CI was analyzed by ROC.The cognitive function of patients was evaluated according to MMSE score.The 89 CSVD patients with CI were divided into mild group(21≤MMSE score<27,n=46),moderate group(10≤MMSE score<21,n=28),and severe group(MMSE score<10,n=15).The levels of Hcy,1,25(OH)_(2)D_(3),3-NT,hs-CRP and HDL-C in the three groups were compared and the correlation between serum Hcy,1,25(OH)_(2)D_(3),3-NT,hs-CRP and HDL-C and the severity of CI was analyzed by Spearman correlation coefficient.Results The levels of serum Hcy,3-NT and hs-CRP in CSVD complicated CI group were significantly higher than those in CSVD non-complicated CI group and the levels of 1,25(OH)_(2)D_(3)and HDL-C were significantly lower than those in CSVD non-complicated CI group,with statistical significance(P<0.05).After R0C analysis,Hcy≥14.516μmol·L^(-1),25(OH)_(2)D_(3)≤0.325ng mL^(-1),3-NT≥5.741ng·mL^(-1),hs-CRP≥3.149mg·L^(-1),HDL-C≤1.160mmol·L^(-1)were the best cut-off values for predicting concurrent CI of CSVD.The areas under the curve were 0.901,0.894,0.899,0.916,0.904,the sensitivity was 0.932,0.838,0.932,0.943,0.865,and the specificity was 0.865,0.932,0.892,0.865,0.920,respectively,P<0

关 键 词：1 25-二羟基维生素D3 脑小血管病 认知功能损害 同型半胱氨酸 超敏C反应蛋白 高密度脂蛋白胆固醇 3-硝基酪氨酸 

分 类 号：R743.32[医药卫生—神经病学与精神病学]