阿尔茨海默病患者部分凝血和生化指标的变化及意义  

Partial coagulation and biochemical indexes in patients with Alzheimer’s disease:Charge analysis and its significance

作　　者：李姗姗[1] 柯将琼[2] 舒旷怡[1] 陈俏 周莲莲[1] 周雅静 江明华[1] LI Shanshan;KE Jiangqiong;SHU Kuangyi;CHEN Qiao;ZHOU Lianlian;ZHOU Yajing;JIANG Minghua(Clinical Laboratory Center,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Geriatric Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院临床检验中心,浙江温州325027 [2]温州医科大学附属第二医院老年医学科,浙江温州325027

出　　处：《温州医科大学学报》2023年第6期482-487,共6页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y20210101)。

摘　　要：目的:分析阿尔茨海默病(AD)患者部分凝血和生化指标的变化,探寻在AD诊治中有应用价值的血液指标。方法:纳入2019年1月至2022年12月在温州医科大学附属第二医院就诊的AD患者148例为AD组,同时纳入100例同期健康体检者为对照组。采用STAGO和西门子等检测系统分析血液中凝血因子XII促凝活性(FXII:C)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(DD)、甘油三酯(TG)、胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、葡萄糖(GLU)、糖化血红蛋白A1c(HbA1c)、脂蛋白A(LPA)、碱性磷酸酶(ALP)和C反应蛋白(CRP)等15个指标水平,用简易精神状态检查、蒙特利尔认知评估法评估认知能力,用日常生活能力评定Barthel指数评估生活能力,用临床痴呆评定量表(CDR)评估痴呆程度。采用独立样本t检验或Kruskal-Wallis检验比较各组差异,相关性分析采用Spearman相关,回归分析采用Logistic回归。结果:AD组FXII:C和CRP水平明显高于对照组(P<0.01),TT、CHOL、HDL、LDL和ALP水平明显低于对照组(P<0.05)。年龄、文化程度、ALP、CRP、FIB、DD与痴呆程度呈正相关(r=0.357、0.289、0.308、0.409、0.416、0.290,P<0.01)。回归分析显示FXII:C是患AD的独立危险因素(OR=1.102,P<0.01),TT和CHOL是患AD的独立保护因素(OR=0.296、0.011,P<0.05)。MoCA评分+FXII:C+CHOL+TT联合筛查AD的曲线下面积最大(95%CI=0.956~1.000),MoCA评分+FXII:C+CHOL联合筛查AD的灵敏度最高为96.2%(曲线下面积=0.963,95%CI=0.918~1.000)。结论:认知评估联合FXII:C、CHOL和TT将提高对AD筛查的灵敏度和特异度;降低FXII活性、避免低胆固醇水平可降低AD的患病率;CRP、FIB是监测AD疾病严重程度的良好指标。Objective:To explore the useful blood indexes in the diagnosis and treatment of Alzheimer’s disease(AD)by analyzing the levels of some blood coagulation and biochemical indicators in AD.Methods:Of all 148 AD patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2022 were included as AD group,while 100 healthy subjects during the same period were assigned as control group.Blood levels of coagulation factor XII activity(FXII:C),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer(DD),triglyceride(TG),total cholesterol(CHOL),HDL-cholesterol(HDL-C),LDL-cholesterol(LDL-C),glucose(GLU),glycated hemoglobin A1c(HbA1c),lipoprotein(LPA),alkaline phosphatase(ALP)and C-reacitve protein(CRP)were analyzed by STAGO and Siemens detection systems.The cognitive ability was assessed by mini-mental state examination and Montreal cognitive assessment(MoCA),life ability was assessed by the Barthel index of daily living,and dementia degree was assessed by clinical dementia rating scale(CDR).Independent sample t test or Kruskal-Wallis test were used to compare the differences among all groups.Spearman correlation analysis was used for correlation analysis.Logistic regression analysis was used for regression analysis.Results:The levels of FXII:C and CRP in AD group were significantly higher than those in control group(P<0.01),while the levels of TT,CHOL,HDL,LDL and ALP in AD group were significantly lower than those in control group(P<0.05).Age,education level,ALP,CRP,FIB,DD were positively correlated with the degree of dementia(r=0.357,0.289,0.308,0.409,0.416,0.290,P<0.01).Regression analysis showed that FXII:C was a independent risk factor for AD(OR=1.102,P<0.01),and TT and CHOL were independent protective factors for AD(OR=0.296,0.011,P<0.05).MoCA score+FXII:C+CHOL+TT combined screening had the largest AUC(95%CI=0.956-1.000),while MoCA score+FXII:C+CHOL combined screening the maximum sensitivity of 96.2%(AUC=0.963,95%CI=0.

关 键 词：阿尔茨海默病 血液标志物 凝血 血脂 

分 类 号：R741[医药卫生—神经病学与精神病学]