血清NO、Hcy、MCP-1和SAA预测OSAHS患者认知功能障碍的应用价值  

Application value of serum NO,Hcy,MCP-1,and SAA in predicting cognitive dysfunction in OSAHS patients

作　　者：黄玉芳[1] 邱容[1] 欧国春 王述红[1] Huang Yufang;Qiu Rong;Ou Guochun;Wang Shuhong(The Second Ward of Respiratory Center,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院呼吸中心二病区,遂宁629000

出　　处：《国际呼吸杂志》2023年第7期824-829,共6页International Journal of Respiration

基　　金：四川省医学科研课题计划(S21012)。

摘　　要：目的研究血清一氧化氮(NO)、同型半胱氨酸(Hcy)、单核细胞趋化蛋白1(MCP-1)和血清淀粉样蛋白A(SAA)预测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知功能障碍的价值。方法本研究为队列研究,采取非随机抽样的方法选取2018年3月至2022年3月于遂宁市中心医院呼吸中心二病区住院的174例OSAHS患者为研究对象,根据蒙特利尔认知评估量表评分分为认知功能障碍(<26分)组56例、认知功能正常(≥26分)组118例。比较2组患者临床资料和血清NO、Hcy、MCP-1、SAA水平,应用受试者工作特征曲线分析NO、Hcy、MCP-1、SAA预测OSAHS患者发生认知功能障碍的价值,采用逐步法行多因素logistic回归分析OSAHS患者发生认知功能障碍的影响因素。结果认知功能障碍组学历为小学及以下者占比高[57.14%(32/56)],而认知功能正常组学历为高中及以上者占比高[53.39%(63/118)]。认知功能障碍组合并低氧血症比例高于认知功能正常组[42.86%(24/56)比16.95%(20/118),χ^(2)=12.38,P<0.001],白日嗜睡患者比例也高于认知功能正常组[39.29%(22/56)比22.03%(26/118),χ^(2)=5.66,P<0.05]。认知功能障碍组血清NO水平低于认知功能正常组[(59.71±5.24)μmol/L比(63.08±6.57)μmol/L,t=3.36,P<0.05],而Hcy、MCP-1、SAA水平均高于认知功能正常组,分别为Hcy(12.47±2.29)μmol/L比(11.35±1.38)μmol/L;MCP-1(33.27±5.16)ng/L比(24.62±5.49)ng/L;SAA(83.06±18.52)μmol/L比(51.76±9.35)μmol/L,差异均有统计学意义(t值分别为4.00、9.90、14.83,均P<0.001)。受试者工作特征曲线显示,血清NO、Hcy、MCP-1、SAA水平对OSAHS患者发生认知功能障碍均有一定预测价值,曲线下面积分别为0.899(95%CI:0.861~0.938)、0.887(95%CI:0.816~0.958)、0.919(95%CI:0.889~0.949)和0.900(95%CI:0.859~0.941)。当NO的最佳截断值为61.428μmol/L时,敏感度为82.6%,特异度为87.3%;当Hcy的最佳截断值为11.952μmo/L时,敏感度为78.3%,特异度为86.4%;当MCP-1的最佳截断值为28.1Objective To investigate the values of serum nitric oxide(NO),homocysteine(Hcy),monocyte chemoattractant protein-1(MCP-1),and serum amyloid A protein(SAA)in predicting cognitive dysfunction in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods It was a cohort study involving 174 OSAHS patients hospitalized in the Second Ward of Respiratory Center of Suining Central Hospital from March 2018 to March 2022 selected using a non-random sampling method.According to the score of the Montreal Cognitive Assessment Scale(MoCA)scores,they were allocated to cognitive dysfunction group(<26 points,n=56)and normal cognitive function group(≥26 points,n=118).Clinical data and serum levels of NO,Hcy,MCP-1,and SAA were compared between groups.The values of NO,Hcy,MCP-1,and SAA in predicting cognitive dysfunction in OSAHS patients were analyzed by plotting the receiver operating characteristic(ROC)curves.Influencing factors for cognitive dysfunction in OSAHS patients were identified by the stepwise logistic regression analysis.Results The proportion of individuals with primary school education or below in the cognitive dysfunction group was high(57.14%[32/56]),while the proportion of individuals with high school education or above in the normal cognitive function group was high(53.39%[63/118]).The proportion of individuals with hypoxemia(42.86%[24/56]vs 16.95%[20/118],χ^(2)=12.38,P<0.001)and daytime sleepiness(39.29%[22/56]vs 22.03%[26/118],χ^(2)=5.66,P<0.05)in cognitive dysfunction group was significantly higher than that of normal cognitive function group.The serum NO level in the cognitive dysfunction group was significantly lower than that in the normal cognitive function group([59.71±5.24]μmol/L vs[63.08±6.57]μmol/L,t=3.36,P<0.05),while the levels of Hcy,MCP-1,and SAA were higher than those in the normal cognitive function group,with the results of Hcy([12.47±2.29]μmol/L vs[11.35±1.38]μmol/L),MCP-1([33.27±5.16]ng/L vs[24.62±5.49]ng/L),SAA([83.06±18.52]μmol/L vs[51.76±9.35]μmol/L),and all di

关 键 词：睡眠呼吸暂停 阻塞性 认知功能障碍 一氧化氮 血清淀粉样蛋白A 危险因素 

分 类 号：R766[医药卫生—耳鼻咽喉科] R749.1[医药卫生—临床医学]