血清脂蛋白相关磷脂酶A2与皮质下缺血性血管病患者认知功能的关系  

Relationship between Serum Lipoprotein Associated-phospholipase A2 and Cognition Impairment in Patients with Subcortical Ischemic Vascular Disease

作　　者：任丽[1] 沈朝阳 苏润萍[1] 袁祖琴 张红金 刘丹[1] 顾金涛 徐红梅 REN Li;SHEN Chao-yang;SU Run-ping;YUAN Zu-qin;ZHANG Hong-jin;LIU Dan;GU Jin-tao;XU Hong-mei(Changzhou Geriatric Hospital Affiliated to Soochow University,Department of Neurology,Changzhou No.7 People's Hospital,Changzhou 213000,China)

机构地区：[1]苏州大学附属常州老年病医院,常州市第七人民医院神经内科,常州213000

出　　处：《中国临床神经科学》2023年第6期663-669,共7页Chinese Journal of Clinical Neurosciences

基　　金：常州市科技计划项目(编号:CJ20199002);常州市卫健委指导项目(编号:WZ202014)。

摘　　要：目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)与皮质下血管性认知损害的关系,进而探究皮质下血管性认知损害发展的危险因素。方法选取2019年1月至2020年12月就诊的皮质下缺血性血管病(SIVD)患者70例,按认知损害程度分为血管性痴呆(SVaD)组35例、皮质下血管性轻度认知损害(SVMCI)组35例,另选择34例认知功能正常的老年人作为对照组。测定Lp-PLA2水平,进行简易精神状态检查(MMSE)、蒙特利尔认知评估(MoCA)、连线测验A(TMT-A)、连线测验B(TMT-B)、波士顿命名(BNT)、画钟测验A(CDT-A)、工具性日常生活能力量表(IADL)等神经心理评估,比较各组间Lp-PLA2水平变化,并将MMSE评分与Lp-PLA2和血管危险因素进行多元线性回归分析。结果SVaD组和SVMCI组的血清Lp-PLA2水平均高于对照组,差异均有统计学意义(均P<0.05);相关性分析显示Lp-PLA2水平与MMSE、MoCA、BNT、CDT-A等量表评分呈负相关(r=-0.432、-0.302、-0.286、-0.297,均P<0.01),Lp-PLA2水平与TMT-A、IADL评分呈正相关(r=0.233,P<0.05;r=0.289,P<0.01);经校正各血管危险因素后行多元线性回归分析显示,高血压病、受教育年限、Lp-PLA2是SIVD患者发生认知损害的独立危险因素(P<0.01),进一步校正白质疏松分级后,Lp-PLA2与认知损害间无相关性。结论SIVD患者的Lp-PLA2水平显著增高,且与认知损害呈负相关,可为评估SIVD患者认知损害严重程度提供参考。Aim To investigate the correlation between lipoprotein associated-phospholipase A2(LpPLA2)and subcortical vascular cognitive impairment,and investigate the risk factors for the development of subcortical vascular cognitive impairment.Methods Serum Lp-PLA2 and vascular risk factor were analyzed in 104 individuals comprising 70 patients with subcortical ischemic vascular disease(SIVD)and 34 controls with normal cognitive function.SIVD patients were divided into two subgroups:a group of cases with vascular dementia(SVaD)and a group of cases with vascular mild cognitive impairment(SVMCI).All of them were subject to the cognitive assessment including Mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Trail Making Test A(TMT-A),Trail Making Test B(TMT-B),Boston Naming Test(BNT),Clock Drawing Test A(CDT-A),Instrumental Activities of Daily Living Scale(IADL)and Clinical Demential Raring(CDR).Results Serum Lp-PLA2 level was significant higher in SMVCI group compared to the controls(67.82±32.45)μg·L^(-1)vs.(50.68±30.70)μg·L^(-1),P=0.045.While serum level of Lp-PLA2 was significant higher in SVa D(84.75±41.18)μg·L^(-1)and SVMCI(67.82±32.45)μg·L^(-1)groups as compared to those in the controls(50.68±30.70)μg·L^(-1);P=0.000,P=0.045.The correlation analysis showed that the Lp-PLA2 level was negatively correlated with the MMSE,Mo CA,BNT,CDT-A score(r=-0.432,-0.302,-0.286,-0.297,P<0.01),while Lp-PLA2 level was positively correlated with TMT-A and IADL score(r=0.233,P<0.05;r=0.289,P<0.01).The LpPLA2 level remained associate with MMSE after all vascular risk factors being controlled.While the Lp-PLA2 level has significant association with MMSE.Multiple linear regression analysis revealed the relation between Lp-PLA2 and cognitive impairment was positive when all the vascular risk factors were being controlled.Conclusion The Lp-PLA2 levels were significantly increased in SIVD patients,and Lp-PLA2 is negatively correlated with cognition dysfunction in SIVD patients.

关 键 词：皮质下缺血性脑血管病 认知损害 脑白质病变 腔隙性脑梗死 脂蛋白相关磷脂酶A2 

分 类 号：R743[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]