基于轨迹模型分类的血清尿酸对阿尔茨海默病患者认知功能影响的研究  

Effect of serum uric acid on cognitive function in patients with Alzheimer’s disease based on trajectory model classification

作　　者：肖焕波[1] 张洪伟[1] 纪颖[1] 刘佳[1] XIAO Huan-bo;ZHANG Hong-wei;JI Ying;LIU Jia(Yanjing Medical College of Capital Medical University,Beijing 101300,China)

机构地区：[1]首都医科大学燕京医学院,北京101300

出　　处：《现代预防医学》2024年第9期1708-1712,共5页Modern Preventive Medicine

基　　金：国家自然科学基金青年项目(82304244);首都医科大学教育教学改革研究课题(2022JYY422)。

摘　　要：目的分析血清尿酸对阿尔茨海默病(Alzheimer disease,AD)患者认知功能的影响。方法研究对象来自阿尔茨海默病神经影像学计划随访队列中随访≥3次的AD患者259例,采用简易精神状态评价量表(mini-mental state examination,MMSE)测定患者的认知功能。使用轨迹分析模型依据随访期间MMSE得分的变化趋势对研究对象进行归类。以不同轨迹组作为因变量,血清尿酸作为自变量,采用多分类logistic回归分析探讨在调整各种混杂因素后,血清尿酸对不同类型AD患者认知功能的影响。结果轨迹模型将研究对象分为三个亚组,分别为认知骤降组、认知缓降组和认知平稳组。不同轨迹亚组间血清尿酸差异有统计学意义(F=4.910,P=0.008)。多分类logistic回归在调整了生物-行为-疾病潜在混杂因素影响后,发现血清尿酸是认知缓降组结局的独立危险因素(认知缓降组OR=1.35,95%CI:1.03~1.77),尿酸水平每升高10 mg/L,认知缓降组AD患者发生认知水平下降的风险较认知平稳组增加35%。而在认知骤降组结局中,未见尿酸与认知功能有风险关联。结论在AD患者中,与认知水平平稳发展者相比,高水平血清尿酸是认知缓慢下降的危险因素。Objective To analyze the effect of serum uric acid(UA)on cognitive function in patients with Alzheimer’s disease(AD).Methods The cognitive function of 259 patients with AD who were followed up more than 3 times in the Alzheimer’s Disease Neuroimaging Initiative(ADNI)follow-up cohort were measured by Mini-Mental State Examination(MMSE).The trajectory analysis model was used to classify the subjects according to the changing trend of MMSE scores during the follow-up period.Taking different trajectory groups as dependent variables and serum UA as independent variables,multi-classification Logistic regression analysis was used to explore the effect of serum UA on cognitive function in patients with different types of AD after adjusting various confounding factors.Results According to the trajectory model,the subjects were divided into three subgroups:cognitive sudden decline group,cognitive slow decline group,and cognitive stationary group.There was significant difference in serum UA among different trajectory subgroups(F=4.910,P=0.008).After adjusting for the influence of bio-behavioral-disease potential confounding factors,multi-classification Logistic regression found that serum UA was an independent risk factor for the outcome of cognitive slow decline group(cognitive slow decline group:OR=1.35,95%CI:1.03-1.77).With each increase of 10 mg/L in UA level,the risk of cognitive decline in AD patients in cognitive slow decline group was 35%higher than that in cognitive stable group.In the cognitive sudden decline group,there was no risk association between UA and cognitive function.Conclusion Compared with those with stable cognitive development,high level of serum UA is a risk factor for slow cognitive decline in patients with AD.

关 键 词：尿酸 认知功能 轨迹分析模型 阿尔茨海默病 

分 类 号：R749.16[医药卫生—神经病学与精神病学]