营养状况和认知功能在APOE ε4与阿尔茨海默病精神行为症状相关性的中介效应  

Mediation effects of nutrition and cognition on association between apolipoprotein E allele 4 and neuropsychiatric symptoms in Alzheimer′s disease

作　　者：洪音 江天琳 李汶逸 姜季委 徐俊 Hong Yin;Jiang Tianlin;Li Wenyi;Jiang Jiwei;Xu Jun(Department of Cognitive Neurology,Beijing Tiantan Hospital Affiliated to Capital Medical University,National Clinical Research Center for Neurological Diseases,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心认知障碍性疾病科,国家神经系统疾病临床医学研究中心,北京100070

出　　处：《中华老年多器官疾病杂志》2024年第8期561-566,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家自然科学基金(82071187,81870821);国家重点研发计划(2021YFC2500100,2021YFC2500103)。

摘　　要：目的探讨营养状况和认知功能在载脂蛋白E等位基因4(APOEε4)与阿尔茨海默病(AD)精神行为症状(NPS)及其亚型相关性的中介效应。方法连续性收集2021年6月至2023年1月首都医科大学附属北京天坛医院阿尔茨海默病生物标志物与生活方式研究(CIBL)队列中293例AD疾病谱[包括遗忘型轻度认知障碍(aMCI)和AD痴呆期]患者,根据是否携带APOEε4将患者分为携带组(107例)和非携带组(186例)。对各NPS亚型患者分别进一步分析入组年龄、性别、体质量指数(BMI)、简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)和微型营养评估量表(MNA)评分等差异。采用SPSS 26.0统计软件进行数据处理。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较。将假设检验中有统计学意义的因素定为后面中介效应分析的混杂因素,采用简单中介效应模型分析营养状况和认知功能在APOEε4与NPS及其亚型中的潜在中介作用。结果与对照组相比,携带组患者出现幻觉、淡漠和异常运动行为的比例更高,差异有统计学意义(P<0.05)。对NPS亚型患者分别进行分析,与非幻觉组相比,幻觉组年龄更大,受教育年限更少,携带APOEε4比例更高,MMSE、MoCA和MNA评分均更低;与非淡漠组相比,淡漠组男性比例更高,携带APOEε4比例更高,MMSE、MoCA和MNA评分均更低;与非异常运动行为组相比,异常运动行为组年龄更大,高脂血症比例更低,携带APOEε4比例更低,MMSE、MoCA及MNA评分更低,差异有统计学意义(P<0.05)。校正混杂因素后,MNA评分介导了29.80%(95%CI 0.062~0.522)APOEε4与淡漠的相关性,19.95%(95%CI 0.011~0.419)APOEε4与异常运动行为的相关性。MMSE评分介导APOEε4与幻觉、淡漠和异常运动行为的相关性分别是24.21%(95%CI 0.078~0.573),39.01%(95%IC 0.155~0.914)和23.37%(95%CI 0.068~0.576)。结论对于aMCI和AD患者而言,营养状况和认知功能部分介导了APOEεObjective To explore the mediation effects of nutrition and cognition in Apolipoprotein E Allele 4(APOEε4)with neuropsychiatric symptoms(NPSs)in Alzheimer′s Disease(AD).Methods A spectrum of 293 AD patients from amnestic mild cognitive impairment(aMCI)to AD dementia stage was consecutively collected from the Alzheimer′s Disease Biomarkers and Lifestyle Study(CIBL)cohort of Beijing Tiantan Hospital Affiliated to Capital Medical University from June 2021 to January 2023.The patients were divided into the carrier group(with APOEε4,n=107)and the non-carrier group(without APOEε4,n=186).Patients in significant NPS sub-groups were further analyzed in age,gender,body mass index(BMI),mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),and micro-nutritional assessment(MNA).SPSS 26.0 was used for data processing.According to the data type,t test,Mann-Whitney U test orχ^(2)test was used for comparison between groups,and statistically significant factors in the hypothesis test were determined as confounding factors in the subsequent mediating effect analysis.A simple mediation effect model was used to analyze the potential mediating effects of nutritional status and cognitive function on APOEε4 and NPS and its subtypes.Results Compared with non-carrier group,the carrier group had higher rates of hallucinations,apathy,and abnormal motor behaviors,the differences were statistically significant(P<0.05).The NPS subtype patients were analyzed separately.Compared with non-hallucination group,patients in hallucination group were older,had lower education years,carried a higher proportion of APOEε4,and lower MMSE,MoCA and MNA scores.Compared with non-apathy group,patients in apathy group had a higher proportion of males,carried a higher proportion of APOEε4,and had lower MMSE,MoCA and MNA scores.Compared with non-aberrant motor activity group,patients in aberrant motor activity group were older,had a lower proportion with hyperlipidaemia,carried a lower proportion of APOEε4,and had lower MMSE,MoCA and

关 键 词：阿尔茨海默病 精神行为异常症状 载脂蛋白E等位基因4 营养状况 认知功能 

分 类 号：R591[医药卫生—内科学] R741[医药卫生—临床医学]