路易体痴呆血脑屏障通透性与血浆促食欲素A水平的关系  

Association between blood-brain barrier permeability and plasma Orexin A level in Dementia with Lewy bodies

作　　者：甘景环 脱厚珍[1] 张拥波[1] 纪勇[2] Jinghuan GAN;Houzhen TUO;Yongbo ZHANG;Yong JI(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of neurology,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050 [2]天津市环湖医院神经内科,天津300350

出　　处：《阿尔茨海默病及相关病杂志》2025年第2期81-91,共11页Chinese Journal of Alzheimer's Disease and Related Disorders

基　　金：国家自然科学基金资助项目(项目编号:82171182);首都医科大学附属北京友谊医院“友谊种子计划”人才项目(项目编号:YYZZ202309);首都医科大学培育(自然类)项目(项目编号:PYZ24081)。

摘　　要：目的:探讨路易体痴呆血脑屏障通透性与血浆促食欲素A的关系。方法:回顾性纳入2021年1月至2022年12月于首都医科大学附属北京天坛医院认知障碍科病房住院治疗的69例诊断为很可能的路易体痴呆患者,和同期在同单位健康管理中心筛选认知功能正常老年人40例作为对照组。根据病历记录,收集了一般人口学资料、基本的临床信息和神经心理评估分数,记录脑脊液Aβ1-40、Aβ1-42、t-Tau和p-Tau181的水平和APOE基因型,通过计算脑脊液白蛋白/血清白蛋白比率(CSF/serum albumin quotient,Qalb)来反馈血脑屏障情况,测定血浆食欲素A水平,采用相关分析的方法评估血浆促食欲素A与Qalb的关系。结果:DLB组患者MMSE(P<0.001)和MoCA(P<0.001)评分低于对照组,CDR(P<0.001)、ADL(P<0.001)和NPI(P<0.001)评分,以及血浆促食欲素A水平(P=0.015)、Qalb水平(P<0.001)显著高于对照组。对照组中,血浆促食欲素A水平在不同体重指数水平(P=0.034),是否有高血压病史(P=0.049)上存在显著差异;Qalb水平存在体重指数水平的差异(P=0.012)。DLB组中,有脑卒中病史的受试者血浆促食欲素A水平显著低于无脑卒中病史的受试者(P=0.025);女性的Qalb水平显著高于男性(P=0.034)。在对照组中,Pearson相关和偏相关分析均显示血浆促食欲素A水平与Qalb存在正性相关(Pearson相关:r=0.589,P<0.001;偏相关:r=0.561,P<0.001)。在DLB中,Pearson相关和偏相关分析均未发现血浆促食欲素A水平与Qalb、神经心理评估分数之间存在显著相关性(均P>0.05)。结论:路易体痴呆患者血浆促食欲素A水平和Qalb水平均高于认知功能正常老年人。认知正常老年人的血浆促食欲素A水平升高与血脑屏障通透性增加有关,提示出促食欲素能系统功能失调可能是血脑屏障损伤的潜在机制。Objective:To analyze the associations between blood brain barrier permeability and plasma orexin-A in Dementia with Lewy bodies(DLB).Methods:A total of 69 patients with probably DLB who were hospitalized in the cognitive impairment department,and 40 healthy controls in the health management center of Beijing Tiantan Hospital from January 2021 to December 2022 were retrospectively included.Demographic and clinical information and neuropsychological assessments were collected from medical records.Cerebrospinal fluid(CSF)levels of Aβ1-40,Aβ1-42,t-Tau and p-Tau181 and APOE genotypes were recorded.CSF/serum albumin quotient(Q-alb)was calculated to reflect the blood-brain barrier permeability,and plasma orexin-A levels were determined.Pearson and Partial correlation analysis were used to evaluate the associations between plasma orexin-A and Qalb.Results:The scores of MMSE(P<0.001)and MoCA(P<0.001)in DLB group were lower than those in control group,and CDR(P<0.001),ADL(P<0.001),NPI(P<0.001),and the levels of plasma orexin-A(P=0.015)and Qalb(P<0.001)were significantly higher than those of control group.In the control group,the plasma orexin-A level was significantly different in different body mass index(BMI,P=0.034)and whether there was a history of hypertension(P=0.049).Qalb level was different from BMI level(P=0.012).In DLB group,the plasma orexin-Alevel of subjects with stroke history was significantly lower than those without(P=0.025).Qalb levels were significantly higher in women than in men(P=0.034).In the control group,Pearson correlation and Partial correlation analysis showed a positive correlation between plasma orexin-A level and Qalb(Pearson correlation:r=0.589,P<0.001;Partial correlation:r=0.561,P<0.001).In DLB,Pearson correlation and Partial correlation analysis did not find significant correlation between plasma orexin-A level and Qalb and neuropsychological assessment scores(P>0.05).Conclusion:The plasma orexin-A and Qalb levels in patients with DLB were higher than controls.The elevated plasma orexin-

关 键 词：路易体痴呆 促食欲素 血脑屏障 脑脊液白蛋白/血清白蛋白比率 

分 类 号：R74[医药卫生—神经病学与精神病学]