实用医学杂志 ›› 2021, Vol. 37 ›› Issue (7): 884-888.doi: 10.3969/j.issn.1006⁃5725.2021.07.011

• 临床研究 • 上一篇    下一篇

脑白质高信号患者血浆脂蛋白磷脂酶A2水平及其与认知功能障碍的关系

邓小莹， 范永祥， 莫志铭， 张志新， 张斌    

  1. 广州医科大学附属第五医院神经内科（广州 510700）

  • 出版日期:2021-04-10 发布日期:2021-04-10
  • 基金资助:
    广东省科技计划项目（编号：2017ZC0235）

Correlation of plasma lipoprotein phospholipase A2 level with cognitive impairment in patients with white matter hyperintensity

DENG Xiaoying，FAN Yongxiang，MO Zhiming，ZHANG Zhixin，ZHANG Bin.   

  1. Depart⁃ ment of Neurology，the Fifth Affiliated Hospital of Guangzhou Medical University，Guangzhou 510700，China

  • Online:2021-04-10 Published:2021-04-10

摘要：

目的 探讨脑白质高信号（WMH）患者血浆脂蛋白磷脂酶 A2（Lp⁃PLA2）水平及其与认知功能障碍的关系。方法 选取 WMH 患者 97 例为病例组（WMH 组），以 MoCA 量表 23 分为界分为认知障碍组 （CI 组）37 例和非认知障碍组（NCI 组）60 例，同期健康体检者 52 例为对照组（HC 组）。采用 t 检验分析 WMH 组与 HC 组血浆 Lp⁃PLA2 水平及 MoCA 得分，应用 logistic 回归分析 WMH 伴认知障碍的相关危险因 素，并进一步分析 Lp⁃PLA2 与 WMH 患者认知障碍的关系及其诊断应用。（1）WMH 组血浆 Lp⁃PLA2 水平比对照组明显增高，MoCA评分显著降低（P＜0.05）；CI组与NCI组相比，性别、年龄、文化程度、饮酒史、 尿酸、总胆固醇、甘油三酯、高密度脂蛋白胆固醇差异无统计学意义（P＞0.05），高血压史、糖尿病史、吸烟史、空腹血糖、同型半胱氨酸、低密度脂蛋白胆固醇、Lp⁃PLA2 差异具有统计学意义（P＜0.05）；（2）logistic 回归显示：空腹血糖、低密度脂蛋白、同型半胱氨酸、Lp⁃PLA2 等 4 个指标是 WMH 伴认知障碍的危险影响因素（P＜0.05）；（3）同型半胱氨酸、Lp⁃PLA2 两指标指标对 WMH 伴认知障碍有较高的诊断价值（AUC= 0.703，95%CI：0.508~0.973；AUC=0.751，95%CI：0.611~0.923）。联合应用价值更高，AUC 为 0.806（95%CI： 0.677~0.960）。结论 WMH 患者具有较高的血浆 Lp⁃PLA2 水平，血浆 Lp⁃PLA2 水平升高可能为 WMH 伴发认知障碍的危险因素，也对其有较高的诊断评估价值。

关键词: 脑白质高信号, 血浆脂蛋白磷脂酶A2, 认知障碍

Abstract:

Objective To investigate the level of plasma lipoprotein phospholipase A2（Lp⁃PLA2）and its relationship with cognitive impairment in patients with white matter hyperintensity（WMH）. Methods A total of 97 patients with WMH were selected as case group（WMH group）. According to the MoCA scale，the WMH group was divided into cognitive impairment group（CI group）and non⁃cognitive impairment group（NCI group）. A group of 52 healthy subjects in the same period were selected as healthy control group（HC group）. The plasma Lp⁃PLA2 levels and MoCA scores of patients with WMH were compared with those of HC group. Plasma Lp⁃PLA2 level and MOCA score were analyzed by t⁃test. Logistic regression was used to analyze the risk factors of WMH with cognitive im⁃ pairment，and the relationship between LP⁃PLA2 and cognitive impairment was further analyzed.Results（1）The level of plasma Lp⁃PLA2 in the WMH group was significantly higher than that in the control group，and the MoCA score was significantly lower（P < 0.05）. There were no statistically significant differences between the CI and NCI groups in terms of gender，age，education level，drinking history，uric acid and high ⁃density lipoprotein，total cholesterol，glycerol（P > 0.05），but the differences were statistically significant in terms of history of hypertension， diabetes，smoking，fasting blood glucose，homocysteine，low⁃density lipoprotein cholesterol，and Lp⁃PLA2（P<0.05）. （2）Logistic regression showed that the four indexes of Fasting blood glucose，low⁃density lipoprotein，homocysteine and Lp⁃PLA2 were the risk factors of WMH with cognitive impairment（P<0.05）；（3）The two indicators of homocys⁃ teine，Lp⁃PLA2 had high diagnostic value for WMH with cognitive impairment（AUC=0.703，95%CI：0.508~0.973； AUC=0.751，95% CI：0.611~0.923）. The combined application value was higher（AUC=0.806，95% CI：0.677~ 0.960）. Conclusion WMH patients have higher plasma Lp⁃PLA2 levels. Increased plasma Lp⁃PLA2 levels may be a risk factor for WMH associated with cognitive impairment，and it also has a higher diagnostic and evaluation value.

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