中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

不同程度肺气肿表型慢阻肺患者血清同型半胱氨酸、趋化因子配体 2 水平与认知功能障碍的关系

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目的 观察不同程度肺气肿表型慢性阻塞性肺疾病(简称慢阻肺)患者血清同型半胱氨酸(HCY)、趋化因子配体 2(CCL2)水平与认知功能障碍的关系。 方法 纳入 2016 年 1 月至 2017 年 3 月依据肺气肿表型分型确定的慢阻肺患者共 62 例,其中肺气肿 1~2 级 37 例(1~2 级亚组),3~4 级 25 例(3~4 级亚组),同期健康体检者 30 例作为对照(体检组)。完善蒙特利尔认知评估(MoCA)量表调查及血清 HCY、CCL2 检测。统计分析不同程度肺气肿表型慢阻肺患者血清 HCY、CCL2 水平与认知功能障碍的关系。 结果 肺气肿慢阻肺患者中,3~4 级亚组与 1~2 级亚组比较,PaO2 降低、PaCO2 升高,血浆 HCY、CCL2 水平升高,差异有统计学意义(均 P<0.05)。肺气肿慢阻肺组 MoCA 评分总分及各亚项评分(除 1~2 级亚组视空间执行能力评分外)均较体检组低;肺气肿慢阻肺患者中 3~4 级亚组 MoCA 评分均低于 1~2 级亚组,差异有统计学意义(均P<0.05)。HCY 和 CLL2 水平与 MoCA 评分总分及其亚项评分均呈负相关(P<0.01),HCY 与 CLL2 呈正相关(P<0.01)。对肺气肿慢阻肺患者血清 HCY、CLL2 水平与认知障碍进行受试者工作特征(ROC)曲线分析,血清 HCY、CLL2 诊断认知障碍的 ROC 曲线下面积分别为 0.79、0.97。 结论 不同程度肺气肿表型患者血清 HCY、CCL2 水平存在不同程度升高,肺气肿程度、HCY、CCL2 水平与认知功能障碍关系紧密。

Objective To observe the relationship of serum levels of homocysteine (HCY) and chemokine C-C motifligand 2 (CCL2) with cognitive impairment in COPD patients with different degrees of emphysema. Methods Sixty-twoCOPD patients identified according to emphysema phenotype classification and admitted from January 2016 to March 2017 were recruited in the study. There were 37 cases in emphysema 1-2 grade and 25 cases in emphysema 3-4 grade. Simultaneous 30 healthy subjects undergoing physical examination were recruited as control. Montreal cognitive assessment (MoCA) scale investigation and serum HCY and CCL2 test were completed. Relationship analysis was conducted on serum HCY, CCL2 levels with cognitive impairment in the COPD patients with different degrees of emphysema. Results Compared with the 1-2 grade subgroup, the PaO2 was lower, PaCO2 was higher, the plasma HCY and CCL2 levels increased in the 3-4 grade subgroup with significant differences (all P<0.05). MoCA total score and subscores were relatively low in the COPD group with emphysema than the control group (except visuospatial ability scores in the 1-2 grade subgroup). MoCA scores were statistically lower in the 3-4 grade subgroup than those in the 1-2 grade subgroup (allP<0.05). Correlation analysis showed that HCY and CLL2 levels were negatively correlated with MoCA scores and subscores (P<0.01), and HCY and CLL2 were positively correlated (bothP<0.01). The area under the receiver operating characteristic curve of HCY and CLL2 for evaluating cognitive impairment was 0.79 and 0.97, respectively. Conclusion In patients with different degrees of emphysema phenotype, serum HCY and CCL2 levels are increased in different degree, and the degree of emphysema is closely related with cognitive dysfunction.

关键词: 慢性阻塞性肺疾病; 肺气肿表型; 同型半胱氨酸; 趋化因子配体 2; 认知障碍

Key words: Chronic obstructive pulmonary disease; Emphysema phenotype; Homocysteine; Chemokine C-C motif ligand 2; Cognitive impairment

引用本文: 崔紫阳, 王红阳, 王昊辰, 李丽蕊, 宋龙霞, 齐佳华, 王越, 戈艳蕾, 李立群, 张嘉宾, 李洪力, 朱晓颖, 张慈, 李真真. 不同程度肺气肿表型慢阻肺患者血清同型半胱氨酸、趋化因子配体 2 水平与认知功能障碍的关系. 中国呼吸与危重监护杂志, 2018, 17(1): 15-19. doi: 10.7507/1671-6205.201708006 复制

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