1.Taizhou People&2.amp;3.#39;4.&5.s Hospital
[摘要] 目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)血清中同型半胱氨酸（Homocysteine, Hcy）和脑源性神经营养因子( brain-derived neurotrophic factor,BDNF )水平与认知功能的关系。方法 随机抽取60例重度OSAHS患者，使用蒙特利尔认知评估量表（Montreal Cognitive Assessment Scale ,MoCA）评估认知功能，根据评估结果分为认知障碍组（18例）和认知正常组（42例），30例健康体检者为对照组。利用ELISA法测定各组血清中Hcy和BDNF水平。结果 认知障碍组与认知正常组和对照组比较，MoCA总分、视空间与执行能力、注意力、抽象及延迟回忆存在差异(P<0.01)，而命名、语言能力及定向评分无明显差异(P>0.05)。认知障碍组血清Hcy水平(34.12±2.85)较认知正常组(30.88±2.10)增高，而血清BDNF水平(9.00±1.67)较认知正常组(11.64±1.73)降低。认知障碍组最低动脉血氧饱和度（lowest arterial oxygen saturation,LSaO2%）、呼吸暂停通气指数（apnea ventilation index,AHI）与认知正常组存在差异(P<0.01)。认知障碍组血清Hcy与MoCA总分（r=-0.880,P=0.000）、LSaO2%(r=-0.595,P=0.009)及BDNF(r=-0.818,P=0.000)呈负相关，与AHI(r=0.681,P=0.002)呈正相关；血清BDNF与MoCA总分（r=0.751,P=0.000）及LSaO2%(r=0.521,P=0.026)呈正相关，与AHI(r=-0.553,P=0.017)呈负相关。血清Hcy和BDNF水平预测认知功能障碍ROC曲线下面积分别为0.902（95%CI：0.824，0.979）和（95%CI：0.868，0.985）。结论 OSAHS患者血清Hcy和BDNF水平的改变与认知障碍的形成有一定的相关性，可作为生物标志物用于认知障碍的早期诊断和预测。
Abstract: Objective To explore the relationship between serum homocysteine (Hcy) and brain-derived neurotrophic factor (BDNF) levels in severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and cognitive function. Method Sixty patients with severe OSAHS were randomly selected to evaluate their cognitive function with Montreal Cognitive Assessment Scale (MoCA). According to the evaluation results, they were divided into cognitive impairment group (18 cases) and cognitive normal group (42 cases), and 30 healthy subjects were used as the control group. The levels of Hcy and BDNF in serum were measured by ELISA. Results There were significant differences in MOCA total score, visual space and executive ability, attention, abstraction and delayed recall between cognitive impairment group and cognitive normal group and control group (P < 0.01), but there were no significant differences in naming, language ability and orientation score (P > 0.05). The level of serum Hcy in cognitive impairment group (34.12 ± 2.85) were higher than that in cognitive normal group (30.88 ± 2.10), while the level of serum BDNF (9.00 ± 1.67) were lower than that in cognitive normal group (11.64 ± 1.73). The lowest arterial oxygen saturation (LSaO2%) and apnea ventilation index (AHI) in cognitive impairment group were different from those in cognitive normal group (P < 0.01). In cognitive impairment group, serum Hcy was negatively correlated with the total score of MOCA (r = -0.880, P = 0.000), LSaO2% (r = -0.595, P = 0.009) and BDNF (r = -0.818, P = 0.000), and positively correlated with AHI (r = 0.681, P = 0.002); Serum BDNF were positively correlated with the total score of MOCA (r = 0.751, P = 0.000) and LSaO2% (r = 0.521, P = 0.026), and negatively correlated with AHI (r = -0.553, P = 0.017). The areas under the ROC curve predicted by serum Hcy and BDNF levels were 0.902 (95% CI: 0.824, 0.979) and (95% CI: 0.868, 0.985), respectively. Conclusion The changes of serum Hcy and BDNF levels in patients with OSAHS are related to the formation of cognitive impairment, and can be used as biomarkers for the early diagnosis and prediction of cognitive impairment.