重度阻塞性睡眠呼吸暂停低通气综合征患者血清同型半胱氨酸及脑源性神经营养因子水平与认知功能的相关性研究

Correlations between serum homocysteine, brain-derived neurotrophic factor and cognitive function in patients with severe obstructive sleep apnea hypopnea syndrome

摘要:

目的探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血清中同型半胱氨酸(Hcy)和脑源性神经营养因子(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(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(LSaO₂)、睡眠呼吸暂停低通气指数(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和0.927。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。

关键词:阻塞性睡眠呼吸暂停低通气综合征;同型半胱氨酸;脑源性神经营养因子;蒙特利尔认知评估量表;认知功能

Abstract:

ObjectiveTo explore the relationships between serum levels of homocysteine (Hcy) and brain-derived neurotrophic factor (BDNF) and cognitive function in patients of severe obstructive sleep apnea-hypopnea syndrome (OSAHS).MethodsSixty 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. Their levels of Hcy and BDNF in serum were measured by enzyme-linked immunosorbent assay.ResultsThere were significant differences in MOCA total score, visual space and executive ability, attention, abstraction and delayed recall scores between cognitive impairment group and cognitive normal group and control group (all P < 0.01), but their differences in naming, language ability and orientation scores were insignificant (all P>0.05). The level of serum Hcy in cognitive impairment group (34.12±2.85) was higher than that in cognitive normal group (30.88±2.10), while the level of serum BDNF (9.00±1.67) was lower than that in cognitive normal group (11.64±1.73). The lowest arterial oxygen saturation (LSaO₂) and apnea hypopnea index (AHI) in the cognitive impairment group were different from those in the 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 was positively correlated with the total score of MOCA (r=0.751, P=0.000) and LSaO₂ (r=0.521, P=0.026), and negatively with AHI (r=-0.553, P=0.017). The areas under the receiver operator characteristic curve predicted by serum Hcy and BDNF levels were 0.902 and 0.927, respectively.ConclusionThe 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.

Key words:Sleep apnea-hypopnea syndrome;Homocysteine;Brain-derived neurotrophic factor;Montreal cognitive assessment;Cognitive function