帕金森病患者血清同型半胱氨酸及血脂水平与脑白质病变的相关性研究

杨光; 徐陈陈; 王佳炜; 丁庭庭; 刘利君; 刘飞飞; 吴桐; 王训

doi:10.16766/j.cnki.issn.1674-4152.002083

帕金森病患者血清同型半胱氨酸及血脂水平与脑白质病变的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002083

1.
安徽医科大学第二附属医院神经内科，安徽合肥 230000
2.
安徽中医药大学神经病学研究所，安徽合肥 230000

基金项目:

国家自然科学基金项目 81904086

详细信息

通讯作者:
王训，E-mail：neurodoc@163.com

中图分类号: R742.5 R446
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- 文章访问数: 246
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-05
- 网络出版日期: 2022-02-15

Study on the correlation between serum homocysteine and blood lipid levels and white matter lesions in patients with Parkinson's disease

1.
Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的寻找帕金森病(PD)患者并发脑白质病(WML)的危险因素，以及同型半胱氨酸(Hcy)和血脂水平与WML的相关性。方法选择2015年1月—2020年1月安徽医科大学第二附属医院神经内科住院的PD患者200例为研究组，同期体检者110例为对照组。对其进行病史和人口学资料采集，测定各组生化指标水平。采用Fazekas分级将研究组分为4组。比较4组间临床资料及生化指标的差异，并应用logistic回归分析以及Spearman相关分析确定PD患者并发WML的影响因素。结果研究组Hcy的水平、WML的发生率及严重程度高于对照组，血脂水平低于对照组(均P＜0.05)；Hcy与WML严重程度呈正相关(r=0.556, P＜0.001)，在调整了人口学及混杂因素后，Hcy水平与WML严重程度仍呈正相关(r=0.400, P＜0.001)，Hcy预测PD患者发生WML的AUC为0.717(95%CI：0.673~0.861, P＜0.001)；WML严重程度与PD患者的H-Y评分、UPDRS运动评分呈正相关(r=0.460、0.360, 均P＜0.001)。结论血Hcy水平升高可能是PD患者并发WML的独立危险因素，HDL-C水平升高是PD患者并发WML的保护因素；Hcy或可作为PD患者并发WML的一种生物标志物。
- 帕金森病 /
- 同型半胱氨酸 /
- 脑白质病变 /
- 危险因素
Abstract: Objective To find out the risk factors of leukoencephalopathy (WML) in patients with Parkinson's disease (PD) and the correlation between homocysteine levels and WML. Methods From January 2015 to January 2020, 200 patients with PD who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University were selected as the study group, and 110 patients with healthy physical examination during the same period were selected as the control group. Medical history and demographic data were collected. The level of biochemical indicators in each group were determined. The Fazekas classification was used to divide the study group into four groups. The differences in clinical data and biochemical indicators between the four groups were compared, and logistic regression analysis and Spearman correlation analysis were used to determine the influencing factors of PD patients with WML. Results The level of Hcy and the incidence and severity of WML in the study group were higher than those of the control group, and the blood lipid level was lower than that of the control group (all P < 0.05), the Hcy and WML were positively correlated (r=0.556, P < 0.001). After adjusting for demographics and confounding factors, the Hcy level was still positively correlated with the severity of WML (r=0.400, P < 0.001). The AUC of Hcy on WML in PD patients was 0.717 (95% CI: 0.673-0.861, P < 0.001); WML severity was positively correlated with PD patients' HY score and UPDRS exercise score (r=0.460, r=0.360, P < 0.001). Conclusion Elevated blood Hcy level may be an independent risk factor for PD patients with WML. Elevated HDL-C level is a protective factor for PD patients with WML. The Hcy may be used as a biomarker for PD patients with WML.
- Parkinson's disease /
- Homocysteine /
- White matter lesions /
- Risk factors

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图 1 Hcy对PD并发WML的ROC曲线分析

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表 1 2组一般临床资料及血生化指标比较

组别	例数	年龄(x±s，岁)	性别(男/女, 例)	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]	吸烟[例(%)]	饮酒[例(%)]	TC(x±s，mmol/L)	TG(x±s，mmol/L)
对照组	110	67.24±10.37	44/66	33(30.0)	12(10.9)	13(11.8)	22(20.0)	16(14.5)	4.70±0.96	1.40±0.69
研究组	200	68.86±9.31	99/101	77(38.5)	25(12.5)	16(8.0)	35(17.5)	32(16.0)	4.35±1.04	1.24±0.72
统计量		1.199^a	2.590^b	2.268^b	0.173^b	1.186^b	0.293^b	0.116^a	-2.903^a	-1.860^a
P值		0.231	0.120	0.139	0.719	0.310	0.646	0.870	0.004	0.006

组别	例数	LDL-C(x±s，mmol/L)	HDL-C(x±s，mmol/L)	载脂蛋白A(x±s，g/L)		载脂蛋白B(x±s，g/L)	脂蛋白a(x±s，mg/L)	Hcy(x±s，μmol/L)	尿酸(x±s，μmol/L)	胱抑素C(x±s，mg/L)
对照组	110	2.93±0.76	1.18±0.25	1.37±0.27		0.89±0.21	270.3±240.4	11.50±2.89	274.7±82.8	0.75±0.29
研究组	200	2.70±0.74	1.19±0.34	1.33±0.31		0.81±0.27	233.6±271.4	14.49±5.57	286.1±94.2	0.80±0.32
统计量		-2.509^a	0.560^a	-8.170^a		-2.419^a	-1.183^a	4.767^a	1.052^a	1.153^a
P值		0.013	0.956	0.414		0.016	0.238	< 0.001	0.294	0.250
注：^a为t值，^b为χ²值。

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表 2 2组脑白质病变发生情况比较[例(%)]

组别	例数	WML	0分	1分	2分	3分
对照组	110	56(50.9)	54(49.1)	52(47.3)	3(2.7)	1(0.9)
研究组	200	157(78.5)	43(21.5)	74(37.0)	48(24.0)	35(17.5)
注：2组WML发生率比较，χ²=67.251，P < 0.001。

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表 3 研究组不同程度WML患者的一般临床资料、血生化指标及临床特征比较

组别	例数	年龄(x±s, 岁)	性别(男/女, 例)	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]	吸烟[例(%)]	饮酒[例(%)]
正常组	43	62.70±9.10	16/27	13(30.2)	6(14.0)	2(4.7)	6(14.0)	5(11.6)
轻度病变组	74	68.18±8.80^a	35/39	30(40.5)	10(13.5)	8(10.8)	12(16.2)	9(12.2)
中度病变组	48	71.67±7.78^a	26/22	25(52.1)	6(12.5)	3(6.2)	8(16.7)	8(16.7)
重度病变组	35	71.90±9.20^a	22/13	9(25.7)	3(8.6)	3(8.6)	9(25.7)	10(28.6)
统计量		10.299^b	1.902^c	2.555^c	0.212^c	0.548^c	0.699^c	1.866^c
P值		< 0.001	0.126	0.055	0.874	0.634	0.577	0.169

组别	例数	TC(x±s，mmol/L)	TG(x±s，mmol/L)	LDL-C(x±s，mmol/L)	HDL-C(x±s，mmol/L)	载脂蛋白A(x±s，g/L)	载脂蛋白B(x±s，g/L)	脂蛋白a(x±s，mg/L)
正常组	43	4.30±0.88	1.31±0.87	2.66±0.65	1.23±0.36	1.41±0.34	0.79±0.20	244.5±256.2
轻度病变组	74	4.58±1.00	1.17±0.67	2.80±0.67	1.28±0.31	1.37±0.28	0.81±0.22	287.6±283.0
中度病变组	48	4.42±1.17	1.28±0.79	2.84±0.83	1.17±0.34	1.31±0.29	0.86±0.30	196.9±164.2
重度病变组	35	3.87±1.00^de	1.23±0.52	2.37±0.75	0.99±0.32^ade	1.21±0.33^ad	0.77±0.39	169.0±121.8
统计量		3.860^b	0.359^b	3.177^b	5.316^b	2.752^b	0.669^b	2.272^b
P值		0.010	0.783	0.260	0.002	0.044	0.572	0.820

组别	例数	Hcy(x±s，μmol/L)	尿酸(x±s，μmol/L)		胱抑素C(x±s，mg/L)	病程(x±s，年)	H-Y分级(x±s，级)	UPDRS-Ⅲ(x±s，分)
正常组	43	11.44±5.96^c	267.2±80.7		0.63±0.18^e	3.21±3.16	1.72±0.57	13.28±3.54
轻度病变组	74	12.50±4.07	282.2±91.3		0.90±0.39^a	4.37±3.76	2.16±0.75^a	16.73±5.95^a
中度病变组	48	15.53±2.60^d	301.6±99.3		0.77±0.31^d	4.24±3.03	2.43±0.61^ad	16.50±3.78^a
重度病变组	35	21.00±5.35^ade	296.0±107.1		0.83±0.25^a	7.37±5.07^ade	2.80±0.73^ade	19.69±3.80^ade
统计量		35.993^b	1.161^b		6.438^b	8.396^b	17.728^b	22.245^b
P值		< 0.001	0.326		< 0.001	< 0.001	< 0.001	< 0.001
注：UPDRS-Ⅲ为UPDRS运动评分。与正常组比较，^aP＜0.05；与轻度病变组比较，^dP＜0.05；与中度病变组比较，^eP＜0.05；^b为F值，^c为χ²值。

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表 4 影响WML严重程度的相关因素logistic回归分析

影响因素	B	SE	Wald χ²	P值	OR值	95%CI
Hcy	0.256	0.047	29.955	< 0.001	1.285	1.171~1.410
HDL-C	1.313	0.576	5.205	0.023	0.269	0.087~0.831

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