苗玲;王敏;秦景云;张向民;

• 1:河北省邯郸市中心医院胸外科
• 2:河北省邯郸市第二医院呼吸内科

摘要(Abstract)：

背景血清同型半胱氨酸(Hcy)和半胱氨酸天冬酶-3(caspase-3)水平与神经退行性病变有关,但二者与慢性阻塞性肺疾病(COPD)患者认知障碍的关系尚未明确。目的 分析血清Hcy和caspase-3水平与COPD患者认知障碍的关系。方法选取2016年1月—2019年6月邯郸市中心医院呼吸内科收治的COPD患者156例作为病例组,根据蒙特利尔认知评估量表(MoCA)评分将其分为A组58例(认知功能正常)、B组65例(轻度认知障碍)及C组33例(中重度认知障碍);另选取同期体检健康者150例作为对照组。比较病例组和对照组受试者动脉血气分析指标[包括动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及pH值]、肺功能指标[包括第1秒用力呼气容积(FEV1)、呼气峰值流速(PEF)、最大呼气中段流量(MMEF)及用力肺活量(FVC)]、MoCA评分,对照组、A组、B组、C组受试者血清Hcy、caspase-3水平;血清Hcy和caspase-3水平与COPD患者MoCA评分的相关性分析采用Pearson相关分析;绘制受试者工作特征曲线(ROC曲线)以评价血清Hcy和caspase-3水平对COPD患者认知障碍的预测价值。结果 (1)病例组患者PaO2、pH值低于对照组,PaCO2高于对照组,FEV1和FVC小于对照组,PEF和MMEF慢于对照组(P<0.05)。(2)病例组患者视空间与执行功能、命名、记忆、注意、语言、抽象思维、延时回忆、定向评分及MoCA总分均低于对照组(P<0.05)。(3)A组、B组、C组患者血清Hcy和caspase-3水平高于对照组,B组和C组患者血清Hcy和caspase-3水平高于A组,C组患者血清Hcy和caspase-3水平高于B组(P<0.05)。(4)Pearson相关分析结果显示,血清Hcy、caspase-3水平与COPD患者MoCA评分呈负相关(r值分别为-0.553、-0.567,P<0.01)。(5)ROC曲线显示,血清Hcy水平预测COPD患者认知障碍的曲线下面积(AUC)为0.781[95%CI(0.695,0.886)],最佳截断值为13.56 ng/L,灵敏度、特异度分别为70.75%、92.62%;血清caspase-3水平预测COPD患者认知障碍的AUC为0.776[95%CI(0.691,0.873)],最佳截断值为7.83 ng/L,灵敏度、特异度分别为71.34%、91.08%。结论血清Hcy和caspase-3水平与COPD患者认知功能呈负相关,且二者均对COPD患者认知障碍具有一定预测价值。

关键词(KeyWords)： 慢性阻塞性肺疾病;认知障碍;同型半胱氨酸;半胱氨酸天冬酶-3;预测

Abstract:

Keywords:

基金项目(Foundation): 河北省医学科学研究课题计划项目(20191792)

作者(Author): 苗玲;王敏;秦景云;张向民;

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DOI:

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