| 摘要: |
| 目的 探究脑白质损伤（WML）老年女性认知功能的影响因素，寻找WML老年女性患痴呆的潜在生物学标志物。方法 纳入2020年1-6月在海军军医大学（第二军医大学）第一附属医院和上海市杨浦区控江医院神经内科门诊及病房就诊的149例WML老年女性患者和48例无WML的老年女性患者。根据WML严重程度将所有入组患者分为无WML组（对照组，48例）、轻度WML组（72例）及中重度WML组（77例）。根据简易精神状态评估（MMSE）量表评分将WML患者分为痴呆组（58例）和无痴呆组（91例）。比较各组血清炎症因子IL-1β、IL-6、TNF-α及25-羟维生素D[25（OH）D]、催乳素等因素的差异，通过logistic回归模型分析这些因素与WML老年女性患者发生痴呆的相关性，通过绘制ROC曲线研究25（OH）D联合催乳素对WML老年女性患者痴呆的诊断价值。结果 与对照组相比，轻度及中重度WML组患者的血清25（OH）D水平均降低[（13.34±3.85）ng/mL、（12.73±3.77）ng/mL vs（15.82±4.07）ng/mL，P<0.01]，血清炎症因子IL-1β、IL-6、TNF-α水平均升高[IL-1β：（75.14±16.03）pg/mL、（75.42±14.38）pg/mL vs（53.96±13.55）pg/mL，P<0.01；IL-6：35.70（28.92，40.67）pg/mL、35.29（28.97，43.41）pg/mL vs 22.38（18.04，27.20）pg/mL，P<0.01；TNF-α：72.72（55.68，88.63）pg/mL、71.52（60.26，85.85）pg/mL vs 50.93（38.93，60.48）pg/mL，P<0.01]。与非痴呆组相比，痴呆组WML患者的血清25（OH）D、尿酸、催乳素和皮质醇水平均降低[25（OH）D：（11.77±3.63）ng/mL vs（13.83±3.72）ng/mL，P<0.01；尿酸：（331.02±150.31）μmol/L vs（380.16±128.02）μmol/L，P<0.05；催乳素：（231.72±79.39）μIU/mL vs（276.84±99.66）μIU/mL，P<0.01；皮质醇：（287.38±149.58）nmol/L vs（358.45±155.32）nmol/L，P<0.01]。多因素logistic回归分析显示，在校正年龄后，25（OH）D（OR=0.821，95% CI 0.717~0.940，P=0.004）和催乳素（OR=0.994，95% CI 0.989~1.000，P=0.042）是WML老年女性患者认知功能的保护因素。ROC曲线分析显示25（OH）D联合催乳素对判断WML老年女性是否患有痴呆具有中度诊断价值（AUC为0.745，P<0.001）。结论 血清25（OH）D和催乳素与WML老年女性患痴呆的风险有关，有望成为此类人群痴呆早期诊断的潜在生物学标志物。 |
| 关键词: 脑白质损伤 老年女性 25-羟维生素D 催乳素 认知障碍 痴呆 |
| DOI：10.16781/j.CN31-2187/R.20220085 |
| 投稿时间：2022-01-22修订日期：2022-02-24 |
| 基金项目:上海申康医院发展中心临床三年行动计划（SHDC2020CR1038B），上海市卫生系统优秀人才培养计划（2018BR29），海军军医大学（第二军医大学）第一附属医院“234学科攀峰计划”（2019YXK013）. |
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| Association of serum 25-hydroxyvitamin D and prolactin levels with the risk of dementia in elderly women with white matter lesions |
| YIN Ge1,SUN Rui1,LIANG Meng1,FANG Ling2,GU Zheng-sheng1,FAN Cun-xiu1,CHAI Chang-feng1,BI Xiao-ying1* |
(1. Department of Neurology, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Neurology, Kongjiang Hospital of Yangpu District, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the factors affecting the cognition of elderly women with white matter lesions (WML) and to look for potential biological markers of dementia in this population. Methods A total of 149 elderly woman patients with WML and 48 elderly woman patients without WML who were treated in the outpatient department and ward in Department of Neurology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) and Kongjiang Hospital of Yangpu District of Shanghai from Jan. to Jun. 2020 were enrolled. The patients were divided into non-WML group (control group, n=48), mild WML group (n=72) and moderate to severe WML group (n=77) according to the severity of WML. WML patients were divided into dementia group (n=58) and non-dementia group (n=91) according to the mini-mental state exam (MMSE) scores. The levels of interleukin (IL)-1β, IL-6, tumor necrosis factor α (TNF-α), 25-hydroxyvitamin D (25(OH)D) and prolactin were compared between groups, and logistic regression model was used to analyze the correlations between these factors and the occurrence of dementia in elderly women with WML. In addition, receiver operating characteristics (ROC) curve was drawn to study the diagnostic value of 25(OH)D combined with prolactin for dementia in elderly women with WML. Results Compared with the control group, the serum 25(OH)D levels of patients in the mild and moderate to severe WML groups were significantly lower ([13.34±3.85] ng/mL,[12.73±3.77] ng/mL vs[15.82±4.07] ng/mL, P<0.01). The serum inflammatory factor levels of patients in the mild and moderate to severe WML groups were increased significantly compared with those of patients in the control group, such as IL-1β ([75.14±16.03] pg/mL,[75.42±14.38] pg/mL vs[53.96±13.55] pg/mL, P<0.01), IL-6 (35.70[28.92, 40.67] pg/mL, 35.29[28.97, 43.41] pg/mL vs 22.38[18.04, 27.20] pg/mL, P<0.01), TNF-α (72.72[55.68, 88.63] pg/mL, 71.52[60.26, 85.85] pg/mL vs 50.93[38.93, 60.48] pg/mL, P<0.01). The levels of serum 25(OH)D, uric acid, prolactin and cortisol in the dementia group were lower than those in the non-dementia group (25(OH)D:[11.77±3.63] ng/mL vs[13.83±3.72] ng/mL, P<0.01; uric acid:[331.02±150.31] μmol/L vs[380.16±128.02] μmol/L, P<0.05; prolactin:[231.72±79.39] μIU/mL vs[276.84±99.66] μIU/mL, P<0.01; cortisol:[287.38±149.58] nmol/L vs[358.45±155.32] nmol/L, P<0.01). The results of multivariate logistic regression analysis suggested that serum 25(OH)D (odds ratio[OR]=0.821, 95% confidence interval[CI] 0.717-0.940, P=0.004) and prolactin (OR=0.994,95% CI 0.989-1.000, P=0.042) were protective factors for dementia in elderly women with WML after adjusting for age. The combination of 25(OH)D and prolactin had moderate diagnostic value for dementia in elderly women with WML, and the area under ROC curve was 0.745 (P<0.001). Conclusion Serum 25(OH)D and prolactin levels are associated with dementia in elderly women with WML, and are expected to be potential biomarkers for early diagnosis of dementia in this population. |
| Key words: white matter lesions elderly women 25-hydroxyvitamin D prolactin cognitive disorders dementia |
