肌萎缩侧索硬化患者血清氧化应激标志物与神经功能、肌电图特征、脑脊液神经标志物的相关性

The correlation of serum oxidative stress markers with neurological function, electromyographic characteristics and cerebrospinal fluid neurological markers in patients with amyotrophic lateral sclerosis

目的分析肌萎缩侧索硬化(ALS)患者血清氧化应激标志物与神经功能、肌电图特征、脑脊液神经标志物的相关性。方法选择2014年2月-2018年6月福建省宁德市医院神经内科确诊为ALS患者36例作为ALS组,同期接受腰硬联合麻醉下腹腔手术的患者作为对照组,比较2组氧化应激标志物、神经功能、肌电图特征、脑脊液神经标志物。结果与对照组比较,ALS组患者的血清8-OhdG、MDA含量均明显升高(t/P=12.444/0.000、16.781/0.000),GPX、SOD含量均明显降低(t/P=11.415/0.000、11.483/0.000);ALS组患者正中神经、尺神经、腓总神经、胫神经的CMAP水平均明显降低(t/P=26.828/0.000、22.162/0.000、19.141/0.000、20.033/0.000);ALS组患者脑脊液中MBP、Tau、pNfH的含量均明显升高,差异有统计学意义(t/P=9.655/0.000、15.939/0.000、15.301/0.000);ALS患者的血清8-OhdG、MDA含量与ALSFRS-r评分及正中神经、尺神经、腓总神经、胫神经的CMAP水平均呈负相关(r/P8-OhdG=-0.312/0.010、-0.384/0.005、-0.291/0.012、-0.225/0.016、-0.183/0.030,r/PMDA=-0.338/0.006、-0.429/0.000、-0.325/0.009、-0.394/0.001、-0.278/0.013),与脑脊液MBP、Tau、pNfH含量呈正相关(r/P8-OhdG=0.362/0.007、0.251/0.014、0.265/0.013,r/PMDA=0.495/0.000、0.294/0.011、0.388/0.001);血清GPX、SOD含量与ALSFRS-r评分及正中神经、尺神经、腓总神经、胫神经的CMAP水平均呈正相关(r/PGPX=0.231/0.014、0.336/0.007、0.312/0.008、0.432/0.000、0.299/0.012,r/PSOD=0.189/0.028、0.398/0.000、0.312/0.007、0.428/0.000、0.311/0.010),与脑脊液MBP、Tau、pNfH含量均呈负相关(r/PGPX=-0.388/0.005、-0.332/0.007、-0.498/0.000,r/PSOD=-0.334/0.006、-0.182/0.027、-0.373/0.001)。结论ALS患者体内氧化应激的过度激活与神经功能及肌电图特征的损害、脑脊液神经标志物的增多有关,血清氧化应激标志物的测定能够用于病情评估。

Objective To analyze the correlation between serum oxidative stress markers and neurological function,electromyographic characteristics and cerebrospinal fluid neurological markers in patients with amyotrophic lateral sclerosis(ALS).Methods Thirty-six patients with ALS diagnosed by Neurology Department of Ningde Hospital of Fujian Province from February 2014 to June 2018 were selected as ALS group and those who underwent abdominal surgery under combined spinal-epidural anesthesia were selected as control group.The oxidative stress markers,neurological function,electromyogram characteristics and cerebrospinal fluid neurological markers were compared between the two groups.Results Compared with the control group,the serum levels of 8-OhdG and MDA in the ALS group were significantly increased(t/P=12.444/0.000,t/P=16.781/0.000),and the GPX and SOD contents were significantly decreased(t/P=11.415/0.000,t/P=11.483/0.000);CMAP levels of median nerve,ulnar nerve,common peroneal nerve and phrenic nerve were significantly lower in patients with ALS(t/P=26.828/0.000,t/P=22.162/0.000,t/P=19.141/0.000,t/P=20.033/0.000);the content of MBP,Tau and pNfH in cerebrospinal fluid of patients with ALS group increased significantly,the difference was statistically significant(t/P=9.655/0.000,t/P=15.939/0.000,t/P=15.301/0.000);Serum 8 OhdG,MDA content in ALS patients was negatively correlated with ALSFRS-r score and CMAP level of median nerve,ulnar nerve,common peroneal nerve and phrenic nerve(8 OhdG:r/P=-0.312/0.010,r/P=-0.384/0.005,r/P=-0.291/0.012,r/P=-0.225/0.016,r/P=-0.183/0.030,MDA:r/P=-0.338/0.006,r/P=-0.429/0.000,r/P=-0.325/0.009,r/P=-0.394/0.001,r/P=-0.278/0.013),with cerebrospinal fluid MBP There was a positive correlation between Tau and pNfH content(8 OhdG:r/P=0.362/0.007,r/P=0.251/0.014,r/P=0.265/0.013,MDA:r/P=0.495/0.000,r/P=0.294/0.011,r/P=0.388/0.001);serum GPX,SOD content was positively correlated with ALSFRS-r score and CMAP level of median nerve,ulnar nerve,common peroneal nerve and phrenic nerve(GPX:r/P=0.231/0.014,r/P=0.336/0.007,r/P=0.312/0.008,r/P=0.432/0.000,r/P=0.299/0.012,SOD:r/P=0.189/0.028,r/P=0.398/0.000,r/P=0.312/0.007,r/P=0.428/0.000,r/P=0.311/0.010),negatively correlated with MBP,Tau,and pNfH content in cerebrospinal fluid(GPX:r/P=-0.388/0.005,r/P=-0.332/0.007,r/P=-0.498/0.000,SOD:r/P=-0.334/0.006,r/P=-0.182/0.027,r/P=-0.373/0.001).Conclusion Over-activation of oxidative stress in ALS patients is related to the damage of nerve function and electromyographic characteristics,and the increase of cerebrospinal fluid neuromarkers.The determination of serum oxidative stress markers can be used to evaluate the condition of ALS patients.