老年代谢综合征患者血清炎性因子及脂联素水平与轻度认知功能障碍的关系

The relationship of serum levels of matrix metalloproteinase-9, intercellular adhesion molecule-I and adiponectin with the mild cognitive impairment in senile metabolic syndrome patients

目的探讨老年代谢综合征（metabolic syndrome，MS）患者血清基质金属蛋白酶（MMP）9、细胞问黏附因子（ICAM1）、脂联素水平与认知功能的相关性。方法采用多种神经心理学量表对MS患者74例和健康对照者30例进行认知功能评定，并测量其体质指数（BMI）、腹围、血压及检测空腹血糖（FBG）、血脂等代谢指标；将MS患者再分为MS＋轻度认知功能障碍（MCI）组（39例）和MS组（35例）；测定所有受试者的MMP-9、ICAM—1和脂联素水平。结果（1）MS＋MCI组的BMI、收缩压、FBG、三酰甘油（TG）水平均高于MS组及对照组（P〈0．05）。MS＋MCI组、MS组血清MMP-9、ICAM-1的水平明显高于对照组（P〈0．01），而脂联素水平明显低于对照组（x^2=26．62，P〈0．01）；MS＋MCI组血清MMP-9水平明显高于MS组（z=-4．61，P〈0．05），脂联素水平明显低于MS组（Z=-5．77，P〈0．05）；（2）Spearman直线相关分析显示，MS＋MCI组、MS组血清MMP9（r=-0．794，P〈0．001）、ICAM-1（r=0．501，P〈0．001）与脂联素显著负相关，MMP9与ICAM-1之间显著正相关（r=0．481，P=0．006）；（3）多重线性回归分析显示，蒙特利尔认知评估量表（MoCA）评分与MMP-9（β=-3．438，P=0．001）、脂联素（β=1．337，P=0．006）、收缩压（β=-0．058，P=0．003）、FBG（β=-0．227，P=0．049）具有线性相关关系；（4）多因素Logisic逐步回归分析结果显示，高MMP-9（OR=1．007）、低脂联素（OR=0．359）水平是老年MS患者发生认知功能障碍的危险因素。结论老年MS患者存在认知功能损害；MCI患者血清炎症因子表达增加，且与代谢异常存在相关性；MMP-9可能促进神经退行性变，而脂联素在这一过程中起到保护作用，表明炎性反应参与老年MS患者MCI的病理过程。

Objective To evaluate the relationships of the serum levels of matrix metalloproteinase 9 （MMP 9）, intercellular adhesion molecule-1 （ICAM-1） and adiponectin with the mild cognitive impairment （MCI） in senile metabolic syndrome （MS）patients. Methods The 74 cases with MS and 30 health controls （control group） were enrolled. Mini-mental state examination （MMSE）, montreal cognitive assessment （MoCA）, digit-symbol test （DST）, auditory verbal memory test （AVMT）, trail making test（TMT）, sunderland clock drawing test （CDT） and verbal fluency test （VFT） were applied to evaluate cognitive function. Based on the cognitive assessment, MS patients were divided into two groups： 39 cases with MCI （MS＋ MCI group） and 35 cases without cognitive impairment （MS group）. The levels of MMP-9, ICAM-1 and adiponectin were measured by ELISA. Biochemical variables were measured by routine methods in all subjects. Results （1）MS＋ MCI group showed the higher levels of BMI, SBP, FBG and MMP-9 （all P〈0. 05） and lower level of adiponectin （P〈0.05） than did the MS group. And MS group had higher levels of MMP-9 and ICAM-1 （P〈0.01） and lower adiponectin level （P〈0.01） than did the control group. （2）Spearman＇ s correlation analysis showed that the serum levels of MMP 9 （r=-0. 794, P〈0. 001） and ICAM-1 （r = -0. 501, P〈0. 001） were negatively correlated with adiponectin. However, MMP-9 was positively correlated with ICAM-1 （ r=0. 481, P= 0. 006）. （ 3 ） Multiple linear regression analysis indicated that there was linear relationship of MoCA with MMP 9 （β= 3. 438, P=0. 0019）, adiponectin （β=1.337, P=0.006）, SBP （β=-0.058, P=0.003） and FBG （β=-0.227, P 0. 049）. （4） Stepwise logistic analysis showed that both high MMP-9 （OR 1. 007） and low adiponectin （OR= 0.359） were risk factors for the decline of cognitive function. Conclusions Elderly patients with MS may show deterioration in memory, calculation and visuospatial perception. Elevated inflammatory factors might contribute, in combination with abnormal metabolism, to MCI. MMP-9 might contribute to neuronal degeneration. However, adiponectin could strongly counteract the risk factors for cognitive impairment.