中重度OSAHS患者海马及脑皮质代谢紊乱与认知功能障碍的相关性研究

Correlative study of the metabolic disorder of hippocampus and cerebral cortex and cognitive impairment in moderate to severe OSAHS patients

目的:分析中重度OSAHS患者手术前后海马及脑皮质代谢产物BDNF、H2S和S-100β的血清水平,并分析其与早期认知功能的相关性。方法:随机选取44例中重度OSAHS患者,经蒙特利尔认知评估量表(MoCA)分为认知功能正常组(19例)和认知功能障碍组(25例)。对认知功能障碍组患者行UPPP手术治疗,术后随访6个月,25例患者中21例(治疗组)得到随访,失访4例;同期随机选取19例体检健康者为对照组。各组均检测血清BDNF、H2S和S-100β水平,并分析其与睡眠紊乱、缺氧和认知功能的相关性。结果:1PSG监测结果显示,OSAHS患者与治疗组和对照组比较:AHI、Ⅰ+Ⅱ期、LA/HT和SLT 90%升高,Ⅲ+Ⅳ期、REM期、MSaO2和LSaO2降低;认知功能障碍组与认知功能正常组比较:Ⅲ+Ⅳ期、REM期和LSaO2降低。2认知功能障碍组与认知功能正常组、治疗组与对照组比较:BDNF和H2S升高,S-100β减低;MoCA总分、注意、记忆/延迟回忆评分降低。3生化指标与PSG相关性:血清BNDF和H2S与AHI负相关,与Ⅲ+Ⅳ期、REM期、MSaO2和LSaO2正相关;S-100β与AHI正相关,与Ⅲ+Ⅳ期、REM期、MSaO2和LSaO2负相关。4生化指标与MoCA评分相关性:血清BNDF、H2S与MoCA总分、注意、记忆/延迟回忆均正相关;S-100β与MoCA总分、注意、记忆/延迟回忆均负相关。5OSAHS患者认知功能障碍的MoCA总评分与血清生化指标的直线回归方程式为:Y^MoCA=40.131+0.22XBDNF+0.012XH2S-0.647XS-100β(R2=0.461)。结论:OSAHS患者睡眠结构紊乱和夜间低氧血症会导致以注意力和回忆力为主的认知功能障碍。外周血BDNF、H2S和S-100β等可间接反映OSAHS患者海马和脑皮质代谢紊乱程度,可作为评估OSAHS患者早期认知功能障碍的较敏感指标。

Objective：To research the serum levels of BDNF,H2 S and S-100βas metabolic product of hippocampus and cerebral cortex in moderate to severe obstructive sleep apnea hypopnea syndrome（OSAHS）patients before and after surgery,and to analyze their correlations with cognitive impairment.Method：Forty-four randomly selected diagnosed OSAHS patients were divided into two groups according to Montreal Cognitive Assessment（MoCA）,19 cases in cognitively normal group and 25 cases in cognitive dysfunction group.Cases in cognitive dysfunction group underwent UPPP oriented surgery,and received 6months follow-up,21 cases were remained as treament group,4cases lost.19 cases of healthy subjects were randomly selected as the normal control group.All groups were detected for the serum BDNF,H2 S and S-100βlevels to analyze the correlations between the biochemical indexes and sleep disorders indexes,hypoxia levels and cognitive function scores.Result：1In the comparison between the treatment group and the normal control group regarding PSG monitoring results,the AHI,Ⅰ＋Ⅱ,LA/HT and SLT90% indexes of OSAHS patients increased,and the Ⅲ ＋ Ⅳphase,REM phase,MSaO2 and LSaO2 decreased.In the comparison between the cognitive dysfunction group and the cognitively normal group,theⅢ＋Ⅳ,REM and LSaO2 indexes of the cognitive dysfunction group decreased.2In the comparison between cognitive dysfunction group and cognitively normal group,and between the treatment group and the normal control group,BDNF and H2 S levels increased and S-100βlevels decreased,and the MoCA total scores,attention,memory/delayed recall scores decreased.3The correlation between biochemical indexes with PSG indexes was as follows.The serum BNDF and H2 S levels were negatively correlated with AHI index.The serum BNDF and H2 S levels were positively correlated with Ⅲ＋Ⅳ stage,REM stage and MSaO2 indexes.The S-100βlevel was positively correlated with AHI index,and S-100βlevels were negatively correlated with Ⅲ ＋ Ⅳ stage,REM stage,MSaO2 and LSaO2indexes.4The correlation between biochemical indexes and MoCA scores was as follows.The serum BNDF and H2 S levels were positively correlated with MoCA total scores,attention,and memory/delayed recall scores.The serum S-100βlevels were negatively correlated with MoCA total scores,attention and memory/delayed recall scores.5The linear regression equation between MoCA total scores in cognitive dysfunction group of OSAHS patients and the serum BNDF,H2 S and S-100βlevels was as follows：Y^MoCA=40.131＋0.22XBDNF＋0.012XH2S-0.647XS-100β（R2=0.461）.Conclusion：OSAHS patients with sleep disorder and nocturnal hypoxemia might suffer from cognitive dysfunction in which attention and memory predominates.Serum BNDF,H2 S and S-100βlevels,which could indirectly reflect the metabolic abnormalities degree of hippocampus and cerebral cortex,are sensitive indicators of early cognitive dysfunction in OSAHS patients.