血脂水平与多系统萎缩患病风险的相关性

Correlation study between lipid levels and the risk of multiple system atrophy

目的探索血脂水平与多系统萎缩（multiplesy stem atrophy，MSA）患者患病的关系，寻找支持MSA诊断的血清标志物。方法连续纳入2011年1月至2015年3月就诊于郑州大学第一附属医院神经内科的MSA患者及年龄、性别相匹配的无神经系统疾病的健康对照，采用两独立样本t检验法比较总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平在患者与健康对照间的差异，采用LSD—t检验法比较MSA各亚型之间及各亚型与对照组间血脂各指标水平差异，采用多元Logistic回归分析在不同血脂水平下MSA患病倾向，采用Spearman法分析MSA患者血脂水平与疾病病程、发病年龄、Hoehn—Yahr分期等的相关性。结果共纳入MSA患者及年龄、性别匹配的无神经系统疾病的健康对照各195例，年龄差异无统计学意义。MSA患者总胆固醇[（4．33±0．90）mmol／L]、甘油三酯[（1．27±0．71）mmol／L]、低密度脂蛋白胆固醇[（2．70±0．76）mmol／L]水平低于对照组[（4．52±0．85）、（1．47±0．86）、（2．85±0．71）mmol／L]，差异有统计学意义（t=2．056、2．528、2．149，均P〈0．05）；亚组分析中，以帕金森样症状为主型的MSA患者总胆固醇[（4．28±0．96）mmol／L]、甘油三酯[（1．20±0．64）mmol／L]水平低于对照组[（4．52±0．85）、（1．47±0．86）mmol/L]，差异有统计学意义（LSD-t=1．983、2．566，均P〈0．05）；校正年龄、性别、既往史等因素后，高水平甘油三酯、高密度脂蛋白胆固醇组与低水平组比较，OR值分别为0．31（95％CI0．15～0．65，P=0．002）及0．38（95％CI0．17～0．83，P=0．016），相关分析显示MSA患者高密度脂蛋白胆固醇水平与发病年龄呈正相关（r=0．15，P=0．039）。结论甘油三酯、高密度脂蛋白胆固醇水平降低可能与MSA患病相关，高密度脂蛋白胆固醇水平越低，MSA发病年龄可能越小。

Objective To look for more serum biomarkers supporting the diagnosis of multiple system atrophy （MSA） and providing more evidence for early treatment. Methods All patients and healthy controls were enrolled from January 2011 to March 2015 in the First Affiliated Hospital of Zhengzhou University. Demographic features and biochemical examination results were collected. The t test was used to compare the lipid levels between MSA patients and controls. LSD-t test was used to compare the lipid levels among subtypes of MSA patients. Multivariate Logistic regression analysis was conducted to analyze the influencing factors. The relevance between lipid levels and onset age, disease duration and Hoehn ＆ Yahr stage was calculated by Spearman correlation coefficients. Results Participants included 195 MSA patients and 195 age- and gender-matched controls with no neurological diseases. The levels of total cholesterol （ （4. 33 ± 0. 90 ） mmoL/L） , triglyceride （ （ 1.27 ± 0.71 ） mmoL/L ）, low-density lipoprotein （ LDL; （2. 70±0. 76） mmol/L） were significantly lower in patients than in controls （ （4. 52±0. 85）, （ 1.47±0. 86）, （2. 85 ±0.71 ） mmol/L , t = 2. 056,2. 528 and 2. 149 respectively, all P 〈 0. 05 ）. The levels of total cholesterol （ （4. 28±0. 96） retool/L） and triglyceride （ （ 1.20±0. 64） mmol/L） were significantly lower in MSA-P patients than in control group （ （4. 52 ± 0. 85 ）, （ 1.47±0. 86） mmol/L; LSD-t = 1. 983, 2. 566, both P 〈 0. 05）. After adjusting for age, gender and histories, the odds ratio （OR） was 0. 31 （95% CI 0.15- 0. 65, P = 0. 002） for MSA patients in the highest quartile of triglyceride and 0. 38 （95% CI 0.17 - 0. 83, P = 0. 016 ） for those in the highest quartile of high-density lipoprotein （ HDL ） , compared with the lowest quartiles. And HDL level was in a significantly positive correlation with onset age （r = 0.15, P = 0. 039 ）. Conclusion Our data suggest that triglyeeride and HDL may be associated with the prevalence of MSA, and the lower levels of HDL, the earlier onset of MSA.