慢性阻塞性肺疾病患者血浆中性粒细胞明胶酶蛋白及内皮素-1水平与认知功能障碍的相关性

Correlation between plasma NGAL and ET-1 levels and cognitive dysfunction in patients with chron- ic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者血浆中性粒细胞明胶酶蛋白（neutrophil gelatinase-associated lipocalin，NGAL）及内皮素-1（endothelin-1，ET-1）水平与认知功能障碍的相关性。方法应用病例对照研究设计选取COPD患者128例，其中无认知功能障碍的COPD患者（DC组）68例，合并认知功能障碍的COPD患者（CC组）60例，选取同期门诊健康体检者（N组）70例。采用简易精神状态量表（MMSE）及蒙特利尔量表（MoCA）评价认知功能。采用酶联免疫吸附法（enzyme immunoassay，ELISA）检测受试对象血浆NGAL及ET-1的表达水平。结果①与N组比较[NGAL：（1．69±0．73）μg／L；ET-1：（13．05±2．37）pg／m1]，DC组血浆NGAL[（2．20±0．60）μg／L]、ET-1水平[（26．19±10．55）pg／ml]升高（均P〈0．05），CC组血浆NGAL[（3．80±2．75）μg／L]、ET-1水平[（37．82±20．29）pg／ml]亦升高，且升高更明显（均P〈0．01），CC组较DC组血浆NGAL、ET-1水平亦升高（均P〈0．05）。②血浆NGAL水平与MMSE评分呈负相关（r=-0．524，P〈0．05），与MoCA评分亦呈负相关（r=-0．527，P〈0．05）；血浆ET-1水平与MMSE评分呈负相关（r=-0．549，P〈0．05），与MoCA评分亦呈负相关（r=-0．558，P〈0．05），血浆NGAL、ET-1水平呈正相关（r=0．564，P〈0．01）。结论NGAL及ET-1可能参与了COPD患者认知功能损害的病理生理过程，二者为评估COPD患者的认知功能障碍提供了一定的临床价值。

Objective To investigate the relationship between the plasma neutrophil gelatinase-associated lipocalin （NGAL）and endothelin-1 （ET-1） levels and cognitive dysfunction in chronic obstructive pulmonary disease （COPD） patients. Methods A case-control study was performed, consisting of 128 patients with COPD（68 patients without cognitive dysfunction and 60 patients with cognitive dysfunction） and 70 normal controls .All patients with COPD were diagnosed by pulmonary function tests and plasma levels of NGAL and ET-1 were determined by enzyme immunoassay. The cognitive function was evaluated by the MMSE and MoCA. Results （1）Compared with normal control, the levels of plasma NGAL and ET-1 were increased （ NGAL： （2.20±0.60） μg/L vs （ 1.69±0.73 ） μg/L, P〈0.05 ;ET-1 ： （ 26.19± 10.55 ） pg/ml vs （ 13.05 ±2.37） pg/ml, P〈0.05） in COPD patients without cognitive dysfunction and in COPD patients with cognitive dysfunction （ NGAL： （ 3.80±2.75 ）μg/L vs （ 1.69±0.73 ） μg/L, P〈0.01 ; ET-1 ： （37.82±0.29） pg/ml vs （ 13.05 ± 2.37）pg/ml, P〈0.01 ）. Compared with the COPD patients without cognitive dysfunction,the levels of plasma NGAL and ET-1 were also increased in COPD patients with cognitive dysfunction （all P〈0.05 ）, （2）The plasma NGAL levels were correlated negatively with MMSE scores （ r=-0.524, P〈0.05 ）, and negatively correlated with MoCA scores （ r=-0.527, P〈0.05）. The plasma ET-1 levels were negatively correlated with MMSE scores（ r=-0.549, P〈0.05） ,and negatively correlated with MoCA scores（ r=-0.558, P〈0.05）.The levels of NGAL and ET-1 were positively correlated（ r=0.564, P〈0.05）.Conclusion NGAL and ET-1 may be involved in the pathophysiological process of cognitive dysfunction in patients with COPD, which provides a certain clinical value for the assessment of cognitive dysfunction in patients with COPD.