皮质下缺血性血管病患者血清碱性磷酸酶变化及其对认知功能的影响

Impact of serum alkaline phosphatase on the cognitive impairment in patients with subcortical ischemic vascular disease

目的：探讨皮质下缺血性血管病（ SIVD）患者血清碱性磷酸酶（ ALP）变化及其对认知功能的影响。方法收集158例SIVD患者，依据认知损害程度分为皮质下血管性轻度认知损害组（SVMCI，n＝86）及皮质下血管性痴呆组（SVaD，n＝72），选择67名认知功能正常的老年人作为对照组。依据头颅MRI将SIVD分为多发性腔隙性脑梗死（LI）组、脑白质疏松（LA）组，并对LA程度分级。测定血清ALP水平，并按照其浓度将受试者均分为3组；采用简易精神状态检查（ MMSE）及剑桥老年认知检查表-中国修订版（ CAMCOG-C）等量表对认知功能进行评价。比较不同认知损害程度组间血清ALP水平，不同ALP浓度间LI、LA及认知损害发生率，并将认知功能评分与ALP等做相关分析和多元回归分析。结果 SVaD和SVMCI患者MMSE评分[17.00（13.00，20.00）、25.00（25.00，26.00）分]及CAMCOG-C评分[59.50（49.00，68.75）、82.50（76.75，89.00）分]均低于对照组[28.00（28.00，29.00）、93.00（89.00，96.00）分]，差异均有统计学意义（Z＝187.337，P＝0.000；Z＝150.480，P＝0.000）。在控制各混杂因素后，血清ALP水平随认知损害程度加重而增高，3组间差异具有统计学意义[分别为（68.60±15.52）、（78.76±13.39）、（86.75±18.85） U／L，F＝22.587，P＝0.000]。不同血清ALP浓度间LI、LA及SVaD发生率差异具有统计学意义（χ2＝8.008， P＝0.018；χ2＝17.998， P＝0.000；χ2＝12.255， P＝0.002）。相关分析示ALP与MMSE、CAMCOG-C总分呈负相关（r＝－0.350，P＝0.000；r＝－0.286，P＝0.000）。在校正各血管危险因素后多元回归分析显示， ALP与认知功能损害仍呈正相关，当进一步校正LA分级后， ALP与认知损害间无相关性。结论SIVD患者血清ALP水平显著升高，其升高水平与SIVD认知损害呈正相关，尤其是脑白质疏松较为严重者。

Objective To explore the levels of serum alkaline phosphatase （ ALP） as well as its impact on the cognitive impairment in patients with subcortical ischemic vascular disease （ SIVD）.Methods One hundred and fifty-eight SIVD patients were divided into two subgroups which included 86 patients with mild cognitive impairment （ SVMCI ） and 72 patients with vascular dementia （ SVaD ） according to the severity of cognitive impairment.Sixty-seven old people with normal cognitive function were selected as control qruop.Multiple lacunar infarction （ LI） or leukoaraiosis （ LA） was detected according to their MRI scan appearances and graded LA according to the severity.Serum ALP was measured by an enzymatic method as well as the Mini-Mental State Examination （ MMSE） and the Cambridge Cognitive Examination-Chinese Version （CAMCOG-C） were used in assessments.Serum ALP was divided into 3 groups and the occurrence rate of LI , LA and cognitive impairment were compared with each other.The levels of ALP were compared in different cognitive impairment and Logistic regression was used to explore the relation between ALP and cognitive impairment.Results Both SVaD and SVMCI groups （17.00 （13.00, 20.00）, 59.50＆amp;nbsp;（49.00, 68.75）;25.00 （25.00, 26.00）, 82.50 （76.75, 89.00）） showed significantly lower scores in MMSE and CAMCOG-C than control group （28.00 （28.00, 29.00）, 93.00 （89.00, 96.00）; Z=187.337, P=0.000; Z=150.480, P=0.000）.A positive relationship between the elevated ALP level and the severity of cognitive impairment was found after adjusting for sex , age and other confunding factors （（68.60 ±15.52）, （78.76 ±13.39）, （86.75 ±18.85） U/L, F=22.587, P=0.000）.The occurrence rate of LI, LA and SVaD among the three groups were significantly different （χ2 =8.008, P=0.018;χ2 =17.998, P=0.000;χ2 =12.255, P=0.002）.The ALP level was negatively correlated with MMSE and CAMCOG-C scores （ r=-0.350, P=0.000; r=-0.286, P=0.000 ）.Logistic regression analysis revealed the relation between ALP and cognitive impairment was positive when we controlled all the vascular risk factors.However , the relation had gone when futher adjusting for the grade of LA.Conclusions The level of ALP is significantly higher in SIVD patients and positively relates with cognitive impairment especially in those whose grade of LA is severe.