低营养状态对β淀粉样蛋白显像阳性的轻中度阿尔茨海默病的影响

Effect of lower nutritional state on mild to moderate Alzheimer's disease with positiveβ-amyloid plaque imaging

目的探讨营养学指标对β-淀粉样蛋白(Aβ)显像阳性的阿尔茨海默病(AD)的影响。方法收集2015年12月~2016年10月北京天坛医院神经变性病科记忆痴呆门诊就诊的AD患者40例作为AD组,所有患者均进行正电子发射计算机断层显像-计算机断层扫描检查,示踪剂为18F标记的脱氧葡萄糖及11 C标记的匹兹堡化合物B,以确定符合AD的病理改变。另外选同期年龄、性别及教育程度相匹配的门诊健康体检者60例作为认知正常组。收集2组临床资料,用多变量logistic回归分析确定AD的影响因素。结果 AD组血清总蛋白[(69.23±3.28)g/L vs(72.49±5.44)g/L]、维生素B12[(415.76±192.71)ng/L vs(545.24±316.86)ng/L]及体质量指数[(22.77±2.70)kg/m2 vs(24.67±3.59)kg/m2]均低于认知正常组(P<0.05,P<0.01)。在校正年龄、性别、教育程度及血管危险因素后,较低水平的血清总蛋白(OR=0.846,P=0.004)、叶酸(OR=0.833,P=0.020)及体质量指数(OR=0.817,P=0.042)与AD独立相关。结论较低水平的营养学指标可能加重AD发生与发展。对于中老年人,特别是中低收入地区的中老年人应进行营养状况调查,并给予相应的膳食指导,可能对预防AD具有重要价值。

Objective To study the effect of lower nutritional state on mild to moderate AD with positive β-amyloid plaque imaging. Methods Forty AD patients who visited the outpatient department of our hospital from December 2015 to October 2016 served as an AD group and 60 age-, sex- and education-matched subjects served as a control group in this study. Their serum total protein （TP）, total homoeysteine, albumin, vitamin B12, folate acid levels and BMI were measured, their vascular risk factors were detected,and the influencing factors of AD were analyzed by multivariate logistic regression analysis. Results The serum TP and vitamin B12 levels and the BMI were significantly lower in AD group than in control group （69. 23±3.28 g/L vs 72. 49±5.44 g/L, 415.76±192.71 ng/L vs 545.24±316.86 ng/L,22.77±2.70 kg/m2 vs 24.67±3.59 kg/m2,P〈 0. 05,P〈0. 01）. Lower serum TP and folate acid levels and BMI were independently associated with AD after adjustment of age, sex, education and vascular risk factors （OR = 0. 846,0. 833, 0. 817,P〈0.05,P〈0.01）. Conclusion Lower nutritional level exacerbates the occurrence and progression of AD. Investigation of nutritional status in middle-aged and old-aged persons, especially in low and moderate income areas,may thus play an important role in preventing AD.