2型糖尿病伴OSAHS患者血清NPY、NGAL水平变化及其与早期认知功能损伤的关系

Changes in levels of serum NPY and NGAL and their relationship with early cognitive impairment in patients with type 2 diabetes mellitus and OSAHS

目的探究2型糖尿病(T2DM)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清神经肽Y(NPY)、中性粒细胞明胶酶相关载脂蛋白(NGAL)水平变化及其与早期认知功能损伤的关系。方法回顾性选取2018年3月至2020年3月于冀中能源峰峰集团有限公司总医院治疗的T2DM患者200例,根据是否合并OSAHS,将患者分为T2DM-OSAHS组(n=135)、T2DM组(n=65)。另选取同期体检的健康人100例作为正常组。比较3组血清NPY、NGAL水平、蒙特利尔认知评估量表(MoCA)评分。根据T2DM-OSAHS组患者MoCA评分情况,将其分为认知功能障碍组(MoCA<26分)、认知正常组(MoCA≥26分)。比较认知功能障碍组与认知正常组血清NPY、NGAL水平、MoCA评分。分析T2DM-OSAHS患者NPY、NGAL水平与早期认知功能损伤的关系。分析T2DM-OSAHS患者的血清NPY、NGAL水平对认知功能障碍的诊断价值。结果T2DM-OSAHS组患者血清NPY、NGAL水平为(2.37±0.79)、(7.34±2.07)μg/L,均高于单纯T2MD组[(1.82±0.64)、(6.28±1.78)μg/L]、正常组[(1.34±0.49)、(5.14±1.23)μg/L],MoCA评分为(25.33±6.57)分,低于单纯T2MD组(28.32±3.64)分、正常组(29.18±3.49)分,差异有统计学意义(P<0.05);T2DM-OSAHS组中,出现认知功能障碍组的患者血清NPY、NGAL为(2.94±0.46)、(7.83±1.08)μg/L,均显著高于认知功能正常组患者[(1.85±0.37)、(6.89±0.92)μg/L];MoCA评分为(24.24±4.26)分,低于认知功能正常组患者(26.37±1.24)分,差异有统计学意义(P<0.05)。Pearson相关性分析可知,T2MD合并OSAHS患者血清NPY、NGAL水平与MoCA评分均呈负相关(r=-0.396、-0.291,P=0.000、0.008)。ROC曲线分析显示,NPY、NGAL联合预测患者认知功能障碍的AUC、特异度、敏感度为0.831、72.8%、93.4%。结论T2DM-OSAHS患者血清NPY、NGAL出现升高,2者联合可以为早期认知功能障碍的发生提供较为准确的预测。

Objective To explore the changes in levels of serum neuropeptide Y(NPY)and neutrophil gelatinase-associated apolipoprotein(NGAL)and their relationship with early cognitive impairment in patients with type 2 diabetes mellitus(T2 DM)and obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 200 T2 DM patients who were treated in the General Hospital of Jizhong Energy Fengfeng Group Co.,Ltd.from March 2018 to March 2020 were enrolled retrospectively.According to presence or absence of OSAHS,they were divided into T2 DM-OSAHS group(n=135)and T2 DM group(n=65).During the same period,100 healthy controls were enrolled as normal group.The levels of serum NPY and NGAL,and score of Montreal Cognitive Assessment(Mo CA)were compared among the three groups.According to different Mo CA scores,patients in T2 DM-OSAHS group were divided into cognitive dysfunction group(Mo CA lower than 26 points)and normal cognition group(Mo CA not lower than 26 points).The levels of serum NPY,NGAL,and Mo CA scores between the cognitive dysfunction group and the cognitive normal group were compared.The relationship between serum NPY,NGAL levels and early cognitive impairment was analyzed.The diagnostic value of serum NPY and NGAL levels in patients with T2 DM-OSAHS for cognitive dysfunction was analyzed.Results The levels of serum NPY and NGAL in T2 DM-OSAHS group were(2.37±0.79),(7.34±2.07)μg/L,which were higher than those in T2 MD group[(1.82±0.64),(6.28±1.78)μg/L]and normal group[(1.34±0.49),(5.14±1.23)μg/L],while Mo CA score were(25.33±6.57)scores,which were lower than those in T2 MD group(28.32±3.64)scores and normal group(29.18±3.49)scores,the differences were statistically significant(P<0.05).In T2 DM-OSAHS group,levels of serum NPY and NGAL in cognitive dysfunction group were(2.94±0.46),(7.83±1.08)μg/L,which were significantly higher than those in normal cognition group[(1.85±0.37),(6.89±0.92)μg/L],while Mo CA score were(24.24±4.26)scores,which were lower than those in normal cognition group(26.37±1.24)scores,the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of serum NPY and NGAL were negatively correlated with Mo CA scores in patients with T2 MD and OSAHS(r=-0.396,-0.291;P=0.000,0.008).ROC curve analysis showed that AUC,specificity and sensitivity of NPY combined with NGAL for predicting cognitive dysfunction were 0.831,72.8%and 93.4%,respectively.Conclusion The levels of serum NPY and NGAL are increased in T2 DM-OSAHS patients.The combination of the two can provide more accurate prediction for occurrence of early cognitive dysfunction.