帕金森病患者脑动脉多普勒测定指数及血清表皮生长因子与动脉硬化和认知障碍的关联分析

Association analysis of cerebral artery Doppler index and serum EGF level with arteriosclerosis and cognitive impairment in 60 patients with Parkinson?s disease

目的分析60例帕金森病(PD)患者脑动脉多普勒测定指数及血清表皮生长因子(EGF)水平与动脉硬化和认知障碍的关联性。方法选取2017年6月至2019年12月期间收治的60例PD患者,根据是否存在脑动脉硬化分为硬化组(22例)、非硬化组(38例),另选60名同期健康体检者作为对照组。所有受试者均行经颅多普勒超声(TCD)检测,采用酶联免疫吸附法测定所有受试者血清EGF,采用蒙特利尔认知评估量表(MoCA)评估认知情况。比较各组受试者间大脑基底动脉(BA)、大脑中动脉(MCA)的搏动指数(PI)、阻力指数(RI)以及血清EGF水平,采用Spearman分析MoCA总分与超声指标和血清EGF的相关性,Logistic回归分析与PD认知功能障碍相关的危险因素。结果3组受试者BA、MCA的RI、PI差异显著,其中硬化组的RI、PI均高于非硬化组、对照组(F=5.244,9.745,4.674,10.465;P=0.007,<0.001,0.011,<0.001)。3组受试者血清EGF水平、MoCA评分差异显著,其中硬化组各指标均显著低于非硬化组、对照组,非硬化组显著低于对照组,差异有统计学意义(F=54.289,38.788;P<0.001)。Spearman相关性分析结果显示,MoCA评分与BA、MCA的RI、PI呈负相关(r=-0.402,-0.436,-0.422,-0.477,P<0.05),与血清EGF水平呈正相关(r=0.667,P<0.05)。单因素分析结果显示,脑动脉硬化(P=0.016)、BA(P<0.001,P<0.001)和MCA(P=0.005,P=0.003)的RI、PI以及EGF(P<0.001)与认知功能障碍相关(P<0.05)。二元Logistic回归分析显示,脑动脉硬化(OR:2.361,95%CI:1.247~3.907)、MCA的RI(OR:1.988,95%CI:1.025~3.855)、PI(OR:2.489,95%CI:1.086~5.703)以及血清EGF(OR:0.312,95%CI:0.168~0.580)均为PD患者认知功能障碍的独立危险因素(P<0.05)。结论BA、MCA的PI、RI以及血清EGF与PD患者脑动脉硬化和MCI存在相关性,其中MCA的PI、RI、血清EGF以及脑动脉硬化是PD患者认知功能障碍的独立危险因素。

Objective To analyze the association of cerebral artery Doppler index and serum epidermal growth factor(EGF)level with arteriosclerosis and cognitive impairment in 60 patients with Parkinson?s disease(PD).Methods A total of 60 PD patients treated during Jun.2017 and Dec.2019 were selected and divided into the arteriosclerosis group(n=22)and non-arteriosclerosis group(n=38).Another 60 healthy controls were enrolled as the control group.Transcranial Doppler(TCD)was performed in all subjects.Serum EGF level was measured with enzyme-linked immunosorbent assay.Cognitive status was assessed with Montreal Cognitive Assessment Scale(MoCA).The pulsatility index(PI)and resistance index(RI)of basilar artery(BA)and middle cerebral artery(MCA),and serum EGF level were compared among the groups.The correlation among the total MoCA score,Doppler index and serum EGF level was explored with Spearman analysis.Risk factors related to cognitive dysfunction of PD were analyzed with Logistic regression.Results The RI and PI of BA and MCA in the three groups were significantly different,among which the RI and PI of the sclerosis group were higher than those of the non-sclerosis group and the control group(F=5.244,9.745,4.674,10.465;P=0.007,<0.001,0.011,<0.001).There were significant differences in serum EGF levels and MoCA scores among the three groups,in which each index of the sclerosis group was significantly lower than that of the non-sclerosis group and the control group,the non-sclerosis group was significantly lower than that of the control group(F=54.289,38.788;P<0.001).Spearman correlation analysis showed that MoCA score was negatively correlated with RI and PI of BA(r=-0.402,-0.436,P<0.05),RI and PI of MCA(r=-0.422,-0.477,P<0.05),but positively correlated with serum EGF level(r=0.667,P<0.05).Univariate analysis showed that cerebral arteriosclerosis(P=0.016),RI and PI of MCA(P=0.005,P=0.003)and BA(P<0.001,P<0.001),and EGF(P<0.001)were associated with cognitive impairment(P<0.05).Binary Logistic regression analysis showed that cerebral arteriosclerosis(OR=2.361,95%CI=1.247-3.907),RI of MCA(OR=1.988,95%CI=1.025-3.855),PI of MCA(OR=2.489,95%CI=1.086-5.703)and serum EGF(OR=0.312,95%CI=0.168-0.580)were independent risk factors of cognitive dysfunction in PD patients.Conclusion PI and RI of MCA and BA as well as serum EGF level are correlated with cerebral arteriosclerosis and mild cognitive impairment in PD patients,among which PI and RI of MCA,serum EGF level and cerebral arteriosclerosis are independent risk factors of cognitive impairment in PD patients.