老年血管性帕金森综合征患者血清sNFL、β-APP表达及其相关性研究

Expression and correlation of serum sNFL andβ-APP in elderly patients with vascular Parkinsonism

目的探究老年血管性帕金森综合征(VP)患者血清神经丝蛋白轻链(sNFL)、β-淀粉样前体蛋白(β-APP)表达及其相关性研究。方法选取2018年1月至2020年1月湖南省郴州市第四医院神经内科住院治疗及门诊就诊的VP患者80例(VP组)和PD患者80例(PD组)以及正常体检的50例无智能障碍、精神健康的老年人(对照组)为研究对象。比较三组研究对象一般资料及血清(sNFL)、β-APP水平,利用酶联免疫吸附法(ELISA)检测血清sNFL、β-APP水平,Pearson法分析VP患者血清sNFL、β-APP水平之间及与UPDRSⅠ评分、MoCA评分之间的关系;利用受试者工作特征曲线(ROC)评价血清sNFL、β-APP对VP发生的预测价值。结果VP组、PD组和对照组在TC水平、糖化血红蛋白水平差异有统计学意义(P<0.05)。VP组患者病程、UPDRSⅠ评分高于PD组(P<0.05),MoCA评分低于PD组(P<0.05)。与对照组相比,PD组、VP组血清sNFL水平逐渐升高,β-APP水平逐渐降低,各组间差异有统计学意义(P<0.05)。VP患者血清sNFL、β-APP水平之间呈负相关(r=-0.527,P<0.05),血清sNFL水平与UPDRSⅠ评分呈正相关(r=0.562,P<0.05),与MoCA评分呈负相关(r=-0.471,P<0.05);血清β-APP水平与UPDRSⅠ评分呈负相关(r=-0.393,P<0.05),与MoCA评分呈正相关(r=0.428,P<0.05)。ROC结果显示,血清sNFL、β-APP水平预测VP发生的曲线下面积(AUC)分别为0.859(95%CI:0.8310.924)、0.803(95%CI:0.7240.867),最佳截断值分别为43.56 pg/mL、6.31ng·mL^(-1),二者联合预测VP发生的AUC为0.933(95%CI:0.8750.946),灵敏度和特异度分别为89.75%、88.00%。结论VP患者血清sNFL水平升高,β-APP水平降低,与VP患者病情严重程度有关,可能作为预测VP发生的潜在血清指标。

Objective To investigate the expression of serum neurofilament light chain(sNFL)andβ-amyloid precursor protein(β-APP)in elderly patients with vascular Parkinsonism(VP).Methods From January 2018 to January 2020,80 VP patients(VP group)and 80 PD patients(PD group)who were hospitalized and outpatients in the Department of Neurology of our hospital,as well as 50 cases of elderly without intellectual impairment and with mental health who underwent normal physical examination(control group)from January 2018 to January 2020 were selected as the research objects.The general information and serum levels of sNFL andβ-APP were compared among the three groups,the serum levels of sNFL andβ-APP were detected by enzyme-linked immunosorbent assay(ELISA),Pearson method was used to analyze the relationship between serum sNFL andβ-APP levels,their relationship with UPDRS I score and MoCA score;receiver operating characteristic curve(ROC)was used to evaluate the predictive value of serum sNFL andβ-APP on the occurrence of VP.Results There were significant differences in TC level and glycosylated hemoglobin level between VP group,PD group and control group(P<0.05).The course of disease and UPDRS I score of VP group were higher than those of PD group(P<0.05),and MoCA score was lower than that of PD group(P<0.05).Compared with those in the control group,the serum sNFL level of PD group and VP group was gradually increased,and the level ofβ-APP was gradually decreased,the difference was statistically significant(P<0.05).There was a negative correlation between serum sNFL andβ-APP levels in VP patients(r=-0.527,P<0.05),serum sNFL level was positively correlated with UPDRS I score(r=0.562,P<0.05),and negatively correlated with MoCA score(r=-0.471,P<0.05);serumβ-APP level was negatively correlated with UPDRS I score(r=-0.393,P<0.05),and positively correlated with MoCA score(r=0.428,P<0.05).ROC results showed that the area under the curve(AUC)of serum sNFL andβ-APP levels in predicting VP occurrence was 0.859(95%CI:0.831-0.924)and 0.803(95%CI:0.724-0.867),and the best cutoff value was 43.56 pg/mL and 6.31 ng/mL,respectively,the AUC of the combined prediction was 0.933(95%CI:0.875-0.946),the sensitivity and specificity were 89.75%and 88.00%,respectively.Conclusion The serum sNFL level is increased and theβ-APP level is decreased in patients with VP.They are related to the severity of VP,and may be used as potential serum indexes to predict the occurrence of VP.