血清总同型半胱氨酸与脊髓亚急性联合变性的相关性研究

The association between serum total homocysteine and subacute combined degeneration of spinal cord

目的探讨血清总同型半胱氨酸(tHcy)水平与脊髓亚急性联合变性(SCD)的相关性。方法采用回顾性调查研究,选取2008年1月至2019年2月空军军医大学西京医院神经内科病房收住的临床确诊为SCD的106例患者作为病例组,另选同期病房收住的非SCD脊髓病变患者(121例)及门诊非脊髓病变神经科轻症患者(104例)作为对照组,采用化学发光免疫分析系统测量血清tHcy浓度,采用多因素logistic回归模型,分析SCD发病风险的危险因素,采用受试者工作特征曲线(ROC)的曲线下面积(AUC)、敏感度、特异度和约登指数(YI)评价tHcy在SCD的诊断效能,采用Spearman相关性分析,观察tHcy与SCD严重程度的相关性。根据tHcy水平将SCD病例组分为tHcy正常或轻度增高组、tHcy中度增高组、tHcy重度增高组,比较三组临床表现、神经传导速度、磁共振资料情况。结果SCD组血清tHcy含量为64.3(26.5,98.8)μmol/L,高于非SCD脊髓病变组13.7(10.8,19.2)μmol/L(H=112.020,P<0.001)及非脊髓病变神经科轻症组10.6(8.2,13.0)μmol/L(H=165.525,P<0.001),差异有统计学意义。多因素logistic回归模型分析结果显示,tHcy是SCD的影响因素(OR=1.107,95%CI:1.077~1.139,P<0.001)。ROC曲线显示,tHcy诊断SCD的曲线下面积(AUC)为0.913(95%CI:0.875~0.951),最佳临界值为24.9μmol/L,在此临界值下的敏感度为79.2%,特异度为91.6%。Spearman相关性分析显示,tHcy与SCD残疾功能评分呈正相关(r=0.254,P=0.009)。结论血清tHcy是SCD的危险因素,并可能与疾病残疾程度相关。关注tHcy水平增高,对SCD诊断具有积极作用。

Objective The research was aimed to investigate the association between serum total homocysteine(tHcy)and subacute combined degeneration of the spinal cord(SCD).Methods A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019,meanwhile,121 patients with spinal cord lesion(not SCD)and 104 neurology mild outpatients were selected as controls.Serum tHcy level was determined by using the chemiluminescent immunoassay assay.A multivariate logistic regression model was used to analyze the risk factors for SCD.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve,sensitivity,specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy.Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity.The SCD patients were categorized into normal or mild tHcy group,moderate tHcy group,and severe tHcy group based on tHcy levels.Clinical symptoms,nerve conduction velocity,magnetic resonance imaging(MRI)findings from the patients were studied.Results The serum tHcy levels in SCD patients were 64.3(26.5,98.8)μmol/L,while in patients with spinal cord lesion(not SCD)group were 13.7(10.8,19.2)μmol/L,neurology mild outpatients were 10.6(8.2,13.0)μmol/L,which was higher in SCD group(H=112.020,P<0.001),(H=165.525,P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD(OR=1.107,95%CI:1.077-1.139,P<0.001).At ROC analysis,tHcy showed diagnostic value with an optimal cut-off value of 24.9μmol/L(AUC 0.913,95%CI:0.875-0.951,sensitivity 79.2%,specificity 91.6%).Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale(r=0.254,P=0.009).Conclusions Serum tHcy is the risk factor for SCD and related to its disability.Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.