脑脊液脂质运载蛋白2检测对早期鉴别诊断血管性痴呆和阿尔茨海默病的价值

The value of cerebrospinal fluid LCN2 detection in early differential diagnosis of vascular dementia and Alzheimer's disease

目的探讨脑脊液脂质运载蛋白2(LCN2)对鉴别诊断血管性痴呆症与阿尔茨海默病的价值。方法选取2017年1月至2019年10月在陕西省第四人民医院接受治疗的阿尔茨海默病病人46例(阿尔茨海默病组)、血管性痴呆病人32例(血管性痴呆症组)为研究对象,用酶联免疫吸附(ELISA)法检测两组病人脑脊液中LCN2水平、β-淀粉样蛋白(Aβ_(1-42))和总tau蛋白(Ttau)水平,并分析两组脑脊液LCN2水平与Aβ1-42蛋白和T-tau蛋白水平、简易精神状态检查量表(MMSE)评分相关性;绘制受试者工作特征(ROC)曲线分析脑脊液LCN2水平对血管性痴呆症和阿尔茨海默病的鉴别诊断价值。结果与阿尔茨海默病组相比,血管性痴呆症组MMSE评分[(23.19±4.28)分比(16.74±4.03)分]、脑脊液中LCN2水平[(134.65±31.52)ng/L比(98.92±18.27)ng/L]、Aβ_(1-42)蛋白水平[(362.18±62.15)μg/L比(207.85±36.49)μg/L]较高(P<0.05),T-tau蛋白水平[(246.75±48.67)μg/L比(304.26±61.53)μg/L]较低(P<0.05)。血管性痴呆症病人脑脊液中LCN2水平与Aβ_(1-42)蛋白水平、MMSE评分呈正相关(P<0.05),与T-tau蛋白水平呈负相关(P<0.05)。ROC曲线结果显示,脑脊液中LCN2水平对阿尔茨海默病和血管性痴呆症诊断的曲线下面积AUC为0.855,灵敏度为71.90%,特异度为91.30%,95%CI为0.77,0.94。结论血管性痴呆症与阿尔茨海默病病人脑脊液LCN2存在显著变化,是鉴别诊断血管性痴呆症和阿尔茨海默病的生物标志物,有利于病人尽早鉴别病情,对症治疗。

Objective To investigate the value of lipocalin-2(LCN2)2 in the differential diagnosis of vascular dementia and Alzheimer's disease.Methods A total of 46 patients with Alzheimer's disease(Alzheimer's disease group)and 32 patients with vascular dementia(vascular dementia group)who were treated in the Fourth People's Hospital of Shaanxi Province from January 2017 to October 2019 were selected as the study objects.The levels of LCN2,β-amyloid protein 1-42(Aβ_(1-42))and total tau protein(T-tau)in cerebrospinal fluid of the two groups were detected by enzyme-linked immunosorbent assay(ELISA),and the correlation between the level of LCN2 and levels of Aβ_(1-42) protein,T-tau protein and MMSE score was analyzed;in addition,receiver operating characteristic curve(ROC)was drawn to analyze the value of cerebrospinal fluid LCN2 level in the differential diagnosis of vascular dementia and Alzheimer's disease.Results Compared with those in the Alzheimer's disease group,MMSE score[(23.19±4.28)scores vs.(16.74±4.03)scores],the levels of LCN2[(134.65±31.52)ng/L vs.(98.92±18.27)ng/L]and Aβ_(1-42) protein[(362.18±62.15)μg/L vs.(207.85±36.49)μg/L] in cerebrospinal fluid of vascular dementia group were higher(P<0.05),and the level of T-tau protein[(246.75±48.67)μg/L vs.(304.26±61.53)μg/L]was lower(P<0.05).The level of LCN2 in cerebrospinal fluid was positively correlated with the level of Aβ_(1-42) protein and MMSE score(P<0.05),and negatively correlated with the level of T-tau protein(P<0.05).The results of ROC showed that the area under curve(AUC)of LCN2 in cerebrospinal fluid for the diagnosis of Alzheimer's disease and vascular dementia was 0.855,the sensitivity was 71.90%,the specificity was 91.30%,and 95%CI was 0.77,0.94.Conclusions There is a significant change of LCN2 in cerebrospinal fluid of patients with vascular dementia and Alzheimer's disease,which is a biomarker for the differential diagnosis of vascular dementia and Alzheimer's disease.It is helpful for patients to differentiate the disease and treat the disease as soon as possible.