老年睡眠呼吸暂停综合征患者血清Nrf2、Hcy、CysC水平变化与认知障碍的关联性

Correlation between Nrf2,Hcy,and CysC levels and cognitive impairment in elderly patients with sleep apnea syndrome

目的:探讨老年睡眠呼吸暂停综合征(SAS)患者血清转录因子红系衍生核因子相关因子-2(Nrf2)、同型半胱氨酸(Hcy)、胱抑素C(CysC)水平变化及与其认知障碍的相关性。方法:选取2021年6月—2023年6月某院收治的SAS患者286例为研究对象,所有研究对象均行多导睡眠图(PSG)监测,根据睡眠呼吸暂停指数(AHI)分为轻度组(n=113)、中度组(n=95)、重度组(n=78)。比较3组患者睡眠呼吸监测指标[睡眠呼吸障碍事件时最低血氧饱和度(LSpO_(2))、最长呼吸暂停时间(Tmax)、氧饱和度低于90%的时间(T90)及睡眠时间]水平和入院时血清Nrf2、Hcy、CysC水平;分析入院时血清各指标水平与睡眠呼吸监测指标的相关性;比较3组患者入院时简易智能精神状态检查量表(MMSE)评分和蒙特利尔认知量表(MoCA)评分,并分析MMSE、MoCA评分与睡眠呼吸监测指标及血清各指标的相关性。结果:轻度组患者入院时Tmax[(37.83±6.62)s]、T90[(22.37±12.14)%]、睡眠时间[(8.42±1.22)h]及血清Nrf2[(2.27±1.07)ng/mL]、Hcy[(24.77±3.15)mmol/L]、CysC[(0.93±0.17)mg/L]水平均低于中度组[(44.62±4.76)s、(28.44±16.22)%、(9.77±1.47)h、(2.66±1.44)ng/mL、(26.89±3.77)mmol/L、(1.02±0.31)mg/L],且中度组患者低于重度组[(63.54±5.77)s、(36.38±11.47)%、(10.56±1.14)h、(3.05±1.67)ng/mL、(30.54±4.21)mmol/L、(1.17±0.22)mg/L],差异均有统计学意义(P<0.05)。轻度组患者LSpO_(2)[(86.21±2.42)%]、MMSE[(26.12±2.24)分]、MoCA [(27.63±2.56)分]均高于中度组[(81.87±2.77)%、(24.33±3.17)分、(27.12±3.12)分],且中度组高于重度组[(74.14±3.11)%、(22.57±2.55)分、(26.54±2.47)分],差异均有统计学意义(P<0.05)。血清Nrf2、Hcy、CysC与AHI、Tmax、T90、睡眠时间均呈正相关,与LSpO_(2)呈负相关(P<0.05);MMSE、MoCA水平与血清Nrf2、Hcy、CysC及AHI、Tmax、T90、睡眠时间呈负相关,与LSpO_(2)呈正相关(P<0.05)。结论:血清Nrf2、Hcy、CysC与患者睡眠呼吸状态及认知障碍密切相关,可作为临床诊断SAS和评估其认知功能水平的辅助指标。

Objective:To explore the correlation between Nrf2,Hcy,and CysC levels and cognitive impairment in elderly patients with sleep apnea syndrome(SAS).Methods:286 patients with SAS in a hospital from June 2021 to June 2023 were selected as objects.All the patients underwent polysomnography(PSG) monitoring.Based on apnea hypopnea index(AHI),they were divided into a mild group(n=113),a moderate group(n=95) and a severe group(n=78).The 3 groups were compared in terms of sleep respiratory monitoring indicators[lowest oxygen saturation(LSpO_(2))in sleep-disordered breathing events,maximum apnea time(Tmax),time of oxygen saturation<90(T90),sleep time] and their serum levels of Nrf2,Hcy,and CysC on admission.Correlation between all relative serum indicators and sleep respiratory monitoring indicators was analyzed.Scores of MMSE and MoCA of the 3 groups on admission were compared and the correlation with sleep respiratory monitoring indicators and all relative serum indicators were assessed.Results:Tmax[(37.83±6.62)s],T90[(22.37±12.14)%],sleep time[(8.42±1.22)h],and serum Nrf2[(2.27±1.07)ng/mL],Hcy[(24.77±3.15)mmol/L],CysC[(0.93±0.17)mg/L]of the patients in the mild group on admission were all lower than those of the moderate group[(44.62±4.76)s,(28.44±16.22)%,(9.77±1.47)h,(2.66±1.44)ng/mL,(26.89±3.77)mmol/L,(1.02±0.31)mg/L],and were further lower than those of the severe group[(63.54±5.77)s,(36.38±11.47)%,(10.56±1.14)h,(3.05±1.67)ng/mL,(30.54±4.21)mmol/L,(1.17±0.22)mg/L],the differences being statistically significant(P<0.05).LSpO_(2)[(86.21±2.42)%],MMSE[(26.12±2.24)分],MoCA[(27.63±2.56)分]of the mild group were all higher than those of the moderate group[(81.87±2.77)%,(24.33±3.17),(27.12±3.12)],and were further higher than those of the severe group[(74.14±3.11)%,(22.57±2.55),(26.54±2.47)],the differences being statistically significant(P<0.05).Serum Nrf2,Hcy,CysC were positively correlated with AHI,Tmax,T90,and sleep time and negatively correlated with LSpO_(2)(P<0.05).Levels of MMSE,MoCA were negatively correlated with Nrf2,Hcy,CysC and AHI,Tmax,T90,sleep time,and positively correlated with LSpO_(2)(P<0.05).Conclusion:Serum Nrf2,Hcy,CysC were closely correlated with patients' sleep respiration status and cognitive impairment,which may be regarded as an assisted indicator for the diagnosis of SAS and assessment of cognitive function.