血管性痴呆患者血清AIM2和载脂蛋白J水平表达与临床病情程度评估及预后的关系研究

Relationship between the Levels of Serum AIM2 and Apolipoprotein J and Clinical Severity in Patients with Vascular Dementia and Their Prognosis

目的探究血管性痴呆(vascular dementia,VD)患者血清黑色素瘤缺乏因子2(absent in melanoma 2,AIM2)、载脂蛋白J(apolipoprotein J,Apo J)水平与病情程度及预后的关系。方法选取滨州市第二人民医院2020年10月~2022年9月接诊的血管性痴呆患者128例作为研究组,依据简易精神状态检查表(mini-mental stateexamination,MMSE)评分评估病情严重程度,将研究组分为轻度组(n=43)、中度组(n=54)和重度组(n=31);治疗90天后根据日常生活能力(activities of daily living,ADL)量表评分评估患者预后,分为Ⅰ级组(n=66)、Ⅱ级组(n=40)和Ⅲ级组(n=22);另选取同期正常健康体检者96例作为对照组。应用实时荧光定量PCR(qRT-PCR)、酶联免疫吸附测定(ELISA)法检测血清AIM2和Apo J表达水平,并进行各组间比较;采用Spearman法分析血清AIM2,Apo J表达水平与MMSE评分的相关性以及与预后的关系;采用Logistic回归分析血管性痴呆患者预后影响因素。结果与对照组比较,研究组血清AIM2 mRNA(3.11±0.57 vs 1.06±0.23)表达水平显著升高,血清Apo J表达水平显著降低(68.83±12.24 ng/L vs 81.07±13.15 ng/L),差异具有统计学意义(t=32.054,7.174,均P<0.001);重度组血清AIM2 mRNA表达水平显著高于轻度组和中度组(q=12.807,15.780),血清Apo J表达水平、MMSE评分均明显低于轻度组和中度组(q=26.021,4.301;12.191,20.802),且中度组血清AIM2 mRNA表达水平显著高于轻度组(q=14.688),血清ApoJ表达水平、MMSE评分均低于轻度组(q=20.338,37.537),差异具有统计学意义(均P<0.001);血管性痴呆患者Ⅲ级组血清AIM2 mRNA(5.27±0.60)表达水平显著高于Ⅱ级组(3.36±0.58)、Ⅰ级组(2.23±0.55),而血清ApoJ(51.22±12.21 ng/L)表达水平显著低于Ⅱ级组(64.15±12.23 ng/L)、Ⅰ级组(77.53±12.25ng/L);Ⅱ级组血清AIM2 mRNA表达水平显著高于Ⅰ级组,而血清ApoJ表达水平显著低于Ⅰ级组,差异具有统计学意义(q=5.630~30.740,均P<0.001);血管性痴呆患者血清AIM2水平与MMSE评分呈负相关性,与预后(ADL分级)呈正相关性(r=-0.535,0.432,均P<0.001);血管性痴呆患者血清ApoJ水平与MMSE评分呈正相关性,与预后(ADL分级)呈负相关性(r=0.467,-0.496,均P<0.001);血清AIM2 mRNA[OR(95%CI):2.746(1.481~5.091),Apo J[OR(95%CI):0.496(0.311~0.791),MMSE评分[OR(95%CI):0.568(0.347~0.931)为血管性痴呆患者预后的影响因素(均P<0.05)。结论血管性痴呆患者血清AIM2 mRNA表达水平升高,血清Apo J表达水平降低,与患者病情程度及预后密切相关,可有效评估患者预后。

Objective To explore the relationship between the serum levels of absent in melanoma 2(AIM2)and apolipoprotein J(Apo J)and the severity and prognosis of vascular dementia(VD).Methods From October 2020 to September 2022,128 patients with vascular dementia were collected as the study group in the Second People’s Hospital of Binzhou.Based on the minimental state examination(MMSE)score,the severity of the condition was evaluated and the study group was separated into mild group(n=43),moderate group(n=54)and severe group(n=31).After 90 days of treatment,the prognosis of patients was evaluated based on the ability of daily living(ADL)scale score and grouped into grade I group(n=66),grade II group(n=40)and grade III group(n=22).Another 96 healthy individuals who underwent physical examination were selected as the control group.The expression levels of serum AIM2 and Apo J were detected by qRT-PCR and ELISA methods,and the differences between the groups were compared.Spearman method was applied to analyze the correlation between serum AIM2 and ApoJ expression levels and MMSE scores,and the relationship between serum AIM2 and Apo J expression levels and prognosis in patients with vascular dementia.Logistic regression was applied to analyze the prognostic factors of vascular dementia patients.Results The expression level of serum AIM2 mRNA(3.11±0.57 vs 1.06±0.23)in the study group was higher than those in the control group,while the expression level of serum ApoJ(68.83±12.24 ng/L vs 81.07±13.15 ng/L)was lower than that in the control group,with significant differences(t=32.054,7.174,all P<0.001).The expression level of serum AIM2 mRNA in the severe group was higher than that in the mild and moderate groups(q=12.807,15.780),the expression level of serum Apo J and MMSE score in the severe group were lower than those in the mild and moderate groups(q=26.201,4.301,12.193,20.802),the expression level of serum AIM2 mRNA in the moderate group was higher than that in the mild group(q=14.688),and the expression level of serum Apo J and MMSE score in the moderate group were lower than those in the mild group(q=20.338,37.537),with significant differences(all P<0.001).The expression level of serum AIM2 mRNA(5.27±0.60)in the grade III group of vascular dementia was higher than that in the grade II(3.36±0.58)and grade I groups(2.23±0.55),while the expression level of serum Apo J(51.22±12.21 ng/L)was lower than that in the grade II(64.15±12.23 ng/L)and grade I groups(77.53±12.25 ng/L).The expression level of serum AIM2 mRNA in the grade II group was higher than that in the grade I group,while the expression level of serum Apo J in the grade II group was lower than that in the grade I group,with significant differences(q=5.630~30.740,all P<0.001).The level of serum AIM2 in patients with vascular dementia was negatively correlated with MMSE score but positively correlated with prognosis(ADL grade)(r=-0.535,0.432,all P<0.001),while the level of serum Apo J in patients with vascular dementia was positively correlated with MMSE score but negatively correlated with prognosis(ADL grade)(r=0.467,-0.496,all P<0.001).Serum AIM2 mRNA[OR(95%CI):2.746(1.481~5.091)],Apo J[OR(95%CI):0.496(0.311~0.791)],and MMSE score[OR(95%CI):0.568(0.347~0.931)]were influencing factors for the prognosis of vascular dementia patients(all P<0.05).Conclusion The increase of serum AIM2 mRNA expression level and the decrease of serum Apo J expression level in patients with vascular dementia were closely related to the clinical severity and prognosis of patients,which may effectively evaluate the prognosis of patients.