血清Aβ1-42、Bcl-2预测老年人认知功能障碍进展为阿尔茨海默病的价值

Value of serum levels of Aβ1-42 and Bcl-2 in predicting the pathogenesis of Alzheimer’s disease in elderly patients with cognitive impairment

目的探究血清β-淀粉样蛋白1-42(Aβ1-42)、B淋巴细胞瘤因子-2(Bcl-2)水平预测老年认知功能障碍病人AD发病的价值。方法回顾性选取徐州医科大学附属医院2017—2019年收治的141例老年认知功能障碍病人。收集病人入院时血清Aβ1-42、Bcl-2水平。随访3年,记录病人AD发生情况,将其分为AD组和无AD组,比较2组病人临床相关资料,分析病人发生AD的影响因素;用ROC曲线分析Aβ1-42、Bcl-2对老年认知功能障碍病人AD发病的预测价值。结果141例病人中失访24例,有效随访的117例病人中AD发生率为24.79%(29/117)。AD组Aβ1-42水平高于无AD组,Bcl-2水平低于无AD组(P<0.01)。2组性别、BMI、合并高血压和冠心病、高血脂、婚姻状况、照顾者、吸烟情况比较,差异均无统计学意义(P>0.05);AD组年龄、合并糖尿病比例、文化程度为初中及以下比例高于无AD组,MoCA评分低于无AD组(P<0.05)。二元Logistic回归分析结果显示,年龄(OR=3.614)、Aβ1-42水平(OR=4.823)是病人发生AD的危险因素,Bcl-2水平(OR=0.311)是保护因素(P<0.05)。ROC曲线显示,Aβ1-42、Bcl-2及二者联合预测老年认知功能障碍病人发生AD的敏感度分别为75.90%、65.50%、89.70%,特异度分别为71.60%、72.70%、90.90%,AUC分别为0.784、0.729、0.920。结论血清Aβ1-42水平是影响老年认知功能障碍病人发生AD的危险因素,血清Bcl-2水平为保护因素,通过检测Aβ1-42、Bcl-2水平可有效预测病人进展为AD的风险,且二者联合预测价值更好。

Objective To investigate the preditive value of serum levels ofβ-amyloid protein 1-42(Aβ1-42)and B-cell lymphoma factor-2(Bcl-2)in the pathogenesis of Alzheimer’s disease(AD)in the elderly patients with cognitive impairment.Methods A total of 141 elderly patients with cognitive impairment admitted to the Affiliated Hospital of Xuzhou Medical University from 2017 to 2019 were retrospectively enrolled in the study.The patients were followed up for 3 years to observe the occurrence of AD,and were divided into AD group and non-AD group.The clinical data of the two groups were compared.Multivariate analysis was used to analyze the influencing factors of AD.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of Aβ1-42 and Bcl-2 for the occurrence of AD in the elderly patients with cognitive impairment.Results Among 141 patients,24 patients were lost to follow-up.The incidence rate of AD in 117 patients with effective follow-up was 24.79%(29/117).The level of Aβ1-42 was significantly higher and the level of Bcl-2 was significantly lower in AD group than that in non-AD group(P<0.01).There were no significant differences in gender,body mass index,hypertension,coronary heart disease,hyperlipidemia,marital status,caregivers and smoking between the two groups(P>0.05).Compared with non-AD group,AD group had higher age,higher proportion of patients with diabetes,higher proportion of patients with an education level of junior high school or below,and a lower Montreal Cognitive Assessment(MoCA)score(P<0.05).Binary Logistic regression analysis showed that age(OR=3.614)and Aβ1-42(OR=4.823)were risk factors for AD,while Bcl-2(OR=0.311)was a protective factor(P<0.05).ROC curve showed that the sensitivity of Aβ1-42,Bcl-2 and their combination to predict AD in the elderly patients with cognitive impairment was 75.90%,65.50%and 89.70%,respectively,and the specificity was 71.60%,72.70%and 90.90%,respectively.The area under the curve(AUC)was 0.784,0.729 and 0.920,respectively.Conclusions The serum level of Aβ1-42 is a risk factor for AD in the elderly patients with cognitive impairment,and the serum level of Bcl-2 is a protective factor.The detection of Aβ1-42 and Bcl-2 can effectively predict the occurrence of AD in the elderly patients with cognitive impairment,and the combination of the two indexes has a better predictive value.