经颅超声联合血清学指标与帕金森病患者认知状态的相关性研究

Correlation study of transcranial sonography combined with serum biomarkers and cognitive status in patients with Parkinson′s disease

目的探讨经颅超声(TCS)联合血清同型半胱氨酸(Hcy)、血糖、血脂与帕金森病(PD)患者认知状态之间的相关性,分析这些参数对评估PD患者认知状态的临床应用价值。方法回顾性收集2020年1月至2023年6月苏州大学附属第二医院收治住院的PD患者152例作为PD组,选取同期年龄和性别相匹配的健康体检者101例作为对照组。收集临床资料[年龄、性别、患病时长、蒙特利尔认知评分量表(MoCA)评分、简易精神状态评价量表(MMSE)评分、统一帕金森评定量表第三部分(UPDRS-Ⅲ)评分、Hoehn-Yahr(H-Y)分期等]、血清学检查(Hcy、血糖、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白浓度)及TCS检查(第三脑室宽度、中脑面积、双侧大脑中动脉收缩期峰值流速、双侧大脑中动脉阻力指数、双侧黑质强回声面积)结果。以Hcy浓度≥15μmol/L为界,将上述两组分为单纯PD组与PD伴Hcy增高组、单纯对照组与单纯Hcy增高组。比较四组间以上参数的差异。分析PD患者Hcy及认知状态(MoCA评分、MMSE评分)与上述参数的相关性。结果PD伴Hcy增高组MoCA评分、MMSE评分低于单纯PD组,UPDRS-Ⅲ评分及H-Y分期高于单纯PD组(均P<0.001)。Hcy浓度由高至低依次为PD伴Hcy增高组、单纯Hcy增高组、单纯PD组、单纯对照组,四组间血清学数据差异及TCS数据差异有统计学意义(均P<0.001)。Spearman相关分析显示:①PD组Hcy浓度与血糖浓度、H-Y分期、低密度脂蛋白浓度、右侧大脑中动脉阻力指数、UPDRS-Ⅲ评分、总胆固醇浓度、三酰甘油浓度、左侧大脑中动脉阻力指数、第三脑室宽度、年龄呈正相关(rs=0.422、0.350、0.348、0.334、0.325、0.300、0.293、0.283、0.221、0.164,均P<0.05);Hcy浓度与中脑面积、MMSE评分、MoCA评分、右侧大脑中动脉收缩期峰值流速、左侧大脑中动脉收缩期峰值流速、高密度脂蛋白浓度呈负相关(rs=-0.328、-0.282、-0.245、-0.229、-0.224、-0.192,均P<0.05)。②PD组MoCA评分及MMSE评分与临床数据、血清学数据、TCS数据均存在相关性,以中脑面积呈最大正相关(rs=0.524、0.516,均P<0.05),H-Y分期为最大负相关(rs=-0.490、-0.468,均P<0.05)。结论PD伴Hcy增高患者认知评分低于单纯PD患者;PD患者Hcy浓度与其血糖浓度相关性最大,其次为H-Y分期;PD患者认知评分与其中脑面积相关性最大,与黑质强回声面积无关。降低PD患者血清Hcy浓度可能是延缓其认知功能损害的途径之一。

Objective To explore the correlation between transcranial sonography(TCS)combined with serum homocysteine(Hcy),blood glucose,blood lipids,the cognitive status of Parkinson′s disease(PD)patients,and to analyze the clinical application value of these parameters in assessing the cognitive status of PD patients.Methods A total of 152 PD patients admitted to the Second Affiliated Hospital of Soochow University from January 2020 to June 2023 were retrospectively collected as the PD group,and 101 healthy examinees matched for age and gender during the same period were selected as control group.Clinical data[age,gender,duration of illness,Montreal Cognitive Assessment(MoCA)score,Mini-Mental State Examination(MMSE)score,Unified Parkinson′s Disease Rating Scale PartⅢ(UPDRS-Ⅲ)score,Hoehn-Yahr(H-Y)stage,etc.],serum tests(Hcy,blood glucose,total cholesterol,triglycerides,low-density lipoprotein,high-density lipoprotein concentration),and TCS examination results(third ventricular width,midbrain area,peak systolic velocity of bilateral middle cerebral arteries,bilateral middle cerebral artery resistance index,bilateral substantia nigra hyperechoic area)were collected.The two groups were divided into pure PD group and PD group with elevated Hcy,pure control group and control group with elevated Hcy,based on an Hcy concentration threshold of≥15μmol/L.The differences in the above parameters among the four groups were compared.The correlation between Hcy and cognitive status(MoCA score,MMSE score)of PD patients and the above parameters were analyzed.Results The MoCA score and MMSE score of the PD group with elevated Hcy were lower than those of the pure PD group,and the UPDRS-Ⅲscore and H-Y stage were higher than those of the pure PD group(all P<0.001).The order of Hcy concentration from high to low was PD group with elevated Hcy,pure Hcy elevation group,pure PD group,and pure control group.The differences in serum data and TCS data among the four groups were statistically significant(all P<0.001).Spearman correlation analysis showed:①In the PD group,the concentration of Hcy was positively correlated with glucose concentration,H-Y stage,low-density lipoprotein concentration,right middle cerebral artery resistance index,UPDRS-Ⅲscore,total cholesterol concentration,triglyceride concentration,left middle cerebral artery resistance index,third ventricular width,and age(rs=0.422,0.350,0.348,0.334,0.325,0.300,0.293,0.283,0.221,0.164,all P<0.05);Hcy concentration was negatively correlated with midbrain area,MMSE score,MoCA score,peak systolic velocity of right middle cerebral artery,peak systolic velocity of left middle cerebral artery,and high-density lipoprotein concentration(rs=-0.328,-0.282,-0.245,-0.229,-0.224,-0.192,all P<0.05).②Clinical data,serum data,and TCS data of PD patients were all correlated with MoCA score and MMSE score,with midbrain area showing the largest positive correlation(rs=0.524,0.516;both P<0.05)and H-Y stage showing the largest negative correlation(rs=-0.490,-0.468;both P<0.05).Conclusions PD patients with elevated Hcy have lower cognitive scores than pure PD patients.The correlation between Hcy concentration and blood glucose concentration is the highest in PD patients,followed by H-Y stage.The cognitive scores of PD patients are most correlated with midbrain area and unrelated to substantia nigra hyperechoic area.Lowering serum Hcy concentration in PD patients may be one of the ways to delay cognitive impairment.