帕金森病患者血清同型半胱氨酸、脑源性神经营养因子、α-突触核蛋白水平与脑白质病变的关系研究

Study on the relationship between the levels of serum homocysteine,brain-derived neurotrophic factor and α-synuclein and the leukodystrophy in patients with Parkinson′s disease

目的 探讨帕金森病患者血清同型半胱氨酸(Hcy)、脑源性神经营养因子(BDNF)、α-突触核蛋白(α-Syn)水平与脑白质病变的关系。方法 选取扬中市人民医院2022年6月至2023年6月收治的104例帕金森病患者为观察组,并选取同期健康体检者60例为对照组,收集两组临床资料并测定血清Hcy、BDNF、α-Syn水平;依据脑白质病变分级将观察组患者分正常组、轻度病变组、中度病变组及重度病变组,比较四组临床资料以及上述指标,并采用多因素Logistic回归分析帕金森病患者脑白质病变的影响因素、受试者工作特征曲线(ROC)分析生化指标对脑白质病变的预测价值。结果 观察组血清Hcy、α-Syn水平高于对照组,BDNF水平低于对照组(P<0.05);轻度病变、中度病变及重度病变组患者年龄、病程、Hoehn-Yahr(HY)分级、统一帕金森病评定量表(UPDRS)-Ⅲ评分、Hcy、α-Syn水平高(大)于正常组,BDNF水平低于正常组(P<0.05);多因素Logistic回归分析显示,Hcy、BDNF、α-Syn水平为帕金森病患者脑白质病变的影响因素(P<0.05);结果显示α-Syn水平诊断帕金森病患者脑白质病变的AUC值最高为0.949,敏感度、特异度分别为82.69%、96.67%;其次为BDNF(0.829);且α-Syn诊断AUC值明显高于BDNF、Hcy诊断(Z=2.832、4.991,P<0.05)。结论 Hcy、α-Syn升高是帕金森病患者脑白质病变的独立危险因素,BDNF升高是其保护因素,且Hcy、α-Syn、BDNF可作为帕金森病患者是否发生脑白质病变的生物标志物。

Objective To explore the relationship between the levels of serum homocysteine(Hcy),brain-derived neurotrophic factor(BDNF)andα-synuclein(α-Syn)and the leukodystrophy in patients with Parkinson's disease.Methods One hundred and four patients with Parkinson's disease admited to our hospital from June 2022 to June 2023 were selected as an observation group.Meanwhile,60 healthy individuals who received physical examinations in the same time were selected as a control group.Clinical data of both groups were collected.Serum levels of Hcy,BDNF andα-Syn were measured.According to the severity of leukodystrophy,the patients in the observation group were further divided into a normal group,a mild lesion group,a moderate lesion group,and a severe lesion group.Clinical data and above-mentioned indicators of the four groups were compared.Multivariate logistic regression analysis was conducted to identify the influencing factors of leukodystrophy in patients with Parkinson's disease.The predictive value of biochemical indicators for leukodystrophy was analyzed using the receiver operating characteristic(ROC)curve analysis.Results The levels of serum Hcy andα-Syn were higher while BDNF level was lower in the observation group than those in the control group(P<0.05).Patient age,course of disease,Hoehn-Yahr(HY)stages,Unified Parkinson's Disease Rating Scale(UPDRS)-III scores,Hcy andα-Syn levels in the mild lesion group,the moderate lesion group and the severe lesion group were higher/larger than those in the normal group,while BDNF level was lower than that of the normal group(P<0.05).Multivariate logistic regression analysis found that the levels of Hey,BDNF andα-Syn were influencing factors of leukodystrophy in patients with Parkinson's disease(P<0.05).ROC curve analysis showed that the AUC ofα-Syn level for diagnosing leukodystrophy in patients with Parkinson's disease was the largest(0.949).Its sensitivity and specificity were 82.69%and 96.67%,respectively.The second was BDNF(0.829).The AUC ofα-Syn was significantly larger than that of BDNF or Hcy(Z=2.832,4.991,P<0.05).Conclusions Elevated Hcy andα-Syn are independent risk factors for leukodystrophy in patients with Parkinson's disease,while elevated BDNF is a protective factor.Hcy,α-Syn and BDNF can serve as biomarkers for leukodystrophy in patients with Parkinson's disease.