脑小血管病患者对氧磷酶1、载脂蛋白A1、脂蛋白相关磷脂酶A2水平与脑白质高信号及认知功能的关系探讨

Relationship between the Levels of Paraoxonase 1,Apolipoprotein A1,Lipoprotein-associated phospholipase A2 and White Matter Hyperintensities and Cognitive Function in Patients with Cerebral Small Vessel Disease

目的:探讨脑小血管病(CVSD)患者对氧磷酶1(PON1)、载脂蛋白A1(ApoA1)、脂蛋白相关磷脂酶A2(LP-PLA2)水平与脑白质高信号(WMH)及认知功能的关系。方法:选取2022-01-2024-01我院收治的165例CVSD患者为研究对象,依据蒙特利尔认知评估量表(MoCA)将其分为无血管性认知损害组(N-VCI,94例)和血管性认知损伤组(VCI,71例)。同期选取165例近1个月体检健康人群作为对照组。比较三组的MoCA评分以及血清PON1、ApoA1、Lp-PLA2水平。采用Fazekas量表评估患者的WMH严重程度。运用相关法分析PON1、ApoA1、Lp-PLA2水平与MoCA、WMH程度的相关性。通过受试者工作特征(ROC)曲线分析PON1、ApoA1、Lp-PLA2单独或联合检测对VCI的临床诊断价值。结果:相较于对照组,N-VCI组和VCI组MoCA评分、PON1、ApoA1水平更低,而Lp-PLA2水平更高(P<0.05);相较于N-VCI组,VCI组PON1、ApoA1水平更低,而Lp-PLA2水平、WMH严重程度、侧脑室旁高信号评分、深部白质高信号评分更高(P<0.05);相关分析显示,PON1、ApoA1水平与MoCA评分呈正相关,与WMH严重程度、PVWMH评分、DWMH评分呈负相关,而Lp-PLA2水平与MoCA评分呈负相关,与WMH严重程度、PVWMH评分、DWMH评分呈正相关(P<0.05)。ROC曲线分析显示,PON1、ApoA1、Lp-PLA2单独诊断患者VCI的曲线下面积(AUC)>0.8,三者联合检测诊断VCI的AUC>0.9。结论:PON1、ApoA1、Lp-PLA2水平与CVSD患者的WMH和认知功能密切相关。三者单独或联合检测对诊断VCI有一定临床价值。

Objective:To explore the relationship between the levels of paraoxonase 1(PON1),apolipoprotein A1(ApoA1),lipoprotein-associated phospholipase A2(LP-PLA2)and white matter hyperintensity(WMH)as well as cognitive function in patients with cerebral small vessel disease(CVSD).Method:165 patients with CVSD from January 2022 to January 2024 were selected as the study subjects.They were divided into the non-vascular cognitive impairment group(N-VCI,n=94)and the vascular cognitive impairment group(VCI,n=71)according to the montreal cognitive assessment scale(MoCA).In the same period,165 healthy people who had undergone physical examinations in nearly one month were selected as the control group.MoCA scores and serum levels of PON1,ApoA1,and Lp-PLA2 were compared among the three groups.The severity of WMH was assessed by the Fazekas scale.The correlation between PON1,ApoA1,Lp-PLA2 levels and MoCA and WMH levels was analyzed by the correlation method.The ROC curve was used to analyze the clinical value of PON1,ApoA1,and Lp-PLA2 alone or in combination in the diagnosis of VCI.Results:Compared with the control group,the MoCA score,PON1,and ApoA1 levels in the N-VCI and VCI groups were lower,while the Lp-PLA2 level was higher(P 0.05).Compared with the N-VCI group,the PON1 and ApoA1 levels in the VCI group were lower,while the Lp-PLA2 level,WMH severity,periventricular hyperintensity score,and deep white matter hyperintensity score were higher(P 0.05).The correlation analysis results showed that PON1 and ApoA1 levels were positively correlated with the MoCA score and negatively correlated with WMH severity,periventricular hyperintensity score,and deep white matter hyperintensity score.While the Lp-PLA2 level was negatively correlated with the MoCA score and positively correlated with WMH severity,periventricular hyperintensity score,and deep white matter hyperintensity score(P 0.05).The ROC curve results showed that the area under the curve(AUC)for diagnosing VCI by PON1,ApoA1,and Lp-PLA2 was>0.8,and the AUC for diagnosing VCI by the combined detection of PON1,ApoA1,and Lp-PLA2 was>0.9.Conclusion:The levels of PON1,ApoA1,and Lp-PLA2 are closely related to WMH and cognitive function in CVSD patients.These three tests alone or in combination have certain clinical value in the diagnosis of patients with VCI.