摘要
目的 前瞻性探讨血管性痴呆(VD)患者血清纤维蛋白原样蛋白2(FGL2)、α-黑色素细胞刺激素(α-MSH)水平及与精神状态的关系.方法 前瞻性纳入2020年1月至2022年7月于华中科技大学同济医学院附属梨园医院接受治疗的VD患者65例作为VD组,按痴呆程度不同,将VD组分为轻度组(n=11)、中度组(n=38)、重度组(n=16);纳入同期于本院进行健康体检者60名为对照组.观察两组血清FGL2、α-MSH水平;认知能力[简易智能精神状态检查量表(MMSE)]、精神状态[蒙特利尔认知评估量表(MoCA)];不同疾病程度患者血清FGL2、α-MSH的水平;两组血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、血管内皮生长因子(VEGF)等细胞因子水平.以Pearson法分析VD患者血清FGL2、α-MSH水平与MMSE评分、MoCA评分及细胞因子水平的相关性;多因素Logistic回归分析VD发生的影响因素.结果 VD组血清FGL2、IL-1β、IFN-γ、TNF-α水平分别为(218.59±50.02)ng/mL、(70.31±10.15)pg/mL、(184.66±25.32)pg/mL、(19.73±5.84)pg/L,均高于对照组[(88.64±17.33)ng/mL、(44.93±8.22)pg/mL、(129.21±20.95)pg/mL、(8.24±2.15)pg/L],α-MSH、VEGF水平及 MMSE 评分、MoCA 评分分别为(10.91±2.14)pg/mL、(714.34±130.12)ng/L、(18.93±3.77)分、(18.12±3.42)分,均低于对照组[(30.66±8.29)pg/mL、(986.20±155.29)ng/L、(27.59±4.85)分、(27.42±4.93)分],差异均有统计学意义(P＜0.05).轻度组、中度组、重度组VD患者血清FGL2水平分别为(165.14±37.68)、(216.77±48.29)、(259.65±53.96)ng/mL,依次升高,α-MSH 水平分别为(13.55±4.12)、(11.17±2.43)、(8.48±1.39)pg/mL,依次降低,差异均有统计学意义(P＜0.05).VD患者血清FGL2水平与α-MSH水平、MMSE评分、MoCA评分、VEGF水平呈负相关(r=-0.651、-0.611、-0.545、-0.603,P＜0.05).血清 α-MSH 水平与 MMSE 评分、MoCA 评分、VEGF 水平呈正相关(r=0.564、0.522、0.549,P＜0.05).FGL2是发生VD的独立危险因素;MMSE评分、MoCA评分、α-MSH、VEGF均是发生VD的独立保护因素(P＜0.05).结论 VD患者血清α-MSH水平降低,FGL2水平升高,二者与MMSE、MoCA评分密切相关,是VD发生的影响因素.
Abstract
Objective To prospectively investigate serum fibrinogen like protein 2(FGL2)and α-melanocyte stimulating hormone(α-MSH)levels in patients with vascular dementia(VD)and their relationship with mental state.Methods A total of 65 patients with VD who were treated in Huazhong University of Science and Technology Tongji Medical College Affiliated Liyuan Hospital from January 2020 to July 2022 were selected as VD group,according to the degree of dementia,the VD group was divided into mild group(n=11),moderate group(n=38)and severe group(n=16).And 60 patients who underwent physical examination in the same hospital during the same period were included as the control group.Serum FGL2 and α-MSH levels,the cognitive ability[mini-mental state examination(MMSE)],mental state montreal cogni-tive assessment(MoCA),serum Interleukin-1β(IL-1 β),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)and vascular endo-thelial growth factor(VEGF)and other cytokines levels were observed in two groups;the levels of serum FGL2 and α-MSH in patients with dif-ferent disease degree were observed.The correlations of serum FGL2 and α-MSH levels with MMSE score,MoCA score and cytokine levels in VD patients were analyzed by Pearson method.The influencing factors of VD were analyzed by multivariate Logistic analysis.Results The serum lev-els of FGL2,IL-1β,IFN-y and TNF-α in the VD group were(218.59±50.02)ng/mL,(70.31±10.15)pg/mL,(184.66±25.32)pg/mL and(19.73±5.84)pg/L,respectively,which were higher than those in the control group[(88.64±17.33)ng/mL,(44.93±8.22)pg/mL,(129.21±20.95)pg/mL,(8.24±2.15)pg/L],the levels of α-MSH,VEGF,MMSE score and MoCA score were(10.91±2.14)pg/mL,(714.34±130.12)ng/L,(18.93±3.77)points and(18.12±3.42)points,respectively,which were lower than those in the control group[(30.66±8.29)pg/mL,(986.20±155.29)ng/L,(27.59±4.85)points,(27.42±4.93)points],and the differences were statisti-cally significant(P＜0.05).The serum FGL2 levels of VD patients in mild group,moderate group and severe group were(165.14±37.68),(216.77±48.29)and(259.65±53.96)ng/mL,respectively,which increased in turn,and the levels of α-MSH were(13.55±4.12),(11.17±2.43)and(8.48±1.39)pg/mL,respectively,which decreased in turn,the differences were statistically significant(P＜0.05).Serum FGL2 level in VD patients was negatively correlated with α-MSH level,MMSE score,MoCA score and VEGF level(r=-0.651,-0.611,-0.545,-0.603;P＜0.05).Serum α-MSH level was positively correlated with MMSE score,MoCA score and VEGF level(r=0.564,0.522,0.549;P＜0.05).Multivariate logistic regression analysis showed that FGL2 was an independent risk factor for the occurrence of VD;High level MMSE score,MoCA score α-MSH and VEGF are independent protective factors for the occurrence of VD(P＜0.05).Con-clusion Serum α-MSH levels were decreased and FGL2 levels were increased in VD patients,which are closely related to MMSE and MoCA scores and are influencing factors for the occurrence of VD.
基金项目
湖北省卫生和计划生育委员会科研项目(W2017P0028)
NETL
NSTL
万方数据