帕金森病患者血清尿酸、同型半胱氨酸和胱抑素C水平与运动症状及认知功能的相关性

doi:10.3969/j.issn.1004-583X.2024.02.005

摘要/Abstract

摘要：

目的探讨帕金森病(Parkinson’s disease, PD)患者血清尿酸(uric acid,UA)、同型半胱氨酸(homocysteine,HCY)、胱抑素C(cystatin C, CysC)水平与PD患者的运动症状及认知功能的关系。方法选取2019年1月至2022年8月河北省人民医院收治PD患者200例。按照首发运动症状分为震颤(tremor-dominant, TD)组(n=104)和非震颤(non-tremor-dominant,NTD)组(n=96),依据蒙特利尔认知评估量表分为PD认知功能正常(cognitive normal in Parkinson’s disease, PD-CN)组(n=118)和PD认知功能障碍(cognitive impairment in Parkinson’s disease, PD-CI)组(n=82)。分别比较各组血清UA、HCY、CysC水平,采用多因素logistic 回归分析PD患者TD和认知功能障碍的危险因素。结果与NTD组相比,TD组血清UA水平较高,Hcy、Cys C水平较低,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示,UA、 HCY和Cys C是PD患者TD的独立危险因素。与PD-CI组相比,PD-CN组血清UA水平较高,HCY、Cys C水平较低,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示:UA、HCY和Cys C是PD患者认知功能障碍的独立危险因素(P<0.05)。结论 PD患者血清UA、HCY、Cys C与运动症状和认知功能相关。

关键词: 帕金森病, 运动症状, 认知, 尿酸, 同型半胱氨酸, 胱抑素C

Abstract:

Objective To investigate the correlation between serum uric acid (UA), homocysteine (HCY) and cystatin C (Cys C) with motor symptoms and cognitive function in Parkinson's disease (PD) patients. Methods A total of 200 PD patients admitted to Hebei General Hospital from January 2019 to August 2022 were enrolled. They were divided into tremor-dominant (TD) group(n=104) and non-tremor-dominant (NTD) group(n=96) according to first-onset motor symptoms. In addition, the PD patients were grouped also into cognitive normal(PD-CN) group(n=118) and cognitive impairment (PD-CI) group(n=82) according to Montreal Cognitive Assessment. The levels of serum UA, HCY and Cys C of the PD patients were compared. Multivariate logistic regression was used to analyze the risk factors of tremor and cognitive dysfunction in PD patients. Results The patients in TD group had significantly higher serum UA levels, significantly lower Hcy and Cys C levels compared with those of the NTD group (P<0.05). The results from multiple logistic regression analysis showed that UA, HCY, and Cys C were independent risk factors for tremor in PD patients. The patients in the PD-CN group pesented significantly higher serum UA levels, significantly lower HCY and Cys C levels relative to those of the PD-CI group (P<0.05). The results from multivariate logistic regression analysis verifyed that UA, HCY, and Cys C were independent risk factors for cognitive dysfunction in PD patients (P<0.05). Conclusion The serum levels of UA, HCY, and Cys C in PD patients are correlated with motor symptoms and cognitive function.

Key words: Parkinson disease, motor symptoms, cognition, uric acid, homocysteine, cystatin C

中图分类号:

R742.5

王九雪, 李娜, 靳玮, 王硕, 常雅君, 王天俊. 帕金森病患者血清尿酸、同型半胱氨酸和胱抑素C水平与运动症状及认知功能的相关性[J]. 临床荟萃, 2024, 39(2): 125-129.

Wang Jiuxue, Li Na, Jin Wei, Wang Shuo, Chang Yajun, Wang Tianjun. Correlation between serum uric acid, homocysteine and cystatin C levels with motor symptoms and cognitive function in Parkinson's disease patients[J]. Clinical Focus, 2024, 39(2): 125-129.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.005

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/125

图/表 4

参考文献 29

[1]	吴月容, 谷有全. 帕金森病的诊断新进展[J]. 卒中与神经疾病, 2019, 26(3):374-376+380.
[2]	李丹, 李嘉, 朱向阳. 帕金森病不同运动亚型与血清尿酸水平的相关性分析[J]. 山西医药杂志, 2019, 48(3):267-269.
[3]	Alexoudi A, Alexoudi I, Gatzonis S. Parkinson's disease pathogenesis, evolution and alternative pathways: A review[J]. Rev Neurol (Paris), 2018, 174(10):699-704. doi: 10.1016/j.neurol.2017.12.003 URL
[4]	李波, 徐世成, 赵安容. 帕金森患者同型半胱氨酸、血尿酸水平变化及其与认知功能状况相关性[J]. 临床军医杂志, 2020, 48(2):179-180.
[5]	Li J, Gu C, Zhu M, et al. Correlations between blood lipid, serum cystatin C, and homocysteine levels in patients with Parkinson's disease[J]. Psychogeriatrics, 2020, 20(2):180-188. doi: 10.1111/psyg.12483 pmid: 31828903
[6]	李东升, 李妙婷. 血清同型半胱氨酸、尿酸水平变化与帕金森患者病程的关联性分析[J]. 中国卫生标准管理, 2022, 13(22):101-104.
[7]	张家和, 柯开富, 施建生, 等. 血尿酸、Cys C及Hcy与老年帕金森病患者病程及疾病严重程度相关性分析[J]. 中国医药导报, 2022, 19(5):82-85.
[8]	吕晨光, 路凯, 王丽, 等. 血清CysC、α-Syn联合MRI对帕金森病病情评估及诊断的意义[J]. 国际检验医学杂志, 2024, 45(5):554-558.
[9]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业. 中国帕金森病的诊断标准 (2016版)[J]. 中华神经科杂志, 2016, 49(4): 268-271.
[10]	王翔宇, 董青, 董双双, 等. 八段锦联合平衡训练改善帕金森病运动和非运动症状的效果[J]. 中国康复理论与实践, 2021, 27(1):111-116. doi: 10.3969/j.issn.1006-9771.2021.01.017
[11]	吴彩葵. 帕金森病发病机制及诊断、治疗和预防研究的进展分析[J]. 中外医疗, 2021, 40(6):192-194.
[12]	仲玲玲, 宋亚颀, 孙晓阳, 等. 不同运动分型帕金森病的血尿酸水平分析[J]. 南京医科大学学报(自然科学版), 2016, 36(12):1507-1509.
[13]	Selikhova M, Williams DR, Kempster PA, et al. A clinico-pathological study of subtypes in Parkinson's disease[J]. Brain, 2009, 132(Pt 11):2947-2957. doi: 10.1093/brain/awp234 pmid: 19759203
[14]	杨静, 董海蓉, 戚志强, 等. 帕金森病患者血清尿酸水平与病程和病情严重程度的相关性研究[J]. 中华老年心脑血管病杂志, 2019, 21(12):1322-1324.
[15]	Helmich RC, Hallett M, Deuschl G, et al. Cerebral causes and consequences of parkinsonian resting tremor: A tale of two circuits?[J]. Brain, 2012, 135(Pt 11):3206-3226. doi: 10.1093/brain/aws023 pmid: 22382359
[16]	Raimo S, Gaita M, Cropano M, et al. The cognitive profile of atypical Parkinsonism: A meta-analysis[J]. Neuropsychol Rev, 2023, 33(2):514-543. doi: 10.1007/s11065-022-09551-6
[17]	Koros C, Simitsi AM, Papagiannakis N, et al. Serum uric acid as a putative biomarker in prodromal Parkinson's disease: Longitudinal data from the PPMI study[J]. J Parkinsons Dis, 2023, 13(5):811-818.
[18]	杨一帆, 高峰, 柳华, 等. 老年帕金森病病人外周血ApoA1/HDL、血尿酸水平与认知功能的关系[J]. 中西医结合心脑血管病杂志, 2023, 21(13):2474-2478.
[19]	Boccardi V, Carino S, Marinelli E, et al. Uric acid and late-onset Alzheimer's disease: Results from the ReGAl 2.0 project[J]. Aging Clin Exp Res, 2021, 33(2):361-366. doi: 10.1007/s40520-020-01541-z
[20]	高焱, 郭晓贤, 康静. 血清Hcy、CysC、UA及EGF水平与帕金森病合并认知功能障碍的关系[J]. 临床医学研究与实践, 2020, 5(27):125-127.
[21]	黄碧霞, 郭少勇. 老年帕金森病患者血清同型半胱氨酸及血尿酸水平与认知功能障碍的相关性分析[J]. 当代医学, 2019, 25(2):100-102.
[22]	Fan X, Zhang L, Li H, et al. Role of homocysteine in the development and progression of Parkinson's disease[J]. Ann Clin Transl Neurol, 2020, 7(11):2332-2338. doi: 10.1002/acn3.v7.11 URL
[23]	Trist BG, Hare DJ, Double KL. Oxidative stress in the aging substantia nigra and the etiology of Parkinson's disease[J]. Aging Cell, 2019, 8(6):e13031.
[24]	周超宁, 党小利, 陈军, 等. 帕金森病患者血尿酸及血同型半胱氨酸水平与认知障碍的关系[J]. 中国老年学杂志, 2019, 39(15):3716-3719.
[25]	Nagai A, Terashima M, Sheikh AM, et al. Involvement of cystatin C in pathophysiology of CNS diseases[J]. Front Biosci, 2008, 13:3470-3479.
[26]	刘顺达, 高娟, 曲传勇, 等. 不同H-Y分期和是否伴认知功能障碍PD患者血清Hcy和Cys C水平变化[J]. 宁夏医学杂志, 2020, 42(2):111-113.
[27]	邹瑜, 钟纯正, 郭春宣, 等. 胱抑素C与同型半胱氨酸在早期帕金森病患者血清中的水平及与睡眠障碍的关系[J]. 脑与神经疾病杂志, 2020, 28(2):96-100.
[28]	Lopes R, Delmaire C, Defebvre L, et al. Cognitive phenotypes in Parkinson's disease differ in terms of brain-network organization and connectivity[J]. Hum Brain Mapp, 2017, 8(3):1604-1621.
[29]	Segura-Aguilar J. On the role of endogenous neurotoxins and neuroprotection in Parkinson's disease[J]. Neural Regen Res, 2017, 12(6):897-901. doi: 10.4103/1673-5374.208560 pmid: 28761417

组别	例数		性别[例(%)]				年龄 (岁)		BMI (kg/m²)		文化程度[例(%)]					高血压病 [例(%)]
组别	例数		男		女		年龄 (岁)		BMI (kg/m²)		小学		中学		高中以上	高血压病 [例(%)]
TD组	104		54(51.92)		50(48.08)		65.51±9.53		25.67±3.35		21(20.09)		72(69.23)		11(10.58)	67(64.42)
NTD组	96		48(50.00)		48(50.00)		66.30±9.39		24.90±3.30		23(23.96)		62(64.58)		11(11.46)	65(67.71)
统计值			χ²=0.125				t=0.352		t=1.750		χ²=1.850					χ²=0.132
P值			0.777				0.555		0.156		0.666					0.877
组别		糖尿病 [例(%)]		冠心病 [例(%)]		吸烟 [例(%)]		饮酒 [例(%)]		认知功能障碍 [例(%)]		UA (μmol/L)		HCY (μmol/L)		Cys C (mg/L)
TD组		32(30.77)		12(11.54)		39(37.50)		21(20.19)		41(39.40)		251.23±84.19		12.4±2.94		0.89±0.08
NTD组		15(15.62)		13(13.54)		40(41.67)		12(12.50)		42(43.80)		249.70±84.71		16.11±6.01		1.01±0.09
统计值		χ²=0.604		χ²=4.405		χ²=0.030		χ²=0.150		χ²=0.230		t=15.360		t=6.927		t=10.650
P值		0.115		0.729		0.929		0.225		0.317		0.026		<0.01		<0.01

组别	例数		性别[例(%)]				年龄 (岁)		BMI (kg/m²)		文化程度[例(%)]					高血压病 [例(%)]
组别	例数		男		女		年龄 (岁)		BMI (kg/m²)		小学		中学		高中以上	高血压病 [例(%)]
TD组	104		54(51.92)		50(48.08)		65.51±9.53		25.67±3.35		21(20.09)		72(69.23)		11(10.58)	67(64.42)
NTD组	96		48(50.00)		48(50.00)		66.30±9.39		24.90±3.30		23(23.96)		62(64.58)		11(11.46)	65(67.71)
统计值			χ²=0.125				t=0.352		t=1.750		χ²=1.850					χ²=0.132
P值			0.777				0.555		0.156		0.666					0.877
组别		糖尿病 [例(%)]		冠心病 [例(%)]		吸烟 [例(%)]		饮酒 [例(%)]		认知功能障碍 [例(%)]		UA (μmol/L)		HCY (μmol/L)		Cys C (mg/L)
TD组		32(30.77)		12(11.54)		39(37.50)		21(20.19)		41(39.40)		251.23±84.19		12.4±2.94		0.89±0.08
NTD组		15(15.62)		13(13.54)		40(41.67)		12(12.50)		42(43.80)		249.70±84.71		16.11±6.01		1.01±0.09
统计值		χ²=0.604		χ²=4.405		χ²=0.030		χ²=0.150		χ²=0.230		t=15.360		t=6.927		t=10.650
P值		0.115		0.729		0.929		0.225		0.317		0.026		<0.01		<0.01

项目	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
项目	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
UA	-0.013	0.004	8.295	0.004	0.987	0.979	0.996
HCY	0.119	0.050	5.778	0.016	1.127	1.022	1.241
CysC	1.302	0.421	7.594	<0.01	4.445	3.221	6.572

项目	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
项目	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
UA	-0.013	0.004	8.295	0.004	0.987	0.979	0.996
HCY	0.119	0.050	5.778	0.016	1.127	1.022	1.241
CysC	1.302	0.421	7.594	<0.01	4.445	3.221	6.572

组别	例数	性别[例(%)]				年龄 (岁)		BMI (kg/m²)		文化程度[例(%)]					高血压病 [例(%)]
组别	例数	男		女		年龄 (岁)		BMI (kg/m²)		小学		中学		高中以上	高血压病 [例(%)]
PD-CN组	118	62(52.54)		56(47.46)		66.38±8.71		25.77±3.35		24(20.34)		82(69.49)		12(10.17)	76(64.41)
PD-CI组	82	40(48.80)		42(51.20)		64.21±8.56		24.80±3.30		20(24.39)		52(63.41)		10(12.20)	56(68.29)
统计值		χ²=0.091				t=0.347		t=0.247		χ²=0.060					χ²=0.141
P值		0.767				0.180		0.166		0.675					0.917
组别	糖尿病 [例(%)]		冠心病 [例(%)]		吸烟 [例(%)]		饮酒 [例(%)]		非震颤症状 [例(%)]		UA (μmol/L)		HCY (μmol/L)		Cys C (mg/L)
PD-CN组	36(30.51)		13(11.02)		39(33.05)		23(29.50)		54(45.8)		300.00±75.74		12.85±5.80		0.95±0.03
PD-CI组	11(13.41)		12(14.63)		40(48.78)		10(12.20)		42(51.2)		265.92±77.19		16.90±5.70		1.05±0.15
统计值	χ²=0.612		χ²=4.130		χ²=0.421		χ²=0.652		χ²=0.240		t=7.860		t=-3.861		t=4.671
P值	0.235		0.789		0.829		0.325		0.269		0.031		<0.01		0.019