老年抑郁患者同型半胱氨酸、血清胱抑素C和血尿酸水平及与认知功能的相关性分析
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摘要
目的观察抑郁发作老年患者血清同型半胱氨酸(Hcy)、血清胱抑素C(Cys-C)、血尿酸(UA)水平及与认知功能的相关性。方法随机选取符合国际疾病分类第十版(ICD-10)的首次抑郁发作的老年患者60例入研究组,招募与研究组相匹配的40例健康志愿者入对照组。测定基线期两组血清Hcy、Cys-C、和UA水平,采用24项汉密顿抑郁量表(HAMD-24)评估抑郁的严重程度,同时采用简易智力状况检查量表(MMSE)及蒙特利尔认知评估量表(Mo CA)评估认知功能。比较两组血清Hcy、Cys-C和UA水平及认知功能的差异,并分析研究组血清Hcy、Cys-C和UA水平与MMSE、Mo CA和HAMD-24总分的相关性。结果基线期研究组血清Hcy、Cys-C水平均高于对照组(t=12.732、4.135,P均<0.01),UA水平与对照组比较差异无统计学意义(t=-0.265,P=0.791),MMSE、Mo CA总分低于对照组(t=-5.643、-9.548;P均<0.01)。研究组Hcy、Cys-C水平分别与MMSE、Mo CA评分总分呈负相关(r=-0.690、-0.501、-0.301、-0.355,P均<0.05),与HAMD-24总分呈正相关(r=0.367、0.390,P均<0.01);UA水平与MMSE、Mo CA和HAMD-24总分无相关性(P均> 0.05)。结论抑郁发作老年患者存在认知功能障碍;血清Hcy和Cys-C水平与认知功能损害可能相关。
Objective To explore the relationship between the levels of serum homocysteine(Hcy),serum cystatin C(Cys-C),serum uric acid(UA)and cognitive function in elderly patients with depression. Methods Sixty elderly patients with first depressive episode in accordance with the International Classification of Diseases(ICD-10)were randomly selected as the study group, Forty healthy volunteers matched with the study group were recruited as the control group. Serum levels of Hcy,Cys-C and UA were detected at admission,The severity of depression was assessed by 24 Hamilton Depression Scale(HAMD-24),Cognitive function was graded by MMSE and MoCA. Analyze the differences of serum Hcy,Cys-C,UA levels and cognitive function between the two groups,and the relationship between serum Hcy,Cys-C,UA levels and the total scores of MMSE,MoCA and HAMD-24 in the study group. Results The levels of serum Hcy and Cys-C in the study group were higher than those in the control group(t=12.732,4.135,P<0.01). There was no significant differences of UA between the study and the control group(t=-0.265,P=0.791). The total scores of MMSE and MoCA in the study group were lower than those in the control group(t=-5.643,-9.548;P< 0.01). The levels of Hcy and Cys-C in the study group were negatively correlated with the total scores of MMSE and MoCA(r=-0.690,-0.501,-0.301,-0.355,P<0.05),and were positively correlated with the total scores of HAMD-24(r=0.367、0.390,P<0.01). There was no significant correlation between UA level and the total scores of MMSE,MoCA and HAMD-24(P>0.05). Conclusion Elderly patients with depression have cognitive impairment. Serum Hcy and Cys-C levels may be related to cognitive impairment.
Objective To explore the relationship between the levels of serum homocysteine(Hcy),serum cystatin C(Cys-C),serum uric acid(UA)and cognitive function in elderly patients with depression. Methods Sixty elderly patients with first depressive episode in accordance with the International Classification of Diseases(ICD-10)were randomly selected as the study group, Forty healthy volunteers matched with the study group were recruited as the control group. Serum levels of Hcy,Cys-C and UA were detected at admission,The severity of depression was assessed by 24 Hamilton Depression Scale(HAMD-24),Cognitive function was graded by MMSE and MoCA. Analyze the differences of serum Hcy,Cys-C,UA levels and cognitive function between the two groups,and the relationship between serum Hcy,Cys-C,UA levels and the total scores of MMSE,MoCA and HAMD-24 in the study group. Results The levels of serum Hcy and Cys-C in the study group were higher than those in the control group(t=12.732,4.135,P<0.01). There was no significant differences of UA between the study and the control group(t=-0.265,P=0.791). The total scores of MMSE and MoCA in the study group were lower than those in the control group(t=-5.643,-9.548;P< 0.01). The levels of Hcy and Cys-C in the study group were negatively correlated with the total scores of MMSE and MoCA(r=-0.690,-0.501,-0.301,-0.355,P<0.05),and were positively correlated with the total scores of HAMD-24(r=0.367、0.390,P<0.01). There was no significant correlation between UA level and the total scores of MMSE,MoCA and HAMD-24(P>0.05). Conclusion Elderly patients with depression have cognitive impairment. Serum Hcy and Cys-C levels may be related to cognitive impairment.
引文
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13.尤志珺,刘丹荣.老年PD患者血尿酸水平与抑郁、认知障碍的关系[J].中国康复,2012,27(4):271-273.
14.王变荣,张志宇,时建铨.老年病人血清尿酸水平与认知功能的相关性研究[J].实用老年医学,2017,31(4):441-444.
2.刘剑涛,赖荫光,张星,等.老年抑郁人群认知功能状况调查[J].国际精神病学杂志,2015;42(5):29-32.
3.聂晓璐,吕晓珍,卓琳,等.2001-2015年中国轻度认知功能障碍患病率的Meta分析[J].中华精神科杂志,2016,49(5):298-306.
4.张明园.精神科评定量表手册第二版.长沙:湖南科学技术出版社,1998,122-166.
5.Lockwood KA,Alexopoulos GS,van Gorp WG.Executive dysfunction in geriatric depression[J].Am J Psychiatry,2002,159(7):1119-1126.
6.Mulsant BH,Ganguli M.Epidemiology and diagnosis of depression in late life[J].Clin Psychiatry,1999,60(suppl 20):9-15.
7.杨昊翔,尹立勇,崔志杰.高同型半胱氨酸血症与老年人认知功能障碍相关性研究[J].临床荟萃,2011,26(12):1026-1028+1032.
8.Seshadri S,Beiser A,Selhub J,et al.Plasma homocysteine as a risk factor for dementia and Alzheimer’s disease[J].NEngl J Med.2002,346(7):476-483.
9.Alshaikh B,Schall JI,Maqbool A,et al.Choline supplementation alterssome amino acid concentrations with no change in homocysteine in chil-dren with cystic fibrosis and pancreatic insufficiency[J].Nutr Res.2016,36(5):418-429.
10.吴凌.老年行为失能和抑郁症状与血清胱抑素C的相关性研究[J].济南:山东大学齐鲁医学院,2018.
11.Sun B,Zhou Y,Halabisky B,et al.Cystatin C-cathepsin B axis regulates amyloid beta levels and associated neuronal deficits in an animal model of Alzheimer's disease[J].Neuron.2008,60(2):247-257.
12.Mosconi G,Angelini ML,Balzi W,et al.Can solid-organtransplanted patients perform a cycling Marathon?Trends in kidney function parame-ters in comparison with healthy subjects[J].Transplant Proc.2016,48(2):415-419.
13.尤志珺,刘丹荣.老年PD患者血尿酸水平与抑郁、认知障碍的关系[J].中国康复,2012,27(4):271-273.
14.王变荣,张志宇,时建铨.老年病人血清尿酸水平与认知功能的相关性研究[J].实用老年医学,2017,31(4):441-444.