老年轻度认知功能障碍患者血清25-羟维生素D水平变化及其临床意义

摘要

目的 观察老年轻度认知功能障碍(MCI)患者与认知功能正常(NC)老年人相比其血清25-羟维生素D[25(OH)D]水平的变化,并探讨其临床意义.方法 符合入组标准的老年人共148例,采用协和版蒙特利尔认知评估量表(MoCA-P)评估其认知功能.根据2003年国家神经系统疾病和中风研究所即NINDS及国际神经科学协会即AIREN修订的MCI诊断标准,将入组的148例老年人分为NC组和MCI组,检测比较两组血清25(OH)D水平,分析血清25(OH)D水平与老年人MCI的相关性,用受试者工作特征曲线(ROC)评价血清25(OH)D水平对老年人MCI的预测价值.结果 MCI组(72例)、NC组(76例)血清25(OH)D水平分别为(33.43±15.04)nmol/L和(41.55±17.53)nmol/L,两组相比,P<0.01;25(OH)D缺乏者MCI组64例(88.9％)、NC组51例(67.1％),两组相比,P<0.01.血清25(OH)D水平与MoCA评分呈正相关(r=0.219,P<0.01),25(OH)D缺乏者较25(OH)D非缺乏者发生MCI风险高(OR=3.816,P<0.01).血清25(OH)D水平降低对预测老年人MCI有一定价值[ROC的曲线下面积为0.637(95％CI为0.548～0.727),P<0.01];血清25(OH)D水平联合受教育年限、年龄对老年人MCI预测价值更高[ROC的曲线下面积为0.723(95％CI为0.642～0.804),P<0.01].结论 老年MCI患者血清25(OH)D水平降低,血清25(OH)D水平降低与老年人MCI的发生相关,25(OH)D缺乏老年人发生MCI风险高,检测血清25(OH)D可能有助于对老年人M C I的预测.%Objective To investigate the change and clinical value of serum 25-hydroxyvitamin D [25(OH)D]level in the elderly patients with mild cognitive impairment (MCI)as compared with those with normal cognition (NC). Meth-ods Totally 148 elderly patients were selected. Cognitive function was assessed by Peking Union Medical College Hospital vision of Montreal Cognitive Assessment (MoCA-P). According to the criteria of MCI revised in 2003 by the international work group [National Institute of Neurological Disorders and Stroke (NINDS)and Association Internationale pour la Re-cherche et l'Enseignement en Neurosciences (AIREN)],the 148 elderly patients were divided into two groups:NC group and MCI group. The serum 25(OH)D levels were detected and compared between the two groups. The relationship be-tween the MCI and serum 25(OH)D level was analyzed. Receiver operating characteristic curve (ROC)was used to evalu-ate the predicting value of 25(OH)D in the elderly MCI patients. Results The serum 25(OH)D levels of the MCI group (n = 72)and NC group (n = 76)were (33. 43 ± 15. 04)nmol/ L and (41. 55 ± 17. 53)nmol/ L,respectively (P <0. 01). The 25(OH)D deficiency in the MCI group (n = 64,88. 9％)was different from the NC group (n = 51,67. 1％) (P < 0. 01). The serum 25(OH)D level and the MoCA score were positively correlated (r = 0. 219,P < 0. 01). The pa-tients with 25(OH)D deficiency had an increased risk of MCI (OR = 3. 816,P < 0. 01). Serum 25(OH)D had a value in predicting MCI in the elderly patients [AUC 0. 637,(95％ CI 0. 548-0. 727),P < 0. 01]. Serum 25(OH)D combined with education years and age had a more higher value in predicting MCI in the elderly patients [AUC 0. 723,(95％ CI 0. 642-0. 804),P < 0. 01]. Conclusions The serum 25(OH)D level of the elderly MCI patients is decreased. Serum 25(OH)D is related to MCI in the elderly patients. Serum 25(OH)D deficiency has an increased risk of MCI. Serum 25(OH)D may contribute to predicting MCI in the elderly patients.