早期帕金森病脂质和内皮功能与认知功能和脑白质微结构改变的关系

摘要

目的 探讨帕金森病(PD)早期血浆载脂蛋白A-1(ApoA-1)和内皮素-1(ET-1)水平的变化及其与认知功能和脑白质微结构改变的相关性.方法 选取早期 PD患者76例为 PD组,并选取同期健康体检人群30名为对照组.检测两组血浆ApoA-1和ET-1水平变化,采用磁共振弥散张量成像检查两组脑白质微结构改变状况,采用蒙特利尔认知评价量表(MoCA)评价受试者认知功能状况,分析PD患者血浆ApoA-1和ET-1水平与MoCA评分和脑白质区域部分各向异性值(FA值)的相关性,以及MoCA评分与各脑白质区域 FA值的相关性.结果 与对照组比较,PD组血浆ApoA-1水平和MoCA评分均降低,双侧颞叶、左侧前扣带束和胼胝体压部等脑白质区域FA值亦降低,而血浆ET-1水平升高(均 P<0.05).与PD组MoCA≥26分者比较,MoCA<26分PD患者血浆ApoA-1水平和脑白质区域FA值均降低,血浆ET-1水平升高(均 P<0.05).PD组血浆ApoA-1水平与其MoCA评分和各脑白质区域FA值均呈正相关(P<0.05),其血浆ET-1水平与其MoCA评分和各脑白质区域 FA值均呈负相关(P<0.05),其MoCA评分与各脑白质区域 FA值均呈正相关(P<0.05).结论 PD早期血浆ApoA-1水平降低而血浆ET-1水平升高,且两者均与其认知功能和脑白质微结构改变状况相关,可能作为其认知功能损害评估的辅助参考指标.%Objective To investigate the plasma apolipoprotein A-1(ApoA-1)and endothelin-1(ET-1)levels in early Parkinson disease(PD)patients and their relationships with cognitive function and cerebral white matter structure change. Methods 76 early PD patients were selected as a PD group,and 30 cases of healthy persons who had physical examination in the same period were selected as a control group. The plasma ApoA-1 and ET-1 levels of the two groups were compared. The magnetic resonance diffusion tensor imaging examination was applied to detect white matter structures of the two groups,and Montreal cognitive assessment scale(MoCA)was applied to evaluate and compare cognitive status of the two groups. Relationships between plasma ApoA-1 and ET-1 levels changes and MoCA score and white matter structure in the PD group were analyzed. The relationship between MoCA score and white matter fractional anisotropy value(FA value)of the PD group was also analyzed. Results Compared with those of the control group,plasma ApoA-1 level and MoCA score in the PD group decreased,FA values in bilateral temporal lobes,left anterior cingulate tract and corpus callosum and other white matter area in the PD group also decreased,and plasma ET-1 level in the PD group increased(P<0.05). Compared with those of the PD patients with MoCA ≥26,plasma ApoA-1 levels and cerebral white matter FA values of the PD patients with MoCA <26 decreased,while plasma ET-1 levels of the patients with MoCA<26 increased(P<0.05).In the PD group,Pearson linear correlation analysis showed that plasma ApoA-1 was positively correlated with MoCA score and brain white matter FA values(P<0.05), the plasma ET-1 level was negatively correlated with MoCA score and the white matter brain FA values(P<0.05),and the MoCA score was positively correlated with the white matter FA values(P<0.05). Conclusions Plasma ApoA-1 level of early PD decreased while plasma ET-1 level of early PD increased,and both of the 2 above factors were correlated with the cognitive function and cerebral white matter structure changes,which may be evaluation tools for cognitive function impairment assessment.