作者：郭陶陶，王晶晶，袁文杏，刘敏，张向民

单位：

056002 河北省邯郸市第二医院呼吸内科；通信作者：张向民，E-mail：1056332108@qq.com

Units：

Department of Respiratory Medicine，the Second Hospital of Handan，Handan 056002，China；Corresponding author：ZHANG Xiangmin，E-mail：1056332108@qq.com

关键词：

慢性阻塞性肺疾病；认知障碍；同型半胱氨酸；8- 羟基脱氧鸟苷酸；血清淀粉样蛋白 A

Keywords：

Chronic obstructive pulmonary disease；Cognition disorders；Homocysteine；8-hydroxy-deoxyguanosineacid；Serum amyloid A protein

CLC：

R 563.9

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.007

Funds：

2019 年度河北省医学科学研究课题计划（20191792）

摘要：

背景　慢性阻塞性肺疾病（COPD）患者常伴有认知障碍，但其具体发生机制目前尚不明确，而积极寻找早期诊断COPD患者认知障碍的指标具有重要临床意义。目的　探讨COPD伴认知障碍患者同型半胱氨酸（Hcy）、8-羟基脱氧鸟苷酸（8-OHdG）、血清淀粉样蛋白A（SAA）水平变化及其与认知功能的相关性。方法　选取2017年1月—2018 年 3 月邯郸市第二医院呼吸内科收治的 COPD 患者 88 例，根据认知功能分为认知障碍组（n=57）和非认知障碍组（n=31）；另选取同期在本院门诊体检健康者 42 例作为对照组。比较三组受试者蒙特利尔认知评估量表（MoCA）评分，Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量；Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量与 COPD伴认知障碍患者 MoCA 评分，Hcy 水平及其 mRNA 相对表达量与 COPD 伴认知障碍患者 8-OHdG、SAA 水平及其 mRNA相对表达量的相关性采用Pearson相关分析。结果　（1）认知障碍组患者视空间与执行能力、命名、注意力、语言、抽象、延迟回忆、定向力评分及 MoCA 总分低于非认知障碍组、对照组（P<0.05）。（2）认知障碍组患者 Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量高于非认知障碍组、对照组（P<0.05）；非认知障碍组患者 Hcy、SAA 水平及其mRNA 相对表达量高于对照组（P<0.05）。（3）Pearson 相关分析结果显示，Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量与 COPD 伴认知障碍患者 MoCA 评分呈负相关（r 值分别为 -0.456、-0.677、-0.413、-0.477、-0.699、-0.478，P<0.05）；Hcy 水平与 COPD 伴认知障碍患者 8-OHdG、SAA 水平呈正相关（r 值分别为 0.335、0.442，P<0.05），且Hcy mRNA相对表达量与COPD伴认知障碍患者8-OHdG、SAA mRNA相对表达量亦呈正相关（r值分别为0.365、0.441，P<0.05）。结论　COPD 伴认知障碍患者 Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量明显升高，且 Hcy、8-OHdG、SAA 水平及其 mRNA 相对表达量与 COPD 伴认知障碍患者认知功能损伤程度呈负相关。

Abstract：

Background　COPD patients usually accompanied with cognitive disorder，but the specific mechanismis unclear so far，therefore it is of great clinical significance to actively find diagnostic indicator for early diagnosing cognitivedisorder in patients with COPD. Objective　To investigate the changes of Hcy，8-OHdG and SAA levels in COPD patientsaccompanied with cognitive disorder and their correlations with cognitive function. Methods　From January 2017 to March2018，a total of 88 patients with COPD were selected in the Department of Respiratory Medicine，the Second Hospital ofHandan，and they were divided into cognitive disorder group（n=57）and non-cognitive disorder group（n=31）according tocogntive function；a total of 42 healthy people admitted to this hospital for physical examination were selected as control groupin addition. MoCA score，levels of Hcy，8-OHdG，SAA and their relative mRNA expression quantity were compared in thethree groups；Pearson correlation analysis was used to analyze the correlations of Hcy，8-OHdG，SAA levels and their relativemRNA expression quantity with MoCA score，as well as Hcy and its relative mRNA expression quantity with 8-OHdG，SAAlevels and their relative mRNA expression quantity in COPD patients accompanied with cognitive disorder. Results　（1）Visualspace and executive capability score，naming score，attention score，language score，abstract score，delayed recall score，directive force score and total MoCA score in cognitive disorder group were statistically significantly lower than those in non-cognitivedisorder group and control group（P<0.05）.（2）Levels of Hcy，8-OHdG，SAA and their relative mRNA expression quantity incognitive disorder group were statistically significantly higher than those in non-cognitive disorder group and control group （P<0.05），meanwhile levels of Hcy，SAA and their relative mRNA expression quantity in non-cognitive disorder group were statisticallysignificantly higher than those in control group（P<0.05）.（3）Pearson correlation analysis results showed that，Hcy，8-OHdG，SAA and their relative mRNA expression quantity was negatively correlated with MoCA score in COPD patients accompanied withcognitive disorder，respectively（r value of -0.456，-0.677，-0.413，-0.477，-0.699，-0.478，P<0.05）；Hcy level waspositively correlated with 8-OHdG and SAA levels in COPD patients accompanied with cognitive disorder，respectively（r valueof 0.335，0.442，P<0.05），meanwhile relative mRNA expression quantity of Hcy was also positively correlated with relativemRNA expression quantity of 8-OHdG and SAA，respectively（r value of 0.365，0.441，P<0.05）. Conclusion　Levels ofHcy，8-OHdG，SAA and their relative mRNA expression quantity are significantly elevated in COPD patients accompanied withcognitive disorder，more over the above index are negatively correlated with the degree of cognitive impairment.

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