作者：苗玲1 ，王敏 1 ，秦景云 1 ，张向民 2

单位：

1.056000 河北省邯郸市中心医院胸外科；2.056000 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：

1.Department of Thoracic Surgery，the Central Hospital of Handan，Handan 056000，China；2.Department of Respiratory Medicine，the Second Hospital of Handan，Handan 056000，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；半胱氨酸天冬酶 -3；预测

Keywords：

Chronic obstructive pulmonary disease；Cognition disorders；Homocysteine；Caspase-3；Forecasting

CLC：

R 563.9

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.009

Funds：

河北省医学科学研究课题计划项目（20191792）

摘要：

背景　血清同型半胱氨酸（Hcy）和半胱氨酸天冬酶 -3（caspase-3）水平与神经退行性病变有关，但二者与慢性阻塞性肺疾病（COPD）患者认知障碍的关系尚未明确。目的　分析血清 Hcy 和 caspase-3 水平与 COPD 患者认知障碍的关系。方法　选取 2016 年 1 月—2019 年 6 月邯郸市中心医院呼吸内科收治的 COPD 患者 156 例作为病例组，根据蒙特利尔认知评估量表（MoCA）评分将其分为 A 组 58 例（认知功能正常）、B 组 65 例（轻度认知障碍）及 C 组 33 例（中重度认知障碍）；另选取同期体检健康者 150 例作为对照组。比较病例组和对照组受试者动脉血气分析指标〔包括动脉血氧分压（PaO 2 ）、动脉血二氧化碳分压（PaCO 2 ）及 pH 值〕、肺功能指标〔包括第 1 秒用力呼气容积（FEV 1 ）、呼气峰值流速（PEF）、最大呼气中段流量（MMEF）及用力肺活量（FVC）〕、MoCA 评分，对照组、A 组、B 组、C 组受试者血清 Hcy、caspase-3 水平；血清 Hcy 和 caspase-3 水平与 COPD 患者 MoCA 评分的相关性分析采用 Pearson 相关分析；绘制受试者工作特征曲线（ROC 曲线）以评价血清 Hcy 和 caspase-3 水平对 COPD 患者认知障碍的预测价值。结果　（1）病例组患者 PaO 2 、pH 值低于对照组，PaCO 2 高于对照组，FEV 1 和 FVC 小于对照组，PEF 和 MMEF 慢于对照组（P<0.05）。（2）病例组患者视空间与执行功能、命名、记忆、注意、语言、抽象思维、延时回忆、定向评分及 MoCA 总分均低于对照组（P<0.05）。（3）A 组、B 组、C 组患者血清 Hcy 和 caspase-3 水平高于对照组，B组和C组患者血清Hcy和caspase-3水平高于A组，C组患者血清Hcy和caspase-3水平高于B组（P<0.05）。（4）Pearson相关分析结果显示，血清Hcy、caspase-3水平与COPD患者MoCA评分呈负相关（r值分别为-0.553、-0.567，P<0.01）。（5）ROC 曲线显示，血清 Hcy 水平预测 COPD 患者认知障碍的曲线下面积（AUC）为 0.781〔95%CI（0.695，0.886）〕，最佳截断值为 13.56 ng/L，灵敏度、特异度分别为 70.75%、92.62%；血清 caspase-3 水平预测 COPD 患者认知障碍的 AUC 为 0.776〔95%CI（0.691，0.873）〕，最佳截断值为 7.83 ng/L，灵敏度、特异度分别为 71.34%、91.08%。结论　血清 Hcy 和 caspase-3 水平与 COPD 患者认知功能呈负相关，且二者均对 COPD 患者认知障碍具有一定预测价值。

Abstract：

Background　Serum levels of homocysteine（Hcy） and caspase-3 are related to neurodegenerativedisorders，however relations of the above two to cognitive disorder in patients with chronic obstructive pulmonary disease（COPD）is not unclear. Objective　To investigate the relation of serum levels of Hcy and caspase-3 to cognitive disorderin patients with COPD. Methods　From January 2016 to June 2019，a total of 156 patients with COPD were selected ascase group in the Department of Respiratory Medicine，the Central Hospital of Handan，and they were divided into A group（with normal cognitive function，n=58），B group（with mild cognitive disorder，n=65）and C group（with moderate tosevere cognitive disorder，n=33） according to MoCA score，meanwhile a total 150 healthy people admitted to this hospitalfor physical examination were selected as control group. Arterial blood-gas analysis results（including PaO 2 ，PaCO 2 and pHvalue），index of pulmonary function（including FEV 1 ，PEF，MMEF and FVC） and MoCA score were compared betweencase group and control group，moreover serum levels of Hcy and caspase-3 were compared in control group and groups A，B，C；Pearson correlation analysis was used to analyze the correlations of serum levels of Hcy and caspase-3 with MoCA in patientswith COPD；ROC curve was drawn to evaluate the predictive value of serum levels of Hcy and caspase-3 on cognitive disorder inpatients with COPD. Results　（1）PaO 2 and pH value in case group were statistically significantly lower than those in controlgroup，PaCO 2 in case group was statistically significantly higher than that in control group，FEV 1 and FVC in case group werestatistically significantly less than those in control group，PEF and MMEF in case group were statistically significantly slowerthan those in control group（P<0.05）.（2）Visual space and executive function score，naming score，memory score，attention score，language score，abstract thinking score，delayed memory score，orientation score and total MoCA score incase group were statistically significantly less than those in control group（P<0.05）.（3）Serum levels of Hcy and caspase-3in groups A，B and C were statistically significantly higher than those in control group，serum levels of Hcy and caspase-3 ingroups B and C were statistically significantly higher than those in A group，meanwhile serum levels of Hcy and caspase-3 in Cgroup were statistically significantly higher than those in B group（P<0.05）.（4）Pearson correlation analysis results showedthat，serum levels of Hcy（r=-0.553）and caspase-3（r=-0.567）was negatively correlated with MoCA score in patients withCOPD，respectively（P<0.01）.（5）ROC curve showed that，AUC，the optimum critical value，sensitivity and specificity ofserum Hcy level in predicting cognitive disorder in patients with COPD was 0.781〔95%CI（0.695，0.886）〕，13.56 ng/L，70.75%and 92.62%，respectively；AUC，the optimum critical value，sensitivity and specificity of serum caspase-3 level in predictingcognitive disorder in patients with COPD was 0.776〔95%CI（0.691，0.873）〕，7.83 ng/L，71.34% and 91.08%，respectively. Conclusion　Serum levels of Hcy and caspase-3 are significantly correlated with cognitive disorder in patients withCOPD，and both them have predictive value on the cognitive disorder to some extent.

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