作者：刘萍1 ，曾强 2 ，王丰 1 ，孙楷 1

单位：

1.643000 四川省自贡市第四人民医院呼吸与危重症医学科；2.621000 四川省绵阳市第三人民医院呼吸内科；通信作者：曾强，E-mail：382313656@qq.com

Units：

1.Department of Pulmonary and Critical Care Medicine，the Fourth People's Hospital of Zigong，Zigong 643000，China；2.Department of Respiratory Medicine，the Third People's Hospital of Mianyang，Mianyang 621000，China；Corresponding author：ZENG Qiang，E-mail：382313656@qq.com

关键词：

慢性阻塞性肺疾病；阻塞性睡眠呼吸暂停低通气综合征；重叠综合征；认知障碍；神经肽 Y；转化生长因子 β；Smad 蛋白质类

Keywords：

Chronic obstructive pulmonary disease；Obstructive sleep apnea hypopnea syndrome；Overlapsyndrome；Cognition disorder；Neuropeptide Y；Transforming growth factor beta；Smad proteins

CLC：

R 563.9　R 563.8

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.010

Funds：

自贡市重点科技计划项目（2013ZC23）

摘要：

背景　目前，慢性阻塞性肺疾病（COPD）- 阻塞性睡眠呼吸暂停低通气综合征（OSAHS）重叠综合征患者认知障碍的发生机制尚未完全明确，早期诊断及治疗难度较大，而寻找有效并客观地评价 COPD-OSAHS 重叠综合征患者认知障碍的指标具有重要意义。目的　分析血清神经肽 Y（NPY）水平和转化生长因子 β（TGF-β）/Smad 信号通路与 COPD-OSAHS 重叠综合征患者认知障碍的相关性。方法　选取 2016 年 4 月—2019 年 6 月自贡市第四人民医院呼吸内科收治的 COPD-OSAHS 重叠综合征患者 36 例作为重叠综合征（OS）组，另选取同期收治的单纯COPD 患者 52 例作为 COPD 组，单纯 OSAHS 患者 52 例作为 OSAHS 组，体检健康者 45 例作为健康对照组。比较四组受试者简易精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分及血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平，有无认知障碍的 COPD-OSAHS 重叠综合征患者血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平；血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平与 COPD-OSAHS 重叠综合征患者 MMSE 评分、MoCA 评分的相关性分析采用 Pearson 相关分析。结果　（1）COPD 组、OSAHS 组、OS 组患者 MMSE 评分、MoCA 评分低于健康对照组，OS 组患者 MMSE 评分、MoCA 评分低于 COPD 组和 OSAHS 组（P<0.05）。（2）COPD 组、OSAHS 组、OS 组患者血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平高于健康对照组，OS 组患者血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平高于 COPD 组和 OSAHS 组（P<0.05）。（3）有认知障碍的 COPD-OSAHS 重叠综合征患者血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平高于无认知障碍的 COPD-OSAHS 重叠综合征患者（P<0.05）。（4）Pearson相关分析结果显示，血清 NPY、TGF-β、Smad1、Smad3、Smad7 水平均与 COPD-OSAHS 重叠综合征患者 MMSE 评分、MoCA 评分呈负相关（P<0.05）。结论　COPD-OSAHS 重叠综合征患者认知障碍程度重于单纯 COPD 患者、单纯OSAHS 患者，而 COPD-OSAHS 重叠综合征患者认知障碍发生和加重与血清 NPY 水平升高及 TGF-β/Smad 信号通路参与有关。

Abstract：

Background　Mechanism of cognitive disorder in patients with COPD-OSAHS overlap syndrome is notyet very clear，and it is difficult to early diagnose and treat，thus it is of great significance to find the effective and objectiveindex to evaluate cognitive disorder in patients with COPD-OSAHS overlap syndrome. Objective　To analyze the correlations ofserum NPY level and TGF-β/Smad signaling pathway to cognitive disorder in patients with COPD-OSAHS overlap syndrome.Methods　From April 2016 to June 2019，a total of 36 patients with COPD-OSAHS overlap syndrome were selected as OSgroup in the Department of Respiratory Medicine，the Fourth People's Hospital of Zigong，meanwhile 52 patients with COPDalone were selected as COPD group，52 patients with OSAHS alone were selected as OSAHS group，moreover 45 healthy peoplewere selected as control group. MMSE score，MoCA score，as well as serum levels of NPY，TGF-β，Smad1，Smad3 andSmad7 were compared in the four groups，moreover serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 were comparedin COPD-OSAHS overlap syndrome patients with cognitive disorder or not；Pearson correlation analysis was used to analyzethe correlations of serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 with MMSE score，MoCA score in patientswith COPD-OSAHS overlap syndrome. Results　（1）MMSE score and MoCA score in COPD group，OSAHS group and OSgroup were statistically significantly lower than those in control group，meanwhile MMSE score and MoCA score in OS groupwere statistically significantly lower than those in COPD group and OSAHS group（P<0.05）.（2）Serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 in COPD group，OSAHS group and OS group were statistically significantly higher thanthose in control group，meanwhile serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 in OS group were statisticallysignificantly higher than those in COPD group and OSAHS group（P<0.05）.（3）Serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 in COPD-OSAHS overlap syndrome patients with cognitive disorder were statistically significantly higher thanthose in COPD-OSAHS overlap syndrome patients without cognitive disorder（P<0.05）.（4）Pearson correlation analysisresults showed that，serum levels of NPY，TGF-β，Smad1，Smad3 and Smad7 was negatively correlated with MMSE scoreand MoCA score in patients with COPD-OSAHS overlap syndrome，respectively（P<0.05）. Conclusion　Degree of cognitivedisorder in COPD-OSAHS overlap syndrome patients is more severe than that in patients with COPD or OSAHS alone，howeverthe occurrence and aggravation of cognitive disorder in COPD-OSAHS overlap syndrome patients are significantly correlated withthe increase of serum NPY level and the involvement of TGF-β/Smad signaling pathway.

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