Correlation between serum oxidative stress indicators and cognitive dysfunction in patients with sleep disorders accompanied by anxiety and depression
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摘要:目的
分析伴有焦虑及抑郁的睡眠障碍人群血清氧化应激指标与认知功能障碍的相关性。
方法选取2021年4月—2023年4月本院收治的196例伴焦虑及抑郁的睡眠障碍患者为研究对象, 检测其氧化应激指标如血清丙二醛(MDA)、总超氧化物歧化酶(T-SOD)、白细胞介素-6(IL-6)、γ-谷氨酰转移酶(γ-GGT)水平。采用蒙特利尔认知评估量表(MoCA)评价患者的认知功能，依据MoCA评分将其分为合并认知功能障碍组(n=80)和未合并认知功能障碍组(n=116)。采用Pearson相关性分析探讨血清MDA、T-SOD、IL-6、γ-GGT水平与匹兹堡睡眠质量指数(PQSI)评分的相关性; 采用Spearman秩相关性分析探讨血清MDA、T-SOD、IL-6、γ-GGT水平与伴有焦虑及抑郁的睡眠障碍患者认知功能障碍的相关性; 采用受试者工作特征(ROC)曲线评价血清MDA、T-SOD、IL-6、γ-GGT对伴有焦虑及抑郁的睡眠障碍患者认知功能障碍的评估价值。
结果合并认知功能障碍组血清MDA、IL-6、γ-GGT、PQSI评分高于未合并认知功能障碍组, T-SOD水平低于未合并认知功能障碍组，差异有统计学意义(P < 0.05)。Pearson相关性分析结果显示，血清MDA、IL-6、γ-GGT水平与PQSI评分呈正相关(r=0.128、r=0.317、r=0.261, P=0.037、P < 0.001、P < 0.001), 血清T-SOD水平与PQSI评分呈负相关(r=-0.145, P=0.021)。Spearman秩相关性分析结果显示，血清MDA、IL-6、γ-GGT水平与认知功能障碍的发生呈正相关(r=0.322、0.554、0.441, P均 < 0.001), 血清T-SOD水平与认知功能障碍的发生呈负相关(r=-0.330, P < 0.001)。ROC曲线分析结果显示，血清MDA、T-SOD、IL-6、γ-GGT单独及联合评估伴有焦虑及抑郁的睡眠障碍患者合并认知功能障碍的AUC依次为0.689、0.694、0.825、0.759、0.955, 截断值依次为9.6 mmol/L、71.6 U/L、5.2 μg/L、48.8 U/L, 灵敏度依次为50.00%、77.50%、71.25%、73.75%、91.25%, 特异度依次为84.48%、62.93%、81.90%、70.69%、88.79%。
结论伴焦虑及抑郁的睡眠障碍患者的认知功能障碍与血清MDA、T-SOD、IL-6及γ-GGT密切相关，早期测定上述指标可为认知功能障碍的临床评估提供参考。
Abstract:ObjectiveTo analyze the correlation between serum oxidative stress indicators and cognitive dysfunction in patients with sleep disorders accompanied by anxiety and depression.
MethodsA total of 196 patients with sleep disorders accompanied by anxiety and depression in the hospital from April 2021 to April 2023 were selected as research objects, and serum malondialdehyde (MDA), total superoxide dismutase (T-SOD), interleukin-6 (IL-6) and γ-glutamyltransferase (γ-GGT) levels were measured in all the patients. Montreal Cognitive Assessment Scale (MoCA) was used to evaluate patients' cognitive function, and based on MoCA score, they were divided into cognitive dysfunction group (n=80) and non-cognitive dysfunction group (n=116). Pearson correlation analysis was used to explore the correlations of serum MDA, T-SOD, IL-6 and γ-GGT levels with Pittsburgh Sleep Quality Index (PSQI) score. Spearman rank correlation analysis was used to explore the correlations of serum MDA, T-SOD, IL-6 and γ-GGT levels with cognitive dysfunction in patients with sleep disorders accompanied by anxiety and depression. Receiver operating characteristic (ROC) curve was used to evaluate the values of serum MDA, T-SOD, IL-6 and γ-GGT in assessing cognitive dysfunction in patients with sleep disorders accompanied by anxiety and depression.
ResultsSerum MDA, IL-6 and γ-GGT levels as well as PSQI score were significantly higher in the cognitive dysfunction group than those in the non-cognitive dysfunction group, while the T-SOD level was significantly lower in the cognitive dysfunction group (P < 0.05). Pearson correlation analysis results showed that serum MDA, IL-6 and γ-GGT levels were positively correlated with PSQI score (r=0.128, r=0.317, r=0.261, P=0.037, P < 0.001, P < 0.001, respectively), while serum T-SOD level was negatively correlated with PSQI score (r=-0.145, P=0.021). Spearman rank correlation analysis results showed that serum MDA, IL-6 and γ-GGT levels were positively correlated with the occurrence of cognitive dysfunction (r=0.322, 0.554, 0.441, P < 0.001), while serum T-SOD level was negatively correlated with the occurrence of cognitive dysfunction (r=-0.330, P < 0.001). ROC curve analysis results showed that the areas under the curve (AUCs) for the individual and combined assessment of serum MDA, T-SOD, IL-6 and γ-GGT in patients with sleep disorders accompanied by anxiety and depression for cognitive dysfunction were 0.689, 0.694, 0.825, 0.759 and 0.955 respectively, with cut-off values of 9.6 mmol/L, 71.6 U/L, 5.2 μg/L and 48.8 U/L, sensitivities of 50.00%, 77.50%, 71.25%, 73.75% and 91.25% respectively, and specificities of 84.48%, 62.93%, 81.90%, 70.69% and 88.79% respectively.
ConclusionCognitive dysfunction in patients with sleep disorders accompanied by anxiety and depression is closely related to serum MDA, T-SOD, IL-6 and γ-GGT, and early measurement of these indicators can provide a reference for the clinical assessment of cognitive dysfunction.
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表 1 2组一般资料比较(x±s)[n(%)]
一般资料 分类 合并认知功能障碍组(n=80) 未合并认知功能障碍组(n=116) t/χ2 P 年龄/岁 54.35±7.48 55.22±7.43 0.803 0.443 性别 男 37(46.25) 50(43.10) 0.190 0.663 女 43(53.75) 66(56.90) 睡眠障碍病程/年 3.27±0.69 3.48±0.92 1.732 0.049 合并糖尿病 是 25(31.25) 32(27.59) 0.308 0.579 否 55(68.75) 84(72.41) 合并高血压 是 29(36.25) 38(32.76) 0.257 0.613 否 51(63.75) 78(67.24) 受教育程度 高中以上 39(48.75) 52(44.83) 0.293 0.588 高中及以下 41(51.25) 64(55.17) 合并冠心病 是 27(33.75) 34(29.31) 0.435 0.509 否 53(66.25) 82(70.69) 饮酒 是 35(43.75) 44(37.93) 0.666 0.414 否 45(56.25) 72(62.07) 吸烟 是 34(42.50) 42(36.21) 0.790 0.374 否 46(57.50) 74(63.79) MDA/(mmol/L) 9.34±2.41 7.86±1.86 4.846 < 0.001 T-SOD/(U/L) 67.27±7.85 73.33±10.25 4.461 < 0.001 IL-6/(μg/L) 5.86±1.37 4.29±1.15 8.682 < 0.001 γ-GGT/(U/L) 52.31±5.62 46.07±7.58 6.268 < 0.001 PQSI评分/分 13.42±2.56 10.23±2.77 8.171 < 0.001 MDA: 丙二醛; T-SOD: 总超氧化物歧化酶; IL-6: 白细胞介素-6; γ-GGT: γ-谷氨酰转移酶; PQSI: 匹兹堡睡眠质量指数。 
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表 2 血清氧化应激指标对伴有焦虑及抑郁的睡眠障碍患者合并认知功能障碍的评估价值
变量 AUC SE P 95%CI 截断值 灵敏度/% 特异度/% 约登指数 MDA 0.689 0.040 < 0.001 0.619~0.753 9.6 mmol/L 50.00 84.48 0.345 T-SOD 0.694 0.038 < 0.001 0.624~0.758 71.6 U/L 77.50 62.93 0.404 IL-6 0.825 0.031 < 0.001 0.765~0.876 5.2 μg/L 71.25 81.90 0.532 γ-GGT 0.759 0.034 < 0.001 0.693~0.817 48.8 U/L 73.75 70.69 0.444 联合预测 0.955 0.012 < 0.001 0.915~0.979 — 91.25 88.79 0.800 MDA: 丙二醛; T-SOD: 总超氧化物歧化酶; IL-6: 白细胞介素-6; γ-GGT: γ-谷氨酰转移酶。
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