伴有阻塞性睡眠呼吸暂停低通气综合征的脑梗死患者血清同型半胱氨酸和胱抑素C水平变化及其对认知功能的影响

段燕燕; 薛孟周; 朱宁

doi:10.7619/jcmp.20212073

伴有阻塞性睡眠呼吸暂停低通气综合征的脑梗死患者血清同型半胱氨酸和胱抑素C水平变化及其对认知功能的影响

The changes of serum homocysteine and cystatin Clevels and their effects on cognitive function inpatients with cerebral infarction accompanied by obstructive sleep apnea hypopnea syndrome

摘要

摘要:
目的探讨伴有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的脑梗死患者血清同型半胱氨酸(Hcy)和胱抑素C(CysC)水平变化及其与认知功能的关系。
方法选取伴有OSAHS的脑梗死患者52例(观察组)和单纯脑梗死患者50例(对照组)为研究对象，根据睡眠呼吸暂停低通气指数(AHI)的不同将观察组分为轻度组17例(合并有轻度OSAHS)和中重度组35例(合并有中重度OSAHS)。所有入组患者均进行多导睡眠监测(PSG), 记录AHI、夜间平均血氧饱和度(MSaO₂)、夜间最低血氧饱和度(LSaO₂)。采用简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估患者的认知功能。采用酶联免疫吸附测定法(ELISA)测定血清Hcy和CysC水平。
结果观察组血清Hcy、CysC水平高于对照组, MMSE评分、MoCA评分低于对照组，差异有统计学意义(P < 0.01)。中重度组血清Hcy、CysC水平高于轻度组, MMSE评分、MoCA评分低于轻度组，差异有统计学意义(P < 0.01); 中重度组AHI高于轻度组, LSaO₂、MSaO₂低于轻度组，差异有统计学意义(P < 0.01)。观察组中，血清Hcy、CysC水平与MMSE评分、MoCA评分均呈负相关，血清Hcy、CysC水平与AHI呈正相关(P < 0.01); 血清Hcy、CysC水平与LSaO₂、MSaO₂呈负相关(P < 0.01)。
结论伴有OSAHS的脑梗死患者血清Hcy、CysC水平升高与患者认知功能受损有关。血清Hcy、CysC水平可在一定程度上反映OSAHS合并脑梗死患者认知功能障碍的严重程度。

Abstract:
Objective To investigate the changes of serum homocysteine (Hcy) and cystatin C (CysC) levels and their relationships with cognitive function in patients with cerebral infarction accompanied by obstructive sleep apnea hypopnea syndrome (OSAHS).
Methods A total of 52 patients with cerebral infarction accompanied by OSAHS (observation group) and 50 patients with cerebral infarction alone (control group) were selected in the study, and the observation group was divided into mild group (17 cases, accompanied by mild OSAHS) and moderate-severe group (35 cases, accompanied by moderate to severe OSAHS) according to different sleep apnea hypoventilation index (AHI). All patients enrolled in the group underwent polysomnography (PSG), and AHI, mean nocturnal oxygen saturation (MSaO₂), and minimum nocturnal oxygen saturation (LSaO₂) were recorded. Patients′cognitive function was assessed using the Simple Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA). Serum Hcy and CysC levels were measured by enzyme-linked immunosorbent assay (ELISA).
Results The serum Hcy and CysC levels of the observation group were higher than those of the control group, and the MMSE score and MoCA score were lower than those of the control group (P < 0.01). The serum Hcy and CysC levels in the moderate to severe group were higher than those in the mild group, and the MMSE score and MoCA score were lower than those in the mild group (P < 0.01). The moderate to severe group had higher AHI, and lower LSaO₂ and MSaO₂ than that in the mild group (P < 0.01). In the observation group, serum Hcy and CysC levels were negatively correlated with MMSE score and MoCA score, and serum Hcy as well as CysC levels were positively correlated with AHI (P < 0.01); serum Hcy and CysC levels were negatively correlated with LSaO₂ and MSaO₂ (P < 0.01).
Conclusion The elevated serum levels of Hcy and CysC in patients with cerebral infarction accompanied by OSAHS are related to the impaired cognitive function of the patients. Serum Hcy and CysC levels can reflect the severity of cognitive dysfunction in patients with OSAHS and cerebral infarction to a certain extent.

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