慢性阻塞性肺疾病伴认知功能障碍患者血清lipocalin-2表达及意义

doi:10.3877/cma.j.issn.1674-6902.2022.01.007

目的

分析血清脂质运载蛋白-2(lipocalin-2)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)稳定期伴认知障碍患者血清中的表达变化及其意义。

方法

依据蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)评分，MoCA分值<26分者为认知受损，将43例COPD稳定期的患者分为认知障碍组23例及认知正常组20例，并选取20例健康体检者做对照组；采用酶联免疫吸附实验(ELISA)分别检测患者外周静脉血清脂质运载蛋白-2(lipocalin-2)水平；分析血清脂质运载蛋白-2与认知功能的相关性，根据血清lipocalin-2水平预测认知障碍的受试者工作特征(ROC)曲线。

结果

与健康对照组相比(60.37±10.77)μg/ml，COPD稳定期伴认知障碍患者血清lipocalin-2水平(82.76±12.90)μg/ml显著增加(P<0.05)；与COPD稳定期认知正常组(69.70±11.51)μg/ml相比，认知功能障碍组血清lipocalin-2水平显著升高，差别有统计学意义(P<0.05)。Pearson相关分析结果显示血清lipocalin-2水平与MoCA评分呈负相关(r＝-0.749，P<0.001)；血清lipocalin-2水平预测COPD稳定期患者认知功能障碍的ROC曲线下面积分别为0.804(95%CI 0.664~0.945，P<0.001)。

结论

血清lipocalin-2表达水平与COPD稳定期患者认知功能障碍密切相关。血清lipocalin-2水平检测可能成为COPD患者出现认知功能障碍的一个重要诊断指标。

关键词: 肺疾病，慢性阻塞性, 认知功能, 蒙特利尔认知评估量表, 脂质运载蛋白-2

Objective

To investigate the correlation and clinical significance of serum lipocalin-2 level with cognitive impairment in patients with the stable stage of chronic obstructive pulmonary disease (COPD).

Methods

According to the Montreal cognitive assessment(MoCA)scale standard for evaluation, a cutoff score of <26 defined as mild cognitive impairment(MCI). A total of 43 patients in the stable stage of COPD were divided into a cognitive impairment group(Cog I) (23 patients)and a cognitive normal group (Cog N)(20 patients), and 20 healthy Subjects as control group. The level of serum lipocalin-2 in each group was detected by enzyme-linked immunosorbent assay (ELISA), the correlation between lipocalin-2 and cognitive function was analyzed, and the ROC curve of cognitive impairment was predicted according to the level of lipocalin-2.

Results

Compared with the healthy control group(60.37±10.77)μg/ml, the serum level of lipocalin-2 in stable COPD patients with cognitive impairment (82.76±12.90) μg/ml was significant higher(P<0.05). Compared with than the cognitive normal group (69.70±11.51)μg/ml, the protein level of lipocalin-2 was increased in serum of stable COPD patients with cognitive impairment(P<0.05). Pearson line correlation revealed that the serum level of lipocalin-2 was negatively correlated with MoCA score (r=-0.749, P<0.001), The areas under ROC curve of serum lipocalin-2 level to predict cognitive dysfunction in the COPD patients was 0.804 (95%CI 0.664-0.945, P<0.001).

Conclusion

The serum lipocalin-2 level is closely related to the cognitive dysfunction of stable COPD patients. The detection of serum lipocalin-2 level may be an important diagnostic index of cognitive dysfunction in COPD patients.

Key words: Chronic obstructive pulmonary disease, Cognitive function, Montreal cognitive assessment, lipocalin-2

图1 三组人群血清lipocalin-2浓度；注：*与对照组相比，P<0.05，#与认知正常组(Cog N)相比，P<0.05

表1 三组人群MoCA评分比较

变　量	对照组(n＝20)	认知正常组(n＝20)	认知障碍组(n＝23)
视空间/执行(5)	4.75±0.55	4.65±0.58	3.04±1.07^ab
命名(3)	2.65±0.49	2.50±0.51	2.39±0.58^a
注意(6)	5.35±0.49	5.40±0.50	3.13±0.69^ab
语言(3)	2.70±0.57	2.60±0.60	2.57±0.59^a
抽象(2)	1.85±0.37	1.90±0.31	1.48±0.51^ab
延时回忆(5)	4.25±0.79	4.15±0.75	2.39±1.11^ab
定向(6)	5.85±0.37	5.75±0.72	4.74±1.14^ab
总分(30)	27.40±1.19	26.95±1.05	19.74±2.96^ab

表1 三组人群MoCA评分比较

变　量	对照组(n＝20)	认知正常组(n＝20)	认知障碍组(n＝23)
视空间/执行(5)	4.75±0.55	4.65±0.58	3.04±1.07^ab
命名(3)	2.65±0.49	2.50±0.51	2.39±0.58^a
注意(6)	5.35±0.49	5.40±0.50	3.13±0.69^ab
语言(3)	2.70±0.57	2.60±0.60	2.57±0.59^a
抽象(2)	1.85±0.37	1.90±0.31	1.48±0.51^ab
延时回忆(5)	4.25±0.79	4.15±0.75	2.39±1.11^ab
定向(6)	5.85±0.37	5.75±0.72	4.74±1.14^ab
总分(30)	27.40±1.19	26.95±1.05	19.74±2.96^ab

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Expression and Significance of Serum lipocalin-2 in Patients with chronic obstructive pulmonary disease with Cognitive Impairment

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Expression and Significance of Serum lipocalin-2 in Patients with chronic obstructive pulmonary disease with Cognitive Impairment