摘要：

目的 探讨血清胱抑素C（Cys-C）表达变化对初诊帕金森病患者轻度认知损害的早期诊断价值。方法 共101 例初诊帕金森病患者分为帕金森病轻度认知损害组（PD-MCI组，43 例）和帕金森病认知功能正常组（对照组，58 例），循环酶法检测血清Cys-C、脂质、肌酐和尿酸水平，简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价认知功能；Logistic 回归分析评价血清Cys-C 与认知功能间的相关性；受试者工作特征曲线（ROC 曲线）计算血清Cys-C 早期诊断帕金森病轻度认知损害之灵敏度、特异度和准确率。结果 PD-MCI 组患者血清Cys-C 水平高于对照组［（1.12 ± 0.10）mg/L 对（1.00 ± 0.15）mg/L，P = 0.000］。各项危险因素筛查仅血清Cys-C 为帕金森病患者轻度认知损害的独立危险因素（OR = 4.285，95%CI：1.301 ~ 14.112；P = 0.017），且与MMSE 总评分（r_s = -0.831，P = 0.000）和MoCA总评分（r_s = -0.848，P  = 0.000），以及视空间能力和执行功能（r_s = -0.495，P  = 0.001）、注意力和计算力（r_s = -0.339，P  = 0.026）、延迟回忆（r_s = -0.307，P = 0.045）评分均呈负相关；ROC 曲线下面积为0.707（95%CI：0.603 ~ 0.811，P  = 0.000），诊断灵敏度和特异度分别为53.50%和82.80%，所对应的血清Cys-C 临界值为1.105 mg/L。结论 血清Cys-C 表达水平升高可能与初诊帕金森病患者轻度认知损害密切相关，具有早期诊断参考价值。

关键词: 半胱氨酸蛋白酶抑制剂, 帕金森病, 认知障碍, 危险因素, 回归分析

Abstract:

Objective  To investigate the diagnostic value of expression level of serum cystatin C (Cys-C) on early diagnosis of newly diagnosed Parkinson's disease with mild cognitive impairment (PD-MCI).  Methods  A total of 101 PD patients were divided into 2 groups: PD-MCI gruop (N = 43) and PD with normal cognition group (control group, N = 58). The levels of serum Cys-C, lipid, creatinine (Cr) and uric acid (UA) were tested. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function, and Logistic regression analysis was used to evaluate the correlation between PD-MCI and the level of serum Cys-C. Receiver operating characteristic (ROC) curve was used to detect the sensitivity and specificity of early diagnosis.  Results  The expression level of serum Cys-C in PD-MCI group [(1.12 ± 0.10) mg/L] was higher than that of control group [(1.00 ± 0.15) mg/L, P = 0.000]. Univariate and multivariate Logistic regression analysis showed that serum Cys-C was the independent risk factor for PD-MCI (OR = 4.285, 95% CI: 1.301-14.112; P = 0.017); Spearman rank correlation analysis showed the expression level of serum Cys-C was negatively correlated with MMSE total score (r_s = -0.831, P = 0.000), MoCA total score (r_s = -0.848, P = 0.000), visuospatial/executive function (r_s = -0.495, P = 0.001), attention/counting (r_s = -0.339, P = 0.026) and delayed recall (r_s = -0.307, P = 0.045). ROC curve analysis showed that area under the curve (AUC) was 0.707 (95%CI: 0.603-0.811, P = 0.000). Diagnostic sensitivity and specificity were 53.50% and 82.80% respectively, and the critical value of serum Cys-C level was 1.105 mg/L.  Conclusions  Increased expression level of serum Cys-C maybe closely related with newly diagnosed PD-MCI, and has a certain value to the early diagnosis of PD-MCI.

Key words: Cysteine proteinase inhibitors, Parkinson disease, Cognition disorders, Risk factors, Regression analysis