<sup>11</sup>C-PIB阳性的认知功能障碍患者临床、基因型及嗅觉特点

doi:10.3969/j.issn.1672-6731.2020.05.013

摘要/Abstract

摘要：

研究背景 总结¹¹C-匹兹堡复合物B（¹¹C-PIB）阳性的认知功能障碍患者临床、基因型和嗅觉功能特点。方法纳入2015年1月至2016年2月27例¹¹C-PIB阳性的认知功能障碍患者[包括19例阿尔茨海默病（AD）和8例轻度认知损害（MCI）]，采用简易智能状态检查量表（MMSE）、蒙特利尔认知评价量表（MoCA）和画钟测验（CDT）评价认知功能，神经精神科问卷（NPI）评价精神行为，日常生活活动能力量表（ADL）评价日常生活活动能力，汉密尔顿抑郁量表21项（HAMD-21）评价抑郁症状；聚合酶链反应-限制性片段长度多态性测定ApoE基因型；T&T嗅觉计定量检测嗅觉功能，测定察觉阈值和识别阈值。结果神经心理学测验比较，AD组MMSE总评分（P=0.000）及其时间定向力（P=0.031）、瞬时记忆（P=0.021）、延迟回忆（P=0.009）、计算力（P=0.000）、复述（P=0.038）、阅读（P=0.021）、书写（P=0.002）、视空间能力（P=0.039），以及MoCA评分（P=0.000）和CDT评分（P=0.020）均低于MCI组，ADL评分高于MCI组（P=0.000），而MMSE量表之地点定向力、命名、理解力，以及NPI和HAMD-21评分组间差异无统计学意义（均P>0.05）。两组嗅觉障碍发生率、察觉域值和识别阈值差异亦无统计学意义（均P>0.05）。不同ApoE基因型之间嗅觉障碍发生率差异有统计学意义（Fisher确切概率法：P=0.000），携带ApoEε4等位基因的患者嗅觉障碍发生率高于未携带该等位基因的患者（0/11对12/13；Fisher确切概率法：P=0.000）。结论 ¹¹C-PIB阳性的认知功能障碍患者（包括阿尔茨海默病和轻度认知损害）存在明显的嗅觉障碍，且与ApoEε4等位基因相关，结合不同临床、基因型和嗅觉功能特点有助于早期诊断阿尔茨海默病。

关键词: 认知障碍, 阿尔茨海默病, 正电子发射断层显像术, 载脂蛋白 E 类, 基因型, 嗅觉

Abstract:

Background To summarize the clinical, genotype and olfactory characteristic in patients with ¹¹C-Pittsburgh compound B (¹¹C-PIB)-positive cognitive impairment. Methods Twenty-seven patients with ¹¹C-PIB-positive cognitive impairment, including 19 patients with Alzheimer's disease (AD) and 8 patients with mild cognitive impairment (MCI), were recruited from January 2015 to February 2016 in Tianjin Huanhu Hospital. The clinical, genotype and olfactory profiles were retrospectively analyzed. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Clock Drawing Test (CDT), Neuropsychiatric Inventory (NPI), Activity of Daily Living Scale (ADL), and Hamilton Depression Scale-21 (HAMD-21) were used to evaluate cognitive function, behavioral and psychological symptoms, activities of daily living, and symptoms of depression, respectively. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine ApoE genotype, and T& T olfactometer was used to test threshold of detection and recognition. Results Compared with MCI patients, AD patients had lower MMSE score (P=0.000), orientation to time (P=0.031), short-term memory (P=0.021), recall (P=0.009), calculation (P=0.000), repetition (P=0.038), reading (P=0.021), writing (P=0.002), visual-spatial ability (P=0.039), MoCA score (P=0.000) and CDT score (P=0.020), and higher ADL score (P=0.000). But there was no significant difference in orientation to place, naming, comprehension, NPI score and HAMD-21 score between 2 groups (P>0.05, for all). There were no statistical differences in incidence of olfactory dysfunction, threshold of detection and recognition between 2 groups (P>0.05, for all). There were statistical differences in the incidence of olfactory disorders among different ApoE genotypes (Fisher's exact probability:P=0.000). To further evaluate the effect of ApoEε4 allele on the olfactory function, subjects were additionally dichotomized according to the presence or absence of at least one ApoEε4 allele. Comparing with the subjects without ApoEε4 allele, the olfactory function decreased significantly in those with ApoEε4 allele (0/11 vs. 12/13; Fisher's exact probability:P=0.000). Conclusions The patients with ¹¹C-PIB-positive cognitive impairment (AD and MCI) had significant olfactory disturbance, which was related to ApoEε4 allele. The assessment of clinical, genotype and olfactory characteristic was helpful in early diagnosis of AD patients.

Key words: Cognition disorders, Alzheimer disease, Positron-emission tomography, Apolipoproteins E, Genotype, Smell

张惠红, 王盼, 豆玉超, 王艳, 张淼, 徐小林, 周玉颖. ¹¹C-PIB阳性的认知功能障碍患者临床、基因型及嗅觉特点[J]. 中国现代神经疾病杂志, 2020, 20(5): 448-454.

ZHANG Hui-hong, WAN Pan, DOU Yu-chao, WANG Yan, ZHANG Miao, XU Xiao-lin, ZHOU Yu-ying. Clinical, genotypic and olfactory characteristics of patients with ¹¹C-PIB-positive cognitive impairment[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 448-454.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/448

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2 ¹¹C-PIB阳性的认知功能障碍患者临床、基因型及嗅觉特点

Clinical, genotypic and olfactory characteristics of patients with ¹¹C-PIB-positive cognitive impairment

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2 ¹¹C-PIB阳性的认知功能障碍患者临床、基因型及嗅觉特点

Clinical, genotypic and olfactory characteristics of patients with ¹¹C-PIB-positive cognitive impairment