摘要：

目的: 探讨帕金森病患者血清8-羟基脱氧鸟苷（8-OHdG）和丙二醛（MDA）水平与认知功能障碍及其严重程度的相关性。方法: 选择2021年2月至2022年2月徐州医科大学附属医院诊断与治疗的126例帕金森病患者，根据是否合并认知功能障碍分为帕金森病认知功能正常组（PDN组，41例）、帕金森病轻度认知障碍组（PD-MCI组，47例）、帕金森病痴呆组（PDD组，38例），并选择同期50例健康体检者作为对照组。采用Hoehn-Yahr分期评估帕金森病患者药物“关”期病情严重程度，统一帕金森病评价量表第三部分（UPDRSⅢ）评估药物“关”期运动功能，蒙特利尔认知评价量表（MoCA）评估安静及药物“开”期认知功能障碍严重程度，并测定帕金森病患者和对照者血清8-OHdG和MDA水平。采用Pearson相关分析及偏相关分析探讨血清8-OHdG和MDA水平与帕金森病患者MoCA评分的相关性，单因素和多因素Logistic回归分析筛查帕金森病患者发生认知功能障碍的影响因素，受试者工作特征（ROC）曲线评估血清8-OHdG和MDA预测帕金森病患者发生认知功能障碍风险的效能。结果: 相关分析显示，帕金森病患者病程（r = -0.241，P = 0.007）、Hoehn-Yahr分期（r = -0.333，P = 0.007）、8-OHdG（r = -0.310，P = 0.000）、MDA（r = -0.291，P = 0.004）与MoCA评分呈负相关关系。Logistic回归分析显示，8-OHdG（OR = 1.335，95%CI：1.137 ~ 1.568；P = 0.000）和MDA（OR = 2.928，95%CI：1.676 ~ 5.115；P = 0.000）水平升高是帕金森病患者发生认知功能障碍的危险因素。ROC曲线显示，8-OHdG、MDA及二者联合预测帕金森病患者发生认知功能障碍的曲线下面积分别为0.831（95%CI：0.761 ~ 0.902，P = 0.000）、0.846（95%CI：0.775 ~ 0.916，P = 0.000）和0.922（95%CI：0.878 ~ 0.966，P = 0.000）。结论: 外周血8-OHdG和MDA有望成为评估帕金森病患者发生认知功能障碍及其严重程度的血清学标志物。

关键词: 帕金森病, 8-羟基-2’-脱氧鸟苷, 丙二醛, 认知障碍, 氧化性应激, 危险因

Abstract:

Objective: To explore the relationship between the levels of serum 8 - hydroxy deoxyguanosine (8 - OHdG) and malondialdehyde (MDA) and cognitive dysfunction in patients with Parkinson's disease (PD). Methods: From February 2021 to February 2022, 126 patients with PD in The Affiliated Hospital of Xuzhou Medical University were divided into normal cognitive function group (PDN group, n = 41), mild cognitive impairment group (PD - MCI group, n = 47) and Parkinson's disease dementia group (PDD group, n = 38), and 50 healthy subjects were selected as control group. Hoehn - Yahr staging was used to evaluate the severity of patients with PD during the "close" period of anti - PD drugs, and the motor function of patients with PD was evaluated by the Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ). Montreal Cognitive Assessment (MoCA) was used to evaluate the severity of cognitive dysfunction at rest and in the "on" period of anti - PD drugs, and the serum 8 - OHdG and MDA of PD patients and controls were collected. Pearson and partial correlation analyses were used to analyze the correlation between the levels of serum 8-OHdG and MDA and MoCA score in PD patients. Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of cognitive dysfunction in PD patients. The efficacy analysis of serum 8 - OHdG and MDA levels in predicting the risk of cognitive dysfunction in PD patients was carried out by using receiver operating characteristic curve (ROC curve). Results: The results of correlation analysis showed that there was a negative correlation between the MoCA score and the duration (r = - 0.241, P = 0.007), Hoehn - Yahr staging (r = - 0.333, P = 0.007), 8 - OHdG (r = - 0.310, P = 0.000) and MDA (r = - 0.291, P = 0.004) in PD patients. The results of Logistic regression analysis showed that the elevated levels of 8 - OHdG (OR = 1.335, 95%CI: 1.137-1.568; P = 0.000) and MDA (OR = 2.928, 95%CI: 1.676-5.115; P = 0.000) were risk factors for cognitive dysfunction in PD patients. The results of ROC curve showed the areas under the curve of 8-OHdG, MDA and their combination in predicting cognitive dysfunction in PD patients were 0.831 (95%CI: 0.761-0.902, P = 0.000), 0.846 (95%CI: 0.775-0.916, P = 0.000) and 0.922 (95%CI: 0.878- 0.966, P = 0.000), respectively. Conclusions: The detection of 8 - OHdG and MDA in peripheral blood is expected to be a serum marker to evaluate the severity of cognitive dysfunction in patients with PD, and to predict cognitive dysfunction in patients with PD.

Key words: Parkinson disease, disorders, Oxidative stress, Risk factors, Logistic models, ROC curve