Department of Rheumatology, University of Sâo Paulo.
Neurology Division, Faculdade de Medicina da Universidade de São Paulo (USP).
Rheumatology (Oxford). 2021 Jan 5;60(1):179-187. doi: 10.1093/rheumatology/keaa252.
Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in anti-phospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in neural plasticity and could potentially be a biomarker of CD in primary APS (PAPS). The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, anti-phospholipid antibodies and serum BDNF levels.
This cross-sectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent a standardized cognitive examination. The demographic, clinical and laboratory characteristics of patients were recorded. Serum BDNF was measured by Enzyme Linked Immunosorbent.
Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only one (5%) healthy control (P =0.019). PAPS patients presented lower serum BDNF levels when compared with controls (P =0.007). Lower levels of BDNF were associated with CD in PAPS patients (P =0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95% CI: 4.73, 3974.32; P =0.004).
CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. The association between CD and low serum BDNF suggests that this neurotrophin can be a promising biomarker for PAPS cognitive impairment.
认知功能障碍（CD）是抗磷脂综合征（APS）中一种未被充分了解的非中风中枢神经系统表现。脑源性神经营养因子（BDNF）是一种神经营养因子，在神经可塑性中起着重要作用，并且可能是原发性 APS（PAPS）中 CD 的生物标志物。本研究旨在评估 PAPS 患者的 CD，并评估其与临床数据、抗磷脂抗体和血清 BDNF 水平的关系。
这项横断面研究比较了 44 名 PAPS 患者和 20 名年龄、性别和教育程度相匹配的健康对照者。PAPS 患者和对照组接受了标准化认知测试。记录了患者的人口统计学、临床和实验室特征。通过酶联免疫吸附法测量血清 BDNF。
与健康对照组相比，44 名 PAPS 患者中有 14 名（31.8%）患有 CD，而健康对照组中只有 1 名（5%）（P=0.019）。与对照组相比，PAPS 患者的血清 BDNF 水平较低（P=0.007）。较低的 BDNF 水平与 PAPS 患者的 CD 相关（P=0.032）。在单因素分析中，CD 与网状青斑、深静脉血栓形成、中风、癫痫发作、吸烟呈正相关，与简易精神状态检查和血清 BDNF 呈负相关。根据多因素分析，PAPS 患者 CD 的唯一独立预测因子是中风（OR 137.06；95%CI：4.73，3974.32；P=0.004）。
CD 在 PAPS 患者中常见；然而，其评估缺乏标准和客观的筛查测试。CD 与低血清 BDNF 之间的关联表明，这种神经营养因子可能是 PAPS 认知障碍的一个有前途的生物标志物。
