脑室周围白质高信号联合同型半胱氨酸在预测帕金森病轻度认知障碍中的应用
Application of Periventricular White Matter Hyperintensities Combined with Homocysteine into Predicting Mild Cognitive Impairment in Parkinson's Disease.
作者信息
Zhang Zuowen, Li Shishuang, Wang Shumei
机构信息
Department of Neurology, Chongqing University Jiangjin Hospital, Chongqing, People's Republic of China.
College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, People's Republic of China.
出版信息
Int J Gen Med. 2023 Feb 28;16:785-792. doi: 10.2147/IJGM.S399307. eCollection 2023.
PURPOSE
To verify the associations between white matter hyperintensities (WMHs), plasma homocysteine (Hcy) levels, and mild cognitive impairment (MCI) in Parkinson's disease (PD) patients and evaluate the predictive value of combination of WMHs and plasma Hcy levels for MCI.
PATIENTS AND METHODS
In this study, 387 patients with PD were divided into MCI group and non-MCI group. Their cognition was evaluated with a comprehensive neuropsychological evaluation including 10 tests. Five cognitive domains, including the memory, attention/working memory, visuospatial, executive and language domains, were evaluated using two tests for each domain. MCI was determined when at least two tests demonstrated abnormal results, either one impaired test in two different cognitive domains or two impaired tests in a single cognitive domain. Multivariate analysis was performed to determine risk factors for MCI in PD patients. The receiver operating characteristic (ROC) curve was employed to assess the predictive values, and the test was employed to compare the area under curve (AUC).
RESULTS
MCI was identified in 195 PD patients with an incidence of 50.4%. Multivariate analysis results showed that PWMHs (OR: 5.162, 95% CI: 2.3189.527), Hcy levels (OR: 1.189, 95% CI: 1.0711.405) and MDS-UPDRS part III score (OR: 1.173, 95% CI: 1.0621.394) were independently correlated with MCI in PD patients after adjusting for confounders. ROC curves showed that the AUCs of PWMHs, Hcy levels and their combination were 0.701 (SE: 0.026, 95% CI: 0.6470.752), 0.688 (SE: 0.027, 95% CI: 0.6350.742) and 0.879 (SE: 0.018, 95% CI: 0.8440.915), respectively. test showed that the AUC of combination prediction was significantly higher than those of individual predictions (0.879 vs 0.701, =5.629, <0.001; 0.879 vs 0.688, =5.886, <0.001).
CONCLUSION
The combination of WMHs and plasma Hcy levels could be applied in the prediction of MCI in PD patients.
目的
验证帕金森病（PD）患者脑白质高信号（WMHs）、血浆同型半胱氨酸（Hcy）水平与轻度认知障碍（MCI）之间的关联，并评估WMHs与血浆Hcy水平联合对MCI的预测价值。
患者与方法
本研究中，387例PD患者被分为MCI组和非MCI组。通过包括10项测试的全面神经心理学评估对其认知功能进行评估。五个认知领域，包括记忆、注意力/工作记忆、视觉空间、执行和语言领域，每个领域使用两项测试进行评估。当至少两项测试结果异常时，即两个不同认知领域中有一项测试受损或单个认知领域中有两项测试受损，则判定为MCI。进行多变量分析以确定PD患者发生MCI的危险因素。采用受试者工作特征（ROC）曲线评估预测价值，并采用检验比较曲线下面积（AUC）。
结果
195例PD患者被诊断为MCI，发病率为50.4%。多变量分析结果显示，在校正混杂因素后，PWMHs（比值比：5.162，95%置信区间：2.3189.527）、Hcy水平（比值比：1.189，95%置信区间：1.0711.405）和MDS-UPDRS第三部分评分（比值比：1.173，95%置信区间：1.0621.394）均与PD患者的MCI独立相关。ROC曲线显示，PWMHs、Hcy水平及其联合的AUC分别为0.701（标准误：0.026，95%置信区间：0.6470.752）、0.688（标准误：0.027，95%置信区间：0.6350.742）和0.879（标准误：0.018，95%置信区间：0.8440.915）。检验显示，联合预测的AUC显著高于个体预测的AUC（0.879对0.701，=5.629，<0.001；0.879对0.688，=5.886，<0.001）。
结论
WMHs与血浆Hcy水平的联合可用于预测PD患者的MCI。
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