Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Neuroscience Program, SRI International, Menlo Park, CA, USA.
Transl Psychiatry. 2024 Jun 1;14(1):233. doi: 10.1038/s41398-024-02953-5.
People living with HIV and those diagnosed with alcohol use disorders (AUD) relative to healthy individuals commonly have low levels of serum albumin, substantiated as an independent predictor of cardiovascular events. White matter hyperintensities (WMH)-a neuroimaging feature of cerebral small vessel disease-are also related to cardiovascular disease. Despite consensus regarding associations between high levels of urine albumin and WMH prevalence, and low serum albumin levels and impaired cognitive functioning, relations between serum albumin and WMH burdens have rarely been evaluated. Here, a sample including 160 individuals with AUD, 142 living with HIV, and 102 healthy controls was used to test the hypothesis that serum albumin would be inversely related to WMH volumes and directly related to cognitive performance in the two diagnostic groups. Although serum albumin and periventricular WMH volumes showed an inverse relationship in both AUD and HIV groups, this relationship persisted only in the HIV group after consideration of traditional cardiovascular (i.e., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes), study-relevant (i.e., race, socioeconomic status, hepatitis C virus status), and disease-specific (i.e., CD4 nadir, HIV viral load, HIV duration) factors. Further, serum albumin contributed more significantly than periventricular WMH volume to variance in performance on a verbal learning and memory composite score in the HIV group only. Relations in both HIV and AUD groups between albumin and hematological red blood cell markers (e.g., hemoglobin, hematocrit) suggest that in this sample, serum albumin reflects hematological abnormalities. Albumin, a simple serum biomarker available in most clinical settings, may therefore help identify periventricular WMH burden and performance levels in specific cognitive domains in people living with HIV. Whether serum albumin contributes mechanistically to periventricular WMH in HIV will require additional investigation.
与健康个体相比，HIV 感染者和诊断为酒精使用障碍（AUD）的个体通常血清白蛋白水平较低，这被证实是心血管事件的独立预测因子。脑白质高信号（WMH）——脑小血管疾病的神经影像学特征——也与心血管疾病有关。尽管人们普遍认为尿液白蛋白水平高与 WMH 患病率、血清白蛋白水平低与认知功能障碍之间存在关联，但血清白蛋白与 WMH 负担之间的关系很少得到评估。在这里，使用包括 160 名 AUD 患者、142 名 HIV 感染者和 102 名健康对照者的样本来检验假设，即血清白蛋白与 WMH 体积呈负相关，与两个诊断组的认知表现呈正相关。尽管血清白蛋白和脑室周围 WMH 体积在 AUD 和 HIV 组中均呈负相关，但在考虑了传统心血管（即年龄、性别、体重指数（BMI）、尼古丁使用、高血压、糖尿病）、与研究相关的（即种族、社会经济地位、丙型肝炎病毒状况）和疾病特异性（即 CD4 最低点、HIV 病毒载量、HIV 持续时间）因素后，这种关系仅在 HIV 组中持续存在。此外，仅在 HIV 组中，血清白蛋白比脑室周围 WMH 体积对 HIV 组言语学习和记忆综合评分的表现差异有更大的贡献。在 HIV 和 AUD 组中，白蛋白与血液学红细胞标志物（如血红蛋白、血细胞比容）之间的关系表明，在该样本中，血清白蛋白反映了血液学异常。白蛋白是大多数临床环境中都可获得的简单血清生物标志物，因此可能有助于识别 HIV 感染者脑室周围 WMH 负担和特定认知领域的表现水平。白蛋白是否在机制上导致 HIV 中的脑室周围 WMH 需要进一步研究。
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