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  • 毛晓薇,王宗文,毕晓莹.神经梅毒患者血脑屏障通透性与认知功能损害的相关性分析[J].第二军医大学学报,2019,40(12):1298-1302    [点击复制]
  • MAO Xiao-wei,WANG Zong-wen,BI Xiao-ying.Correlation between blood-brain barrier permeability and cognitive impairment of neurosyphilis patients[J].Acad J Sec Mil Med Univ,2019,40(12):1298-1302   [点击复制]
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神经梅毒患者血脑屏障通透性与认知功能损害的相关性分析
毛晓薇1,王宗文2,毕晓莹1*
0
(1. 海军军医大学(第二军医大学)长海医院神经内科, 上海 200433;
2. 同济大学附属天佑医院神经内科, 上海 200331
*通信作者)
摘要:
目的 测定神经梅毒患者脑脊液白蛋白/血清白蛋白比值(QALB),探讨神经梅毒患者血脑屏障通透性与认知功能损害的相关性。方法 回顾性收集2010年1月至2018年1月海军军医大学(第二军医大学)长海医院确诊的93例抗人类免疫缺陷病毒(HIV)阴性神经梅毒患者的病例资料。根据简易智力状态检查(MMSE)量表评分将患者分为认知功能障碍组(38例)与无认知功能障碍组(55例),比较2组患者的人口学资料、临床资料、脑脊液生物化学资料。采用Pearson双变量相关分析研究神经梅毒患者血脑屏障通透性与认知功能障碍之间的相关性。结果 认知功能障碍组与无认知功能障碍组神经梅毒患者的性别、年龄、文化程度、婚姻状况等差异均无统计学意义(P均>0.05)。2组患者的脑脊液白细胞计数、蛋白定量、免疫球蛋白G(IgG)、IgG指数、IgG 24 h鞘内合成率、寡克隆带阳性率差异亦均无统计学意义(P均>0.05)。认知功能障碍组患者的QALB高于无认知功能障碍组[(16.42±9.24)×10-3 vs(3.60±1.11)×10-3],差异有统计学意义(t=10.907,P<0.01)。QALB偏高(> 7×10-3)患者的认知功能障碍发生率高于QALB正常(≤ 7×10-3)的患者,分别为92.11%(35/38)和67.27%(37/55),差异有统计学意义(χ2=7.927,P=0.002)。Pearson双变量相关分析结果示QALB与MMSE评分呈负相关(r=-0.410,P=0.024)。结论 血脑屏障损伤的神经梅毒患者易出现认知功能障碍,血脑屏障通透性越高认知功能障程度越严重,检测血脑屏障通透性有助于临床评估神经梅毒患者的智力损害情况。
关键词:  血脑屏障  脑脊液  神经梅毒  认知  预后
DOI:10.16781/j.0258-879x.2019.12.1298
投稿时间:2019-09-27修订日期:2019-11-18
基金项目:上海市科委西医引导类项目(16411969900).
Correlation between blood-brain barrier permeability and cognitive impairment of neurosyphilis patients
MAO Xiao-wei1,WANG Zong-wen2,BI Xiao-ying1*
(1. Department of Neurology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Neurology, Tianyou Hospital, Tongji University, Shanghai 200331, China
*Corresponding author)
Abstract:
Objective To determine the cerebrospinal fluid/serum albumin ratio (QALB) in patients with neurosyphilis, and to explore the correlation between the blood-brain barrier permeability and the cognitive impairment. Methods A retrospective study was conducted on the clinical data from 93 patients with anti-human immunodeficiency virus (HIV)-negative neurosyphilis diagnosed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2018. According to the mini-mental state examination (MMSE) score, the patients were divided into cognitive dysfunction group (n=38) and non-cognitive dysfunction group (n=55), and the demographic data, clinical data and cerebrospinal fluid biochemical data were compared between the two groups. Pearson bivariate correlation analysis was used to analyze the relationship between blood-brain barrier permeability and cognitive dysfunction in neurosyphilis patients. Results There were no significant differences in gender, age, education level, marital status, cerebrospinal fluid leukocyte count, cerebrospinal fluid protein, immunoglobulin G (IgG), IgG index, 24-h intrathecal IgG synthesis, or oligoclonal band between the cognitive dysfunction group and non-cognitive dysfunction group (all P>0.05). The QALB was significantly higher in the cognitive dysfunction group than that in the non-cognitive dysfunction group ([16.42±9.24]×10-3 vs[3.60±1.11]×10-3, t=10.907, P<0.01). The incidence of cognitive dysfunction was significantly higher in the elevated QALB (> 7×10-3) patients versus the normal QALB (≤ 7×10-3) patients (92.11%[35/38] vs 67.27%[37/55], χ2=7.927, P=0.002). Pearson bivariate correlation analysis showed that QALB was negatively correlated with MMSE score (r=-0.410, P=0.024). Conclusion The neurosyphilis patients with blood-brain barrier damage are prone to cognitive dysfunction, and the higher the blood-brain barrier permeability, the more serious the cognitive dysfunction. Monitoring the permeability of blood-brain barrier can contribute to the assessment of intelligent damage in patients with neurosyphilis.
Key words:  blood-brain barrier  cerebrospinal fluid  neurosyphilis  cognition  prognosis