血清IGF-1及TNF-α水平与帕金森病患者认知功能障碍的相关性
吴 晗 李 震 李则衡 祖 洁 徐传英 崔桂云
徐州医科大学附属医院，江苏 徐州 221006
通信作者：崔桂云
【摘要】 目的 探讨血清胰岛素样生长因子-1（IGF-1）、肿瘤坏死因子-α（TNF-α）水平与帕金森病（PD）认知功能障碍的相关性，以期为帕金森病认知功能障碍寻找可能的生物标志物。方法 选取2019-12-2021-06 在徐州医科大学附属医院帕金森中心就诊的帕金森病患者 108 例（PD 组），收集其一般资料并完善 H-Y 分级、MMSE、MoCA 及 UPDRS-Ⅲ评估，根据国际运动障碍协会（MDS）的诊断标准将帕金森病组分为 PD 伴认知正常组（PD-NC）、PD 伴轻度认知障碍组（PD-MCI）及 PD 伴痴呆组（PDD），PD-MCI 组及 PDD 组定义为 PD 伴认知功能障碍组（PD-CI），选取同期健康体检者 68 例为健康对照组（HC 组），分析IGF-1、TNF-α与 MoCA 得分、UPDRS-Ⅲ得分、病程、受教育年限等指标有无相关性。采用二元 Logistic 回归分析寻找帕金森病患者发生认知功能障碍的影响因素，绘制 ROC 曲线分析血清 IGF-1 诊断帕金森病患者发生认知功能障碍的价值。结果 PD 组与 HC 组间一般资料比较差异无统计学意义，PD 组血清 TNF-α显著升高，IGF-1 显著降低，差异有统计学意义（P<0.001）。PD 组内各亚组间血清 TNF-α水平差异无统计学意义（P>0.05），各亚组间 IGF-1 水平差异有统计学意义（P<0.001）。PD 患者血清 IGF-1 与 MMSE、MoCA 呈正相关（P<0.05），校正后相关性仍显著（P<0.001），IGF-1 水平与 TNF-α水平呈负相关（r=-0.591，P<0.001），但 TNF-α与 MMSE、MoCA 评分等无显著相关性（P>0.05）。二元 Logistic 回归分析显示，低水平的 IGF-1 可能是 PD 合并认知功能障碍的危险因素（P<0.05）。ROC 曲线显示，血清 IGF-1 诊断 PD 合并认知功能障碍的 AUC 为 0.711，P<0.05，阈值为 111.50 μg/L，灵敏度为 70.9%，特异度为 69.0%。结论 帕金森病患者血清IGF-1 水平与认知功能障碍相关，且低水平的 IGF-1 是 PD 患者发生认知功能障碍的危险因素。帕金森病患者血清 TNF-α水平与认知障碍严重程度无关。血清 IGF-1 可能是 PD 患者认知功能障碍的生物标志物。
【关键词】 帕金森病；认知功能障碍；胰岛素样生长因子-1；肿瘤坏死因子-α；炎症
【中图分类号】 R742.5 【文献标识码】 A 【文章编号】 1673-5110 （2022） 05-0545-07
基金项目：江苏省科技厅青年基金项目（编号：BK20180991）
DOI：10.12083/SYSJ.220241
Correlation between serum levels of IGF and TNF-α and cognitive impairment in patients with Parkinson’s disease
WU Han, LI Zhen, LI Zeheng, ZU Jie, XU Chuanying, CUI Guiyun
The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
Corresponding author：CUI Guiyun
【Abstract】 Objective To study Analysis of the Correlation between serum IGF-1, TNF-α and cognitive impairment in patients with Parkinson’s disease. Methods One hundred and eight patients with PD admitted to the Affiliated Hospital of Xuzhou Medical University from December 2019 to June 2021 were selected as the PD group, in addition，68 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group. All PD patients were assessed for severity of cognitive impairment using MMSE, MoCA scores and for severity of motor impairment using Hoehn-Yahr stage and UPDRS Ⅲ scores. The PD group was divided into PD-NC, PD-MCI and PDD based on the diagnostic criteria for MDS. The PD-MCI and PDD groups were defined as the PD-CI group. Bivariate correlations were evaluated in order to assess correlations between IGF-1, TNF-α, MoCA, MMSE, UPDRS Ⅲ scores, disease duration and years of education. Binary Logistic regression analysis was used to find the influencing factors for the occurrence of cognitive impairment in PD patients, and ROC curve was drawn to analyze the value of serum IGF-1 in diagnosing the occurrence of cognitive impairment in PD patients. Results There were no significant differences in age, gender, years of
education, BMI, smoking, drinking, or hypertension between the PD and HC groups（P>0.05）, and serum TNF-α was significantly higher and IGF-1 was significantly lower（P<0.001）. There were significant differences in IGF-1 levels among the subgroups in PD patients（P<0.001）, and no significant differences in serum TNF-α（P>0.05）.Serum IGF-1 was positively correlated with MMSE and MoCA in PD patients（P<0.05）. After adjusting, the above associations remained significant（P<0.001）. IGF-1 and TNF-α were negatively correlated（r=-0.591,P<0.001）, but there was no correlation between TNF-α and MMSE or MoCA scores（P>0.05）. Binary Logistic regression was used to analyze the risk factors of cognitive impairment in PD patients. The results showed that longer disease duration, shorter years of education, and low levels of IGF-1 may be risk factors （P<0.05）. The ROC curve showed that the AUC of serum IGF-1 for the diagnosis of PD with cognitive impairment was 0.711（P<0.05）, and the threshold value was 111.50 μg/L, corresponding to a sensitivity of 70.9% and a specificity of 69.0%. Conclusion Serum level of IGF-1 is associated with cognitive impairment in PD patients, and low level of IGF-1 is a risk factor for the development of cognitive impairment in patients with PD. Serum TNF-α level did not correlate with cognitive impairment severity. Serum IGF-1 may be a biomarker for cognitive impairment in PD.
【Key words】 Parkinson’s disease；Cognitive impairment；Insulin-like growth factor-1；Tumor necrosis factor-α；Inflammation
