肌萎缩侧索硬化患者认知功能损害与代谢水平的相关性

豆瑞霞; 谷成; 张璐璐; 梁韫华; 张毅

doi:10.16766/j.cnki.issn.1674-4152.004078

肌萎缩侧索硬化患者认知功能损害与代谢水平的相关性

doi: 10.16766/j.cnki.issn.1674-4152.004078

豆瑞霞^{1, 2},
谷成²,
张璐璐^{1, 2},
梁韫华^{1, 2},
张毅^2, ,

1.
甘肃中医药大学第一临床医学院，甘肃兰州 730000
2.
甘肃省人民医院神经内科，甘肃兰州 730000

基金项目:

科技部科技创新2030-“脑科学与类脑研究”重大项目 2021ZD0201801

甘肃省科技计划项目 23JRRA1290

详细信息

通讯作者:
张毅，E-mail：zhangyi9310@21cn.com

中图分类号: R744.8
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出版历程
- 收稿日期: 2025-01-25
- 网络出版日期: 2025-10-25

Correlation between cognitive impairment and metabolic level in patients with amyotrophic lateral sclerosis

DOU Ruixia^{1, 2},
GU Cheng²,
ZHANG Lulu^{1, 2},
LIANG Yunhua^{1, 2},
ZHANG Yi^{2
, ,}

1.
Department of Neurology, Gansu Provincial People' s Hospital, Lanzhou, Gansu 730000, China

摘要

摘要: 目的探索肌萎缩侧索硬化(ALS)患者认知损害与代谢指标的关系，以期提高ALS患者认知损害的早期干预率。方法回顾性分析2022年7月—2024年3月在甘肃省人民医院门诊及住院部就诊的36例ALS患者的基本临床资料，收集血肌酐(Cr)、尿酸(UA)、肌酸激酶(CK)、总胆固醇(TC)、甘油三酯(TG)、高/低密度脂蛋白胆固醇(H/LDL-C)等代谢指标，采用Spearman、logistic回归对代谢指标与认知损伤的相关性进行分析。结果对36例ALS患者使用简易精神状态检查表(MMSE)评估显示，20例伴发认知功能障碍，认知功能障碍的发生率为55.56%。与非认知障碍组比较，认知障碍组女性占比、ALS患者功能评分量表(ALSFRSr)评分、CK和LDL-C等指标均较高, 教育程度及UA均较低, 差异有统计学意义(P＜0.05)。蒙特利尔认知评估量表(MoCA)评估显示，19例伴发认知功能障碍，认知功能障碍的发生率为52.78%。与非认知障碍组比较，认知障碍组女性占比、ALSFRSr评分、CK和LDL-C等指标均较高, 教育程度及UA均较低，差异有统计学意义(P＜0.05)。Logistic回归分析显示，女性、高ALSFRSr评分及低UA均为患者认知损害的主要危险因素(P＜0.05)。结论女性、ALSFRSr评分、血脂、延髓起病、教育水平及UA与ALS患者认知损害相关，对ALS患者应加强以上因素的关注并及时干预。
- 肌萎缩侧索硬化症 /
- 认知损害 /
- 代谢指标
Abstract: Objective To explore the relationship between cognitive impairment and metabolic indicators in patients with amyotrophic lateral sclerosis (ALS) in order to improve the early intervention rate of cognitive impairment in ALS patients. Methods The basic clinical data of 36 ALS patients who visited the Outpatient and Inpatient Departments of Gansu Provincial People' s Hospital from July 2022 to March 2024 were collected. Metabolic indexes such as serum creatinine (Cr), uric acid (UA), creatine kinase (CK), total cholesterol (TC), triglycerides (TG), high/low-density lipoprotein cholesterol (H/LDL-C) were also collected. Spearman and logistic regression were used to analyze the correlation between metabolic indexes and cognitive impairment. Results Univariate analysis: among the 36 ALS patients, 20 patients had cognitive impairment after minimum mental state examination (MMSE) evaluation, and the incidence of cognitive impairment was 55.56%. Compared with the non-cognitively impaired group, the cognitively impaired group had a higher percentage of females, higher ALSFRSr scores, higher CK and LDL-C, and lower education and UA, with statistically significant differences (P < 0.05). After Montreal cognitive assessment (MoCA) evaluation, 19 patients had cognitive impairment, and the incidence of cognitive impairment was 52.78%. Compared with the non-cognitively impaired group, the cognitively impaired group had a higher percentage of females, higher ALSFRSr scores, higher CK and LDL-C, and lower education and UA, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that female, high ALSFRSr score, and low UA were the main risk factors for cognitive impairment in patients (P < 0.05). Conclusion Female gender, ALSFRSr score, blood lipids, bulbar onset, education level and UA are associated with cognitive impairment in ALS patients. It is necessary to pay more attention to the above factors and intervene in time for ALS patients.
- Amyotrophic lateral sclerosis /
- Cognitive impairment /
- Metabolic markers

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表 1 不同MMSE评分分组ALS患者各项代谢指标比较

Table 1. Comparison of metabolic parameters in ALS patients with different MMSE scores

组别	例数	性别 (男性/女性，例)	年龄 (x±s, 岁)	延髓起病 [例(%)]	起病年龄 (x±s, 岁)		教育程度 [M(P₂₅, P₇₅), 年]	病程 (x±s, 年)	BMI (x±s)	ALSFRSr评分 [M(P₂₅, P₇₅), 分]
认知障碍组	20	9/11	59.40±12.12	11(55.00)	56.85±11.90		7.00(5.75, 9.00)	10.42±4.98	22.15±3.46	39.00(35.75, 41.00)
非认知障碍组	16	14/2	53.75±12.99	9(56.25)	52.12±12.47		10.00(9.00, 12.50)	11.65±5.45	22.48±4.93	22.00(21.75, 25.50)
统计量			1.350^b		1.161^b		2.624^c	0.766^b	0.233^b	-4.613^c
P值		0.014^a	0.187	0.999^a	0.254		0.008	0.444	0.816	< 0.001

组别	例数	TC (x±s, mmol/L)	TG[M(P₂₅, P₇₅), mmol/L]	CK (x±s, mmol/L)		Cr [M(P₂₅, P₇₅), mmol/L]		UA [M(P₂₅, P₇₅), μmol/L]	LDL-C[M(P₂₅, P₇₅), mmol/L]	HDL-C (x±s, mmol/L)
认知障碍组	20	4.26±0.96	1.04(0.77, 1.62)	236.22±136.37		55.05(46.50, 60.20)		275.50(194.25, 298.75)	2.48(1.99, 2.89)	1.15±0.30
非认知障碍组	16	4.37±0.95	1.30(1.01, 2.01)	116.88±39.11		61.79(50.33, 69.78)		436.79(432.75, 461.25)	1.77(1.22, 1.89)	1.10±0.32
统计量		0.358^b	-1.545^c	3.734^b		-0.462^c		-4.551^c	-3.004^c	0.322^b
P值		0.721	0.124	0.001		0.648		< 0.001	0.002	0.750
注：^a为采用Fisher精确检验，^b为t值，^c为Z值。

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表 2 不同MoCA评分分组ALS患者各项代谢指标比较

Table 2. Comparison of metabolic parameters in ALS patients with different MoCA scores

组别	例数	性别 (男性/女性，例)	年龄 (x±s, 岁)	延髓起病 [例(%)]	起病年龄 (x±s, 岁)		教育程度 [M(P₂₅, P₇₅), 年]	病程 (x±s, 年)	BMI (x±s)	ALSFRSr评分 [M(P₂₅, P₇₅), 分]
认知障碍组	19	8/11	58.89±12.23	10(52.63)	56.37±12.02		7.00(5.50, 9.00)	10.42±4.98	21.97±3.45	39.00(36.00, 41.00)
非认知障碍组	17	15/2	54.65±13.11	10(58.82)	52.94±12.53		10.00(9.00, 12.00)	11.65±5.45	22.67±4.84	22.00(22.00, 25.00)
统计量			1.013^b		0.836^b		-2.933^c	0.689^b	0.501^b	-4.837^c
P值		0.006^a	0.322	0.749^a	0.408		0.003	0.488	0.618	< 0.001

组别	例数	TC (x±s, mmol/L)	TG[M(P₂₅, P₇₅), mmol/L]	CK (x±s, mmol/L)		Cr [M(P₂₅, P₇₅), mmol/L]		UA [M(P₂₅, P₇₅), μmol/L]	LDL-C[M(P₂₅, P₇₅), mmol/L]	HDL-C (x±s，mmol/L)
认知障碍组	19	4.30±0.97	1.06(0.77, 1.66)	246.13±132.50		54.40(46.50, 58.25)		275.00(192.50, 288.50)	2.48(2.01, 2.90)	1.15±0.30
非认知障碍组	17	4.32±0.95	1.29(1.01, 2.01)	112.83±41.39		69.18(51.00, 70.60)		436.59(432.00, 458.00)	1.77(1.23, 1.89)	1.10±0.32
统计量		0.057^b	-1.248^c	4.163^b		-0.939^c		-4.578^c	-3.392^c	0.534^b
P值		0.953	0.208	< 0.001		0.346		< 0.001	< 0.001	0.597
注：^a为采用Fisher精确检验，^b为t值，^c为Z值。

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表 3 MMSE评分评估认知障碍与各代谢指标的Spearman相关分析

Table 3. Spearman correlation analysis between cognitive impairment assessed by MMSE score and various metabolic indicators

项目	r值	P值
教育程度	-0.446	0.006
病程	-0.111	0.521
BMI	-0.016	0.925
Cr	-0.081	0.640
TC	-0.046	0.791
TG	-0.264	0.119
UA	-0.772	< 0.001
LDL-C	0.509	0.002
CK	0.429	0.009

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表 4 MoCA评分评估认知障碍与各代谢指标的Spearman相关分析

Table 4. Spearman correlation analysis between cognitive impairment assessed by MoCA score and various metabolic indicators

因素	r值	P值
教育程度	-0.498	0.002
病程	-0.105	0.543
BMI	-0.070	0.686
Cr	-0.161	0.349
TC	0.019	0.913
TG	-0.215	0.209
UA	-0.777	< 0.001
LDL-C	0.577	< 0.001
CK	0.512	0.001

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表 5 MMSE评分评估认知障碍相关因素的logistic回归分析

Table 5. Logistic regression analysis of factors linked to cognitive impairment based on MMSE scores

自变量	B	SE	Waldχ²	P值	OR值	95% CI
模型1
女性	2.330	0.880	2.640	0.008	10.310	1.820~58.390
ALSFRSr评分	0.461	0.154	2.981	0.003	1.590	1.172~2.153
UA	-0.033	0.010	-3.360	< 0.001	0.972	0.953~0.990
模型2
高ALSFRSr评分	3.411	1.380	2.470	0.013	30.252	2.024~452.420
低UA水平	3.313	1.410	2.336	0.019	27.391	1.710~438.172
注：男性=0，女性=1；连续性变量，以实际值赋值；ALSFRSr评分，低评分=0，高评分=1；UA水平，正常/高UA=0，低UA=1。

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表 6 MoCA评分评估认知障碍相关因素的logistic回归分析

Table 6. Logistic regression analysis of factors linked to cognitive impairment based on MoCA scores

变量	B	SE	Waldχ²	P值	OR值	95% CI
模型1
女性	2.149	0.881	2.444	0.015	8.562	1.527~47.963
ALSFRSr评分	0.367	0.109	3.211	0.001	1.444	1.151~1.814
UA	-0.033	0.010	-3.302	< 0.001	0.970	0.950~0.990
模型2
高ALSFRSr评分	4.001	1.366	2.923	0.004	54.873	3.720~808.708
低UA水平	3.518	1.675	2.091	0.036	33.718	1.259~907.153
注：男性=0，女性=1；连续性变量，以实际值赋值；ALSFRSr评分，低评分=0，高评分=1；UA水平，正常/高UA=0，低UA=1。

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