摘要
目的检测老年2型糖尿病(T2DM)患者血清外泌体神经元特异性烯醇化酶(NSE)和磷酸化tau(P-tau)的表达,并探讨其与患者发生轻度认知功能障碍(MCI)的相关性。方法选取2019年1月至2020年12月于联勤保障部队第921医院就诊的114例老年T2DM患者为研究对象(研究组),另选取同期健康体检者100名为对照组。采用ExoQuick-TC提取研究对象血清源性外泌体。采用酶联免疫吸附测定法(ELISA)检测研究对象血清源性外泌体中NSE和P-tau的表达。使用简易认知状态评价量表(MMSE)和蒙特利尔认知评估量表(MoCA)对研究对象进行认知评估。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。应用Spearman秩相关分析血清外泌体中NSE及P-tau表达水平与认知受损严重程度的相关性。应用受试者工作特征(ROC)曲线分析血清源性外泌体中NSE和P-tau表达水平对MCI的预测价值。结果研究组老年T2DM患者出现认知受损的比例高于对照组;MMSE和MoCA分值明显低于对照组;发生MCI的比例高于对照组,差异均有统计学意义(P<0.05)。根据MoCA分值将研究组患者分为MCI组(n=71)和非MCI组(n=43),MCI组血清外泌体中NSE和P-tau表达分别为(13.27±1.61)μg/L和(17.14±2.45)pg/ml,明显高于非MCI组的(10.86±1.43)μg/L和(14.49±2.25)pg/ml(t=5.728,6.154;P<0.05)。相关性分析显示,老年T2DM患者血清外泌体中NSE和P-tau表达水平与MMSE(r=-0.547,-0.562;P<0.05)和MoCA分值(r=-0.583,-0.597;P<0.05)存在负相关。ROC曲线分析结果显示,血清外泌体中NSE表达预测老年T2DM患者发生MCI的曲线下面积(AUC)为0.729,血清外泌体中P-tau表达预测老年T2DM患者发生MCI的AUC为0.741,而两者联合预测老年T2DM患者发生MCI的AUC为0.827,高于NSE和P-tau单个指标的预测价值(t=3.836,3.478;P<0.05)。结论血清外泌体中高表达的NSE和P-tau与老年T2DM患者MCI的发生密切相关,二者联合的预测价值更高。
Objective To detect the contents of neuron-specific enolase(NSE)and phosphorylated tau(P-tau)in serum-derived exosomes of the elderly patients with type 2 diabetes mellitus(T2DM),and explore the correlation of them with mild cognitive impairment(MCI).Methods A total of 114 elderly T2DM patients admitted in our hospital from Jan.2019 to Dec.2020 were enrolled and assigned as the study subjects(study group),and another 100 healthy volunteers taking physical examination in the same period were assigned as the control group.Exosomes in the blood samples from the study subjects were extracted by ExoQuick-TC.Enzyme linked immunosorbent assay(ELISA)was used to detect the contents of NSE and P-tau in serum-derived exosomes.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were employed to evaluate the cognitive status of the subjects.SPSS statistics 19.0 was used for data analysis.The data difference between groups was analyzed by student′s t test and Chi-square test.Spearman rank correlation analysis was adopted to study the correlation of NSE and P-tau contents in serum-derived exosomes with the severity of cognitive impairment.Receiver operating characteristic(ROC)curve was plotted to analyze predictive value of NSE and P-tau levels in serum-derived exosomes for MCI.Results The study group had significantly larger proportion of cognitive impairment,lower MMSE and MoCA scores,and higher incidence of MCI than the control group(all P<0.05).Based on the MoCA score,the 114 patients in the study group were further divided into MCI group(n=71)and non-MCI group(n=43).The levels of NSE and P-tau in serum-derived exosomes in MCI group were(13.27±1.61)μg/L and(17.14±2.45)pg/ml,which were significantly higher than those of the non-MCI group[(10.86±1.43)μg/L and(14.49±2.25)pg/ml;t=5.728,6.154;P<0.05].Correlation analysis showed that the levels of NSE and P-tau in serum-derived exosomes were negatively correlated with MMSE score(r=-0.547,-0.562;P<0.05)and MoCA score(r=-0.583,-0.597;P<0.05)in the elderly T2DM patients.ROC curve analysis indicated that the area under the curve(AUC)of NSE level to predict MCI in elderly T2DM patients was 0.729,and that of P-tau level was 0.741.And,the AUC of their combination was 0.827,which was significantly higher than that of NSE(t=3.836,P<0.05)and p-tau(t=3.478,P<0.05)in the prediction of MCI.Conclusion Higher levels of NSE and P-tau in serum-derived exosomes are closely associated with the occurrence of MCI in elderly T2DM patients.Their combination has higher predictive value for the occurrence of MCI in the patients.
作者
郑桃林
刘超
彭璠
Zheng Taolin;Liu Chao;Peng Fan(Department of Endocrinology,No.921 Hospital of PLA Joint Logistics Support Force,Changsha 410003,China;Cadre Ward,No.921 Hospital of PLA Joint Logistics Support Force,Changsha 410003,China)
出处
《中华老年多器官疾病杂志》
2023年第6期433-438,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
湖南省教育厅科研基金(19C1137)。
