广西医学

目的分析阿尔茨海默病（AD）患者血清C-X-C基序趋化因子配体12（CXCL12）、几丁质酶3样蛋白1（CHI3L1）的表达水平及其临床意义。方法选择113例AD患者作为AD组，60例血管性痴呆（VD）患者作为VD组，60例健康体检者作为对照组，根据简易精神状态检查（MMSE）量表评分结果将AD组患者分为轻度组（n=27）、中度组（n=51）、重度组（n=35）。比较AD组、VD组、对照组之间及不同病情严重程度的AD患者之间的血清CXCL12、CHI3L1表达水平。采用Pearson检验分析AD患者血清CXCL12、CHI3L1表达水平与MMSE量表评分的相关性，采用受试者工作特征（ROC）曲线分析血清CXCL12、CHI3L1表达水平对AD的诊断效能。结果与对照组相比，AD组和VD组的血清CXCL12表达水平降低，血清CHI3L1表达水平升高，且AD组的血清CXCL12表达水平低于VD组，血清CHI3L1表达水平高于VD组（P＜0.05）；不同病情严重程度AD患者血清CXCL12、CHI3L1表达水平差异有统计学意义，其中血清CXCL12表达水平为重度组＜中度组＜轻度组，血清CHI3L1表达水平为重度组＞中度组＞轻度组（P＜0.05）。Pearson相关分析结果显示，AD患者血清CXCL12表达水平与MMSE量表评分呈正相关，血清CHI3L1表达水平与MMSE量表评分呈负相关，血清CXCL12表达水平与血清CHI3L1表达水平呈负相关（P＜0.05）。ROC曲线分析结果显示，血清CXCL12、CHI3L1表达水平单独及联合诊断AD的曲线下面积分别为0.862、0.831、0.915，二者联合诊断的效能优于单独诊断（P＜0.05），且血清CXCL12和CHI3L1表达水平的最佳截断值分别为2.03 ng/mL和211.08 ng/mL。结论 AD患者血清中CXCL12表达下调、CHI3L1表达上调，二者表达异常与AD病情严重程度密切相关。二者或可作为辅助诊断AD及判断其病情严重性的生物学标志物。

ObjectiveTo analyze the expressions of serum C-X-C motif chemokine ligand 12 (CXCL12) and chitinase 3-like protein 1 (CHI3L1) in patients with Alzheimer′s disease (AD) and their clinical significance. MethodsA total of 113 patients with AD were selected as AD group, 60 patients with vascular dementia (VD) as VD group, and 60 healthy check-up individuals as control group. Patients in the AD group were divided into mild group (n=27), moderate group (n=51), or severe group (n=35) according to the Mini-Mental State Examination (MMSE) scale score. The expressions of serum CXCL12 and CHI3L1 were compared between the AD group, VD group and the control group, and between AD patients with different severities. The correlation of serum CXCL12 and CHI3L1 expressions with MMSE scale score in AD patients was analyzed by using the Pearson test. The diagnostic efficiency of serum CXCL12 and CHI3L1 expressions on AD was analyzed by employing the receiver operating characteristic (ROC) curve. ResultsCompared with the control group, serum CXCL12 expression was declined, and serum CHI3L1 expression was elevated in the AD group and the VD group; moreover, serum CXCL12 expression in the AD group was lower than that in the VD group, and serum CHI3L1 expression in the AD group was higher than that in the VD group (P＜0.05). There were statistically significant differences in serum CXCL12 and CHI3L1 expressions between AD patients with different severities, therein serum CXCL12 expression exhibited in an ascending order as follows, the severe group, the moderate group, and the mild group, whereas serum CHI3L1 expression interpreted in a descending order: the severe group, the moderate group, and the mild group (P＜0.05). The results of Pearson correlation analysis revealed that serum CXCL12 expression positively correlated with MMSE scale score, serum CHI3L1 expression negatively correlated with MMSE scale score, and serum CXCL12 expression negatively correlated with serum CHI3L1 expression in AD patients (P＜0.05). The results of ROC curve analysis indicated that areas under the curve of serum CXCL12 and CHI3L1 expressions for single and combined diagnosis of AD were 0.862, 0.831, and 0.915, respectively, and the efficiency of the combined diagnosis of the two was superior to single diagnosis (P＜0.05); in addition, the optimal cut-off value of serum CXCL12 and CHI3L1 expressions were 2.03 ng/mL and 211.08 ng/mL, respectively. ConclusionSerum CXCL12 expression is down-regulated and serum CHI3L1 expression is up-regulated in patients with AD. The abnormal expression of the two are closely related to the severity of AD. The two indices may be regarded as biochemical markers for adjuvant diagnosis of AD and judging the severity.