摘要
目的:探讨视网膜影像结构参数联合载脂蛋白E(ApoE)基因多态性对阿尔茨海默病(AD)的辅助诊断价值。方法:本研究为病例对照研究,采用方便抽样法,连续纳入2023年5月至2024年6月在四川省人民医院神经内科就诊的71例AD确诊患者和在健康管理中心参加体检的156例健康体检者作为AD病例组和健康对照组。采用光学相干断层扫描(OCT)测量研究对象视网膜神经纤维层(RNFL)和视网膜神经纤维层-内丛状层(RNFL-IPL)的厚度等视网膜影像结构参数。通过问卷调查收集研究对象人口学特征和疾病史等信息,采集静脉血检测ApoE基因多态性。将视网膜影像结构参数、ApoE基因多态性和其他相关指标纳入多因素logistic回归模型,分析影响AD患病的主要因素。根据多因素分析结果绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评估不同模型对AD的辅助诊断效能。结果:纳入分析的227例研究对象中,女性153例,男性74例;AD病例组71例,年龄(66.73±8.83)岁;健康对照组156例,年龄(61.95±8.21)岁。受教育程度小学及以下(OR=4.683,95%CI:2.133~10.282)、生活视力<0.5(OR=2.716,95%CI:1.121~6.583)、携带≥1个ApoEε4基因(OR=5.331,95%CI:2.309~11.891)均与AD患病呈正相关,RNFL增厚(OR=0.923,95%CI:0.854~0.998)与AD患病呈负相关(均P<0.05)。包含了眼底影像学特征和ApoE基因多态性的AD风险评估模型(模型4)的预测效能最高(AUC=0.857,P<0.001)。结论:视网膜影像结构参数在AD患者和健康体检者间存在差异,联合视网膜影像结构参数和ApoE基因多态性的风险评估模型具有较高的预测价值,有望作为AD的辅助诊断工具。
Objective To investigate the adjunctive diagnostic value of retinal imaging structural parameters combined with apolipoprotein E(ApoE)gene polymorphisms for Alzheimer′s disease(AD).MethodsIt was a case-control study,71 confirmed AD patients who attended the Department of Neurology in Sichuan Provincial People′s Hospital from May 2023 to June 2024 and 156 healthy medical checkups who participated in medical checkups in the Health Management Center were continuously with convenience sampling method;the subjects were included as the AD case group and healthy control group,respectively.Optical coherence tomography(OCT)was used to measure the structural parameters of retinal imaging such as the thickness of the retinal nerve fiber layer(RNFL)and the retinal nerve fiber layer-inner plexiform layer(RNFL-IPL)in the study subjects.Information on demographic characteristics and disease history of the study participants were collected through a questionnaire,and venous blood was collected to test for ApoE gene polymorphisms.The retinal imaging structural parameters,ApoE gene polymorphisms and other related indicators were included in a multifactorial logistic regression model to analyze the main factors affecting the risk of AD.Based on the results of the multifactorial analysis,the receiver operating characteristic(ROC)curves were plotted and the areas under the curve(AUC)were calculated to evaluate the efficacy of different models in the adjunctive diagnosis of AD.ResultsOf the 227 study subjects included in the analysis,153 were females and 74 were males;there were 71 cases in the AD case group with a mean age of(66.73±8.83)years,and there were 156 subjects in the healthy control group with an average age of(61.95±8.21)years.Educational attainment of elementary school and below(OR=4.683,95%CI:2.133-10.282),living visual acuity<0.5(OR=2.716,95%CI:1.12-6.583),and carrying≥1 ApoEε4 genes(OR=5.331,95%CI:2.309-11.891)were positively correlated with the risk of AD.RNFL thickening(OR=0.923,95%CI:0.854-0.998)was negatively associated with the risk of AD(all P<0.05).The AD risk assessment model(Model 4),which included fundus imaging features and ApoE gene polymorphisms,had the highest predictive efficacy(AUC=0.857,P<0.001).ConclusionRetinal imaging structural parameters differ significantly between AD patients and healthy examinees,and a risk assessment model combining retinal imaging structural parameters and ApoE gene polymorphisms has high predictive value and is expected to serve as an auxiliary diagnostic tool for AD.
作者
张辉望
蒋娟
熊慧贤
侯钦钏
兰永丽
张沫
何沛原
蒲炜
刘慧丽
肖骁
肖军
刘玉萍
帅平
Zhang Huiwang;Jiang Juan;Xiong Huixian;Hou Qinchuan;Lan Yongli;Zhang Mo;He Peiyuan;Pu Wei;Liu Huili;Xiao Xiao;Xiao Jun;Liu Yuping;Shuai Ping(Department of Health Management&Physical Examination,Sichuan Academy of Medical Sciences,Sichuan Provincial People′s Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Preventive Medicine,School of Public Health,North Sichuan Medical College,Nanchong 637100,China;School of Medicine,University of Electronic Science and Technology,Chengdu 610054,China;Department of Neurology,Sichuan Academy of Medical Sciences,Sichuan Provincial People′s Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China)
出处
《中华健康管理学杂志》
北大核心
2025年第8期590-596,共7页
Chinese Journal of Health Management
基金
四川省科技计划(2022YFS0600)
电子科技大学医工交叉联合基金(ZYGX2021YGLH208)
四川省医学科学院·四川省人民医院院科研基金(2021LY15)
关键词
阿尔茨海默病
APOE基因
视网膜影像结构参数
风险评估模型
Alzheimer′s disease
Apolipoprotein E gene
Retinal imaging structural parameters
Risk assessment models
