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| 首发与复发老年抑郁症患者AD7c-NTP及Hcy水平与认知功能关系的研究 |
| Association of AD7c-NTP and hcy levels with cognitive impairment in elderly patients with first-episode depression and recurrent depressive disorder |
| 投稿时间：2025-08-27 |
| DOI：10.3969/j.issn.1000-0399.2026.05.001 |
| 中文关键词: 老年抑郁症 首发性抑郁障碍 复发性抑郁障碍 阿尔茨海默病相关神经丝蛋白 同型半胱氨酸 认知障碍 |
| 英文关键词: Late life depression First-episode depression Recurrent depressive disorder Alzheimer disease-associated neurofilament protein Homocysteine Cognitive impairment |
| 基金项目:安徽省临床医学研究转化专项项目(编号:202204295107020065); 芜湖市卫生健康委科研项目(编号:WHWJ2022Z018) |
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| 中文摘要: |
| 目的 比较首发性与复发性老年抑郁症（LLD）患者尿液阿尔茨海默病相关神经丝蛋白（AD7c-NTP）及血清同型半胱氨酸（Hcy）水平，并分析LLD患者AD7c-NTP、Hcy与认知功能的关系。方法 采用横断面病例对照设计，选取2023年1月至2025年2月在芜湖市第四人民医院就诊的135例符合ICD-10抑郁发作标准的抑郁症患者为LLD组，根据抑郁发作次数将其分为首发组62例，复发组73例，选取同期健康体检者66例作为对照组。收集所有受试者的一般资料，采用24项-汉密尔顿抑郁量表（HAMD-24）、简易精神状态检查量表（MMSE）及蒙特利尔认知评估量表（MoCA）评估所有受试者抑郁症状及认知功能；通过酶联免疫吸附法（ELISA）检测所有受试者尿液AD7c-NTP水平，循环酶法检测所有受试者血清Hcy水平。比较LLD患者与对照组在认知功能、AD7c-NTP及Hcy水平的差异，并进一步比较首发组与复发组在上述指标上的差异；采用Spearman相关分析探讨LLD组患者AD7c-NTP、Hcy水平与认知评分的相关性；采用受试者工作特征（ROC）曲线分析AD7c-NTP和Hcy对LLD患者认知障碍的预测价值。结果 复发组尿液AD7c-NTP水平和血清Hcy水平高于首发组（P<0.05），且MoCA评分和MMSE评分更低（P<0.05）。LLD患者AD7c-NTP水平与MMSE评分（rs=-0.484,P<0.001）、MoCA评分（rs=-0.544,P<0.001）呈负相关，Hcy水平与MMSE评分（rs=-0.472,P<0.001）、MoCA评分（rs=-0.409,P<0.001）呈负相关。AD7c-NTP、Hcy单独及联合预测LLD认知障碍的曲线下面积（AUC）分别为0.865、0.886、0.922，联合预测效果更佳（P<0.05）。结论 首发LLD患者较复发患者尿AD7c-NTP和血清Hcy水平升高更明显，认知损害更严重。AD7c-NTP和Hcy与认知功能呈负相关，二者联合检测对LLD认知障碍具有较高的预测价值。 |
| 英文摘要: |
| Objective To compare the levels of urinary Alzheimer disease-associated neuronal thread protein（AD7c-NTP） and serum homocysteine（Hcy） between patients with first-episode and recurrent late-life depression（LLD）, and to analyze the relationship between these biomarkers and cognitive function in the overall LLD population. Methods A cross-sectional case-control study was conducted. A total of 135 patients diagnosed with a depressive episode according to ICD-10 criteria at the Fourth People's Hospital of Wuhu from January 2023 to February 2025 were enrolled as the LLD group. Based on the number of depressive episodes, they were divided into a first-episode group（n=62） and a recurrent group（n=73）. Additionally, 66 healthy individuals undergoing health checks during the same period were selected as the control group. General data were collected from all participants. Depressive symptoms and cognitive function were assessed using the 24-item Hamilton Depression Rating Scale（HAMD-24）, the Mini-Mental State Examination（MMSE）, and the Montreal Cognitive Assessment（MoCA）. Urinary AD7c-NTP levels were measured by enzyme-linked immunosorbent assay（ELISA）, and serum Hcy levels were measured by an enzymatic cycling assay. Differences in cognitive function, AD7c-NTP, and Hcy levels were compared between the overall LLD group and the control group, and further compared between the first-episode and recurrent subgroups. Spearman correlation analysis was used to explore the relationship between AD7c-NTP, Hcy levels, and cognitive scores in the LLD group. Receiver operating characteristic（ROC） curve analysis was performed to evaluate the predictive value of AD7c-NTP and Hcy for cognitive impairment in LLD. Results The recurrent group exhibited higher urinary AD7c-NTP and serum Hcy levels compared to the first-episode group（P<0.05）, along with significantly lower MoCA and MMSE scores（P<0.05）. In the overall LLD group, AD7c-NTP levels were negatively correlated with MMSE scores（rs =-0.484, P<0.001） and MoCA scores（rs =-0.544, P<0.001）. Similarly, Hcy levels were negatively correlated with MMSE scores（rs =-0.472, P<0.001） and MoCA scores（rs =-0.409, P<0.001）. The area under the ROC curve（AUC） for predicting cognitive impairment in LLD was 0.865 for AD7 cNTP alone, 0.886 for Hcy alone, and 0.922 for their combination, with the combined prediction showing significantly better performance（P<0.05）. Conclusion Recurrent LLD patients have higher urinary AD7c-NTP and serum Hcy levels and more severe cognitive impairment than first-episode patients. Both AD7c-NTP and Hcy levels are negatively correlated with cognitive function. The combined detection of AD7 cNTP and Hcy holds significant predictive value for cognitive impairment in LLD patients. |
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