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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 8  |  Page : 907-911

Increased Serum Cystatin C in Early Parkinson's Disease with Objective Sleep Disturbances


1 Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
2 Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
3 Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
4 Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China

Correspondence Address:
Prof. Chun-Feng Liu
Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu 215004
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.229902

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Background: Sleep disturbance is one of the major non-motor symptoms which cause the disability of Parkinson's disease (PD) patients. Cystatin C (CysC) is a more sensitive biomarker than serum creatinine or estimated glomerular filtration rate. Previous studies have reported altered CysC levels in neurodegenerative disorders and sleep disorders. This study aimed to explore the correlations of serum CysC levels and objective sleep disturbances in early PD. Methods: We recruited 106 early PD patients and 146 age- and sex-matched controls. All participants underwent clinical investigation and video-polysomnography. Sleep parameters and serum levels of CysC were measured. Then, we investigated the relationships between CysC and clinical variables and objective sleep disturbances in early PD patients. Results: The mean serum level of CysC was significantly higher in patients with early PD (1.03 ± 0.19 mg/L) compared to controls (0.96 ± 0.15 mg/L, P = 0.009). There were significantly positive correlations between serum CysC levels and age (r = 0.334, P < 0.001), gender (r = 0.264, P = 0.013), and creatinine levels (r = 0.302, P = 0.018) in early PD patients. Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index (AHI) (r = 0.231, P = 0.017), especially hypopnea index (r = 0.333, P < 0.001). In early PD patients, elevated serum CysC levels were positively correlated with oxygen desaturation index (r = 0.223, P = 0.021), percentage of time spent at oxygen saturation (SaO2) <90% (r = 0.644, P < 0.001), arousal with respiratory event during sleep (r = 0.247, P = 0.013). On the contrary, the elevated serum CysC levels were negatively correlated with mean and minimal SaO2(r = −0.323, −0.315, both P = 0.001) in PD patients. Conclusions: The level of serum CysC was higher in early PD patients. PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation. Therefore, the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.

 

 Abstract in Chinese

血清胱抑素C水平与早期帕金森病客观睡眠障碍的关系

摘要

背景: 帕金森病(PD)是常见的神经系统变性疾病,睡眠障碍是其主要的非运动症状之一,可导致PD患者的日常生活功能障碍。血清胱抑素C(Cys C)是一种半胱氨酸蛋白酶抑制剂,与血清肌酐或肾小球滤过率相比,对监测肾功能受损更灵敏。有研究报告Cys C水平的变化与许多神经系统疾病有关,此外亦有研究发现失眠、不宁腿综合征患者的Cys C水平较正常对照出现变化。我们的研究探讨PD患者Cys C水平的变化及其与客观睡眠障碍之间的关系。
方法: 连续纳入在苏州大学附属第二医院神经内科就诊的早期PD患者106例,选取年龄性别匹配的健康中老年人146名作为对照组。所有研究对象进行一般情况、运动功能(PD患者)、生物化学指标、多导睡眠监测及睡眠参数分析采集,胱抑素等血清指标采用生化分析仪进行分析,采用SPSS17.0软件分析PD组CysC水平的变化及其与临床参数和客观睡眠障碍指标之间的关系。
结果: PD组CysC平均水平(1.03 ± 0.19 mg/l)较健康对照组(0.96 ± 0.15 mg/l)显著升高(p =0.009)。斯皮尔曼相关分析提示PD组的CysC水平与年龄(r = 0.334, p <0.001)、性别(r = 0.264, p =0.013)、肌酐(r = 0.302, p =0.018)存在相关性。 PD患者CysC水平与睡眠呼吸暂停低通气指数(AHI)(r = 0.231, p =0.017)、低通气指数(HI)(r = 0.333, p <0.001)、氧减指数(ODI)(r = 0.223, p =0.021)、血氧饱和度<90%的比例(r = 0.644, p <0.001)、呼吸相关微觉醒指数(r = 0.247, p =0.013)均存在显著正相关。而与整夜平均血氧饱和度和最低血氧饱和度均呈显著负相关(r = -0.323, -0.315, both p =0.001)。
结论: 早期PD患者CysC水平升高,且CysC水平越高,PD患者的睡眠呼吸事件及缺氧情况越严重。CysC可能作为一个潜在的生物标记物用以评价早期PD患者的睡眠呼吸障碍。



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