高同型半胱氨酸血症与皮质下缺血性血管病患者认知功能障碍的关系

The relationship between hyperhomocysteinemia and subcortical ischemic vascular disease in cognitive impairment

目的探讨高同型半胱氨酸血症(Hhcy)及叶酸、维生素B12缺乏与皮质下缺血性血管病(SIVD)不同程度认知功能障碍的相关性。方法将119例SIVD患者按照简易精神状态量表(MMSE)认知功能程度的不同分为痴呆组与非痴呆组。其中痴呆组54例,非痴呆组65例。对所有受试者检测其同型半胱氨酸(Hcy)及血清叶酸、维生素B12水平。结果痴呆组血浆Hcy水平为(43±9)μmol/L,显著高于非痴呆组的(20±6)μmol/L(P<0.01);血清叶酸和维生素B12水平分别为(8±4)nmol/L、(290±154)pmol/L,显著低于非痴呆组的(13±3)nmol/L、(504±141)pmol/L(均P<0.01)。采用Spearm an相关方法分析,显示不同性别的Hcy水平与MMSE分数均呈负相关(男:r=-0.685,女:r=-0.689,二者均P<0.01),与年龄均呈正相关(男:r=-0.592,女:r=0.576,二者均P<0.01);Hcy水平与糖尿病、血脂、高血压、吸烟、饮酒等其他危险因素无明显相关性(P>0.05)。结论伴随血浆Hcy水平增高SIVD认知功能障碍程度加重,Hhcy可能是SIVD认知功能障碍的独立危险因素,叶酸、维生素B12缺乏是间接引起Hhcy,而导致SIVD重要的营养因素。

Objective To discuss the correlations between different levels of cognitive impairment in hyperhomocysteinemia （Hhcy） , folacin, vitamin B12 relevant factor deficiency and subcortical ischemic vascular disease （SIVD）. Methods A total of 119 patients with SIVD were divided into dementia group （ n = 54） and non-dementia group （ n = 65 ） according to Mini-Mental Status Examination （ MMSE ） scale. The levels homocysteine （Hcy） were detected with high performance liquid chromatography （HPLC） ; the levels of serum folacin and Vitamin Bl2 were detected with chemiluminescence method simultaneously. Results Serum Hcy level in the dementia group was 43 ±9 μmoL/L, and it was significantly higher than that of the non-dementia group （20 ±6μmoL/L） （ P 〈0.01 ）. Serum folacin and Vitamin Bt2 levels in the dementia group were 8 ±4 nmoL/L, 290 ±154 pmoL/L respectively, and they were significantly lower than those of the non-dementia group 13 ± 3 nmoL/L, 504 ± 141 pmoL/L, both P 〈 0. 01 ）. Spearman correlation method indicated that Hcy level of different genders was negatively correlated with MMSE scores, and positively correlated with ages. Hcy level had no significant correlation with diabetes, blood lipid, hypertension, smoking and alcohol intake （P 〉 0. 05 ）. Conclusion The level of SIVD cognitive impairment aggravated with the increase of serum Hcy level. Hhcy may be an independent risk factor of SIVD cognitive impairment. Folacin and Vitamin B12deficiency is an important nutrition factor that may indirectly cause Hcy and result in SIVD.