合并高同型半胱氨酸血症的脑白质疏松患者轻度认知功能障碍的治疗

Clinical observation of the treatment of mild cognitive impairment with hyperhomocysteinemia and leukoaraiosis

目的高同型半胱氨酸血症可能为认知功能损害的独立危险因素，干预高同型半胱氨酸血症是否能改善认知功能，尚需进一步研究证实。方法2009年1月～2011年3月宣武医院神经内科门诊患者，头部MRI证实存在脑白质疏松，同时不合并重要部位或大面积脑梗死患者。简易智能状态检查（MMSE）11～24分（为轻，中度病人）。共入组87例，高同型半胱氨酸血症组45例，合并高同型半胱氨酸血症组42例。两组均采用抗血小板、降血压、降血脂的药物和维生素B6、叶酸、甲钴胺治疗。两组分别于服药前及服药后8周、12周，采用简易智能状态量表（MMSE）对患者进行评价，同时复查血同型半胱氨酸水平。结果在治疗后12周末以高同型半胱氨酸血症组MMSE评分改善较好（P〈0．05）。结论高同型半胱氨酸血症可能为认知功能损害的独立危险因素，对高同型半胱氨酸血症进行药物干预可能达到改善认知功能障碍及痴呆或延缓其进展的作用。

Objective Hyperhomocysteinemia may be an independent risk factors for cognitive impairment. Whether treatment of hyperhomocysteinemia can improve cognitive function should be confirmed by further studies. Methods 87 cases of Mild Cognitive Impairment with or without hyperhomo- cysteinemia were divided into two groups： hyperhomocysteinemia group and without hyperhomocysteinemia group. Before and after 12 weeks of treatment,all patients＇memory quotient was measured with Clinical Memory Scale--MMSE. Results Compared with without hyperhomocysteinemia group, hyperhomocys- teinemia group had a significantly better outcome in improving memory （P 〈 0.05）. Conclusions Hyperho- mocysteinemia may be independent risk factors for cognitive impairment. Treatment of hyperhomocys- teinemia may delay the progression of cognitive impairment.