血浆同型半胱氨酸水平与脑梗死后轻度认知功能障碍的相关性研究

Correlation between plasma total homocysteine and mild cognitive impairment in senile patients with cerebral infarction

目的：探讨脑梗死（CI）后轻度认知功能障碍（MCI）与空腹血浆同型半胱氨酸（Hcy）水平的关系，并分析影响认知功能障碍和血浆Hcy水平的相关因素。方法收集重庆市巴南区人民医院2011年1月至2012年12月门诊及住院的脑梗死后MCI患者76例（MCI组），同期收集单纯脑梗死患者45例（CI组），并设健康对照35例（对照组）。检测入选对象的Hcy水平、C-反应蛋白（CRP）、血糖、血脂、糖化血红蛋白（HbA1c）、叶酸（FA）、维生素B12（VitB12）、血肌酐（Scr）、血尿酸（UA）等指标。结果 FA、VitB12、UA均为Hcy影响因素（OR值分别为0.74、0.86、0.53，P〈0.05）。MCI组患者的血浆Hcy水平为（17.65±5.6）μmol/L，明显高于CI组的（10.75±3.5）μmol/L和对照组的（6.23±1.1）μmol/L，差异均有统计学意义（P〈0.05）；血浆Hcy水平对预测脑卒中患者是否发生MCI有一定的价值（ROC曲线下面积为0.825，95%CI为0.758～0.893，P〈0.01）；Logistic回归分析显示，SBP、血浆CRP、UA、LDL-C、FA、VitB12、Hcy均是老年脑梗死后MCI的影响因素（OR值分别为：1.65、1.25、1.11、1.40、0.84、0.98、3.58，P〈0.05或P〈0.01）。结论老年脑梗死后MCI形成有多种影响因素，其中血浆同型半胱氨酸水平可能在其中占有重要地位。

Objective To explore the correlation between fasting plasma total homocysteine （Hcy） level and mild cognitive impairment （MCI） in senile patients with cerebral infarction （CI） and the relationship between MCI and Hcy level. Methods Seventy-six senile CI patients with MCI in our hospital from January 2011 to December 2012 were recruited as the MCI group, while 45 senile CI patients were recruited as the CI group. 35 healthy elders were recruited as the control group. The parameters of C-reactive protein （CRP）, Hcy, total glyceride （TG）, total cholesterol （TC）, low density lipoprotein-C （LDL-C）, high density lipoprotein-C （HDL-C）, Serun creatinine （SCr）, Hemoglobin A1c （HbA1c）, fasting plasma glucose （FPG）, 2 h plasma glucose （2 hPG）, folic acid （FA） and vitamin B12 （VitB12） were detected. Results Logistic regression analysis showed that FA, VitB12 and UA （OR value：0.74, 0.86, 0.53, P〈0.05） were independent risk factors of Hcy. Patients in MCI group had a higher level of Hcy than that in CI group and control group [（17.65±5.6）μmol/L vs （10.75±3.5） μmol/L and （6.23±1.1） μmol/L, P〈0.01]. ROC curve showed that Hcy level was valuable in predicting the occurrence of mild cognitive impairment in senile patients with CI （AUC 0.825, 95%CI 0.758～0.893,P〈0.01）. Logistic regression analysis showed that SBP, CRP, UA, LDL-C, FA, VitB12 and Hcy [OR value：1.65, 1.25, 1.11, 1.40, 0.84, 0.98, 3.58, （P〈0.05 or P〈0.01） ] were independent risk factors of mild cognitive impairment in senile CI patients. Conclusion There were multiple factors that could induce mild cognitive impairment in senile patients with CI mellitus, in which Hcy level might play an important role.