老年精神病患者高同型半胱氨酸血症与冠心病的相关因素分析

Relative factors analysis of hyperhomocysteinemia and coronary heart disease in senile psychopath

目的调查老年精神病患者血清同型半胱氨酸(homocysteine,Hcy)水平,探究与高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)相关的疾病诊断。方法以自拟调查表收集老年期常见精神病患者的一般资料、精神疾病诊断[精神分裂症(Sch)、阿尔茨海默病(AD)、血管性痴呆(VD)和抑郁症]和躯体疾病诊断[高血压病、2型糖尿病、冠心病、缺血性卒中和高脂血症]、辅助化验检查资料;电化学发光法检测Hcy浓度,以HHcy为因变量,以Logistic单因素检验和多因素回归分析与其相关的疾病。结果共获得合格病例583例,Hcy浓度中位数15.50μmol/L,HHcy 320例。单因素分析显示性别(χ2=39.910,P=0.000)、年龄(χ2=18.048,P=0.000)、Sch(χ2=4.166,P=0.041)、VD(χ2=8.489,P=0.004)、AD(χ2=4.445,P=0.035)、冠心病(χ2=7.740,P=0.005)、缺血性卒中(χ2=8.714,P=0.003)、低叶酸血症(χ2=27.833,P=0.000)和低维生素B12血症(χ2=17.009,P=0.000)均与HHcy相关。Logistic多元回归显示,除了性别、年龄因素外,只有冠心病是与HHcy显著相关的疾病诊断(Waldχ2=6.085,OR=1.645,P=0.014)。结论老年期精神病患者的HHcy可能与冠心病合并症相关,而与其精神疾病诊断无关,这有助于提醒老年精神科医生关注临床诊疗,防患医疗风险。

Objective To survey the serum total homocysteine （Hcy） levels in the ageds with mental diseases （MDs）, and to investigate the related diagnosis of mental or physical illness with hyperhomoeysteinemia （HHey）. Methods A random-designed investigation was carried out by using a standard structured questionnaire, including serum concen- trations of Hey, folacin and eobalamin, present diagnosis [MDs composed of schizophrenia （Seh）, Alzheimer＇s disease （AD）, vascular dementia （VD）, major depressive disorder and bipolar disorder], and physical illness composed of hyper- tension, diabetes mellitus, isehemie stroke （IS）, coronary heart disease （CHD）, hypedipidemia, personal medical history, history of medications, exposure to lifestyle factors, etc. Mono-variante and multivariate Logistic regression analysis were performed to identify the related diseases with HHey. Results In total, 583 cases were eligible for inclusion with the mean serum Hey concentration of 15.50 μmol/L, HHey of 320 eases. Mono-variant analyses showed that male （χ2= 39.910,P = 0.000）, age （χ2=18.048,P=0.000）, Seh （χ2=4.166,P=0.041）, VD （χ2=8.489,P=0.004）, AD （χ2=4.445,P= 0.035）, CHD （χ2=7.740,P=0.005）, IS （χ2=8.714,P=-0.003）, serum folaein （χ2=27.833,P=0.000） and eobalamin （χ2=17.009, P=0.000） were all significantly associated with HHey; After adjusting the variates of sex, age, serum folaein and eohal amin, further study by multivariate Logistic regression found that CHD （Waldχ2=6.085, OR=1.645 ,P=0.014） was the only diagnosed disease significantly correlated to HHey. Conclusion HHey in elderly patients with MDs is more possiblely associated with the risk of CHD than their diagnostic mental illness or other combined somatopathie disease, which may help geriatric psychiatrist to focus on the important clinical problem and to prevent the medical risk.