不同认知损害的痴呆患者血浆同型半胱氨酸水平及VitB_(12)和叶酸的干预效果研究

The Level of Plasma Homocysteine and the Intervention Effect of Vitamin B_(12) and Folic Acid in Patients with Dementia

目的探讨阿尔茨海默病(AD)、血管性痴呆(VD)、轻度认知功能障碍(MCI)、非痴呆血管性认知功能障碍(VCIND)患者血浆同型半胱氨酸(Hcy)水平及Vit B12、叶酸干预对患者认知功能改善的作用。方法从2013年11月至2014年9月在宁夏医科大学总医院门诊和住院收集AD患者30例、VD患者30例、MCI患者30例、VCIND患者30例及我院门诊查体正常老年人30例,五组均测定血Hcy水平并测定MMSE和Mo CA评分。同时对AD组(28例)、VD组(30例)、MCI组(28例)、VCIND组(30例)进行Vit B12及叶酸干预治疗4周,于治疗结束时复测血Hcy水平及MMSE、Mo CA评分。结果 1治疗前血Hcy水平,AD组(24.4±10.3)μmol·L-1、VD组(41.7±10.8)μmol·L-1、MCI组(14.5±3.3)μmol·L-1、VCIND组(21.8±8.0)μmol·L-1、正常对照组(10.3±2.8)μmol·L-1,与正常对照组比较,VD、AD、VCIND与MCI组血浆Hcy水平均显著增高(P均=0.000);VD组Hcy水平显著高于AD、VCIND与MCI组(P均=0.000);AD组与VCIND组间差异无统计学意义,但均高于MCI组(P=0.001)。2VD、AD、VCIND与MCI组干预治疗后血Hcy水平与治疗前相比均明显降低(P<0.05);VD与AD组干预治疗后MMSE和Mo CA评分与治疗前相比无明显变化(P>0.05),但VCIND组与MCI组干预治疗后MMSE和Mo CA评分均较治疗前明显升高(P<0.05)。结论采用Vit B12、叶酸干预治疗降低血Hcy对改善轻度认知功能障碍及非痴呆血管性认知功能障碍的认知损害有一定效果,但痴呆期的患者使用Vit B12、叶酸辅助干预治疗尚未显示有效。

Objective To investigate the level of plasma homocystein and the intervention effect of vitamin B12 and folic acid in patients with dementia. Methods 30 AD,30VD,30 MCI,30VCIND cases and 30 normal old people were selected in outpatient and inpatient patients from November 2013 to September 2014. Plasma Hcy levels and the MMSE and Mo CA scores were detected in all of the subjects of five groups. With Vit B12 and folic acid intervention on patients of four groups for four weeks,plasma Hcy levels and MMSE,Mo CA scores were detected at the end of treatment. Results The plasma Hcy levels before treatment in AD（ 24. 4 ± 10. 3）μmol·L^-1,VD（ 41. 7 ± 10. 8） μmol·L^-1,MCI（ 14. 5 ± 3. 3） μmol·L^-1,VCIND（ 21. 8 ± 8. 0） μmol·L^-1were significantly higher than that in normal controls（ 10. 3 ± 2. 8） μmol·L^-1（ P〈0. 05）. The plasma Hcy levels in each groups after intervention were significantly lower than those before intervention.Conclusion High Hcy levels are closely related to the development of dementia,but short- term intervention with Vit B12 and folic acid can ＇t improve cognitive function in patients with dementia. For early dementia patients with mild cognitive impairment,the timely intervention with Vit B12 and folic acid can improve cognitive function with a certain extent and slow disease progression.