同型半胱氨酸对脑梗死后痴呆的诊断价值研究

Diagnostic Value of Homocysteine on Dementia after Cerebral Infarction

目的研究同型半胱氨酸(Hcy)对脑梗死后痴呆的诊断价值。方法选取广西中医药大学附属瑞康医院神经内科住院病人120例,行Hcy检测和头颅CT或MRI检查。根据NINDS-AIREN有关血管性痴呆(VD)的诊断标准,将病人分为脑梗死后痴呆(痴呆组)和脑梗死后无痴呆(非痴呆组)两组,另选健康体检者30名为对照组,比较各组血滴Hcy水平。并以NINDS-AIREN作为诊断的金标准,Hcy作为一种生物学诊断试验指标,计算痴呆组和非痴呆组Hcy的敏感度、特异度、准确度、预测值和似然比及ROC直线下面积。结果痴呆组、非痴呆组病人Hcy水平均较对照组显著增高(P<0.01),且痴呆组升高较非痴呆组显著(P<0.01)。Hcy诊断试验的敏感度为70.00%,特异度为58.33%,准确度64.17%,阳性预测值和阴性预测值分别为62.69%和66.04%,阳性似然比和阴性似然比分别为1.68和0.51。ROC曲线下面积为0.642 4。结论 Hcy与VD的发病有一定关系,但由于Hcy诊断价值较低,故不能认为Hcy是一种VD早期诊断的生物学标记物。

Objective To research the diagnostic value of homocysteine（Hcy） on dementia after cerebral infarction. Methods One hundred and twenty patient hospitalized in neurology department and 30 cases of healthy controls,were carried the examination of plasma homocysteine and CT or MRUwere randomly divided into two groups, namely,dementia group and non dementia group after cerebral infarction on the basis of vascular dementia diagnosed by NINDS AIREN standard. The levels of plasma homocysteine were compared with each group. According to diagnosis criteria of VD in NINDS AIREN as a gold standard,Hcy was used as a bio-logical index of vascular dementia diagnosis. Sensivity,specificity,degree of accuracy, predicted value and likelihood ratio of Hcy in two groups were measured.The area under ROC cueve was calculated. Results Compared to non dementia group and control group,Hcy level in dementia group was rised remarkably （P 〈0 .0 1 ）,The Hcy level in non dementia group was higher than that in control group （P 〈0.01）. Sensibility, specificity,positive predicted value,negative predicted value,positive likelihood ratio and nega-tive likelihood ratio of Hcy tests were 70.00%, 58.33%, 64.17%, 62.69%, 66.04%, 1.68 and 0.51 respectively.The area under ROC cueve was 0.642 4.Conclusion There are certain relationship between vascular dementia and Hcy, but on account of lower diagnos-tic value of its to vascular dementia,Hcy was not considered biomarker for early diagnosis of vascular dementia.