合并认知功能障碍的脑小血管病老年患者血同型半胱氨酸及炎症介质水平的改变及意义

Change and significanceof plasma homocysteine and inflammatory mediators in elderly patients with cerebral small vessel disease combined with cognitive impairment

目的:分析合并认知功能障碍的脑小血管病老年患者血同型半胱氨酸(homocysteine,Hcy)及炎症介质水平的改变及意义。方法:收集86例脑小血管病老年患者一般资料,所有患者均接受蒙特利尔认知评估量表(montreal cognitive assessment,Mo CA)的评估,并根据评分情况将患者分为观察组(Mo CA<23分,伴有认知功能障碍,n=41)及对照组(Mo CA≥23分,认知功能正常,n=45)。结果:观察组患者外周血Hcy水平显著高于对照组患者(P<0.05)。观察组患者Mo CA评分与Hcy水平呈现显著负相关关系(r=-0.647,P<0.05)。ROC曲线分析显示,以17.65μmol/L为截点值,Hcy诊断脑小血管病老年患者合并认知功能障碍的敏感性为75.61%,特异性为71.11%,曲线下面积为0.79。结论:合并认知功能障碍的脑小血管病老年患者外周血Hcy水平显著升高,升高程度与认知功能障碍程度相关,对认知功能障碍具有一定辅助诊断价值。

Objective： To analysze the change and significanceof plasma homocysteine and inflammatory mediators in elderly patients with cerebral small vessel disease combined with cognitive impairment. Methods： The clinical data of 86 elderly patients with cerebral small vessel disease combined with cognitive impairment were selected,All patients were evaluated by the Montreal Cognitive Assessment Scale（ Mo CA） and were divided into observation group（ Mo CA〈23 with cognitive impairment,n = 41） and control group（ Mo CA≥23 points,cognitive functioning normally,n = 45）. Results： The level of Hcy in the peripheral blood of the observation group was significantly higher than that of the control group（ P〈0. 05）. There was significant negative correlation between the Mo CA score and the level of Hcy（ r=-0. 647,P〈0. 05） in the observation group. ROC curve analysis showed that with a cut-point value of 17. 65μmol/L,the sensitivity of Hcy in elderly patients with cerebral small vessel disease combined with cognitive impairment was 75. 61%,specificity was 71. 11%,area under the curve was 0. 79. Conclusion： The level of Hcy in the peripheral blood of elderly patients with cerebral small vessel disease combined cognitive impairment increase significantly,and the degree of increasing is correlated with the degree of cognitive dysfunction,and it has certain auxiliary diagnostic value for cognitive dysfunction.