皮质下缺血性脑小血管病患者认知功能障碍及其与外周血同型半胱氨酸相关性

Cognitive dysfunction and its correlation with peripheral blood homocysteine in patients with subcortical ischemic cerebrovascular disease

目的分析皮质下缺血性脑小血管病患者认知功能障碍及其与外周血同型半胱氨酸(Hcy)的相关性。方法选择2017年3月—2019年3月安徽省第二人民医院神经内科治疗的皮质下缺血性脑小血管病患者137例作为研究对象,根据认知损害情况将其分成认知损害组(A组,n=65)、认知正常组(B组,n=72)。另选择同期于医院健康体检者60例作为对照组(C组)。对3组研究对象的临床资料进行分析。结果3组研究对象在MMSE总分、CAMCOG-C总分、CAMCOG-C亚项中注意和运用评分比较,差异均有统计学意义(F/P=86.335/<0.001、8.385/0.001、13.049/<0.01、14.104/<0.001);3组血清Hcy水平比较差异有统计学意义(F/P=146.218/<0.001);Pearson相关性分析结果显示,皮质下缺血性脑小血管病患者血清Hcy水平与MMSE评分、CAMCOG-C评分、CAMCOG-C亚项注意及运用评分均呈负相关(r/P=-0.397/0.038、-0.382/0.046、-0.514/0.024、-0.569/0.028)。ROC曲线分析结果显示,血清Hcy水平诊断皮质下缺血性脑小血管病患者认知功能障碍的AUC为0.822(95%CI 0.753~0.878,P<0.01),Hcy截断值22.57μmol/L,敏感度为77.33%,特异度为76.83%,约登指数0.542。结论皮质下缺血性脑小血管病患者血清Hcy水平与认知功能障碍显著相关,Hcy的检测有助于认知功能障碍高危人群的早期筛查。

Objective To analyze the relationship between cognitive impairment and peripheral blood homocysteine(Hcy)in patients with subcortical ischemic cerebrovascular disease.Methods From March 2017 to March 2019,137 patients with subcortical ischemic cerebrovascular disease treated in the Department of Neurology of the Second People's Hospital of Anhui Province were selected as the research objects.According to the cognitive impairment,they were divided into cognitive impairment group(n=65)and cognitive normal group(n=72).Another 60 healthy people in the same period were selected as the control group.The clinical data of the three groups were analyzed.Results There were statistically significant differences in the total score MMSE、CAMCOG-C and attention and application score of CAMCOG-C(F/P=86.335/<0.001、8.385/0.001,13.049/<0.01,14.104/<0.001).There was significant difference in serum Hcy level among the three groups(F/P=146.218/<0.001).Pearson correlation analysis showed that serum Hcy level was negatively correlated with MMSE score,CAMCOG-C score,attention and application score of CAMCOG-C(r/P=-0.397/0.038,-0.382/0.046,-0.514/0.024,-0.569/0.028).ROC curve analysis showed that the AUC of serum Hcy level in the diagnosis of cognitive impairment in patients with subcortical ischemic cerebrovascular disease was 0.822(95%CI 0.753-0.878,P<0.01),the cut-off value of Hcy was 22.57μmol/L,the sensitivity was 77.33%,the specificity was 76.83%,and the Youden index was 0.542.Conclusion The level of serum Hcy in patients with subcortical ischemic cerebrovascular disease is significantly correlated with cognitive dysfunction.The detection of Hcy is helpful for early screening of high-risk groups of cognitive dysfunction.