老年高同型半胱氨酸血症患者认知功能与心血管因素的关系

Relationship between cognitive function and cardiovascular risk factors in elderly patients with hyperhomocysteinemia

目的探讨老年高同型半胱氨酸血症患者认知功能与心血管危险因素的关系。方法选择2011年8月至2013年4月在中国医科大学附属第一医院老年病科住院的患者157例,男75例,女82例,年龄60~74〔平均(69.26±4.81)〕岁。根据血浆同型半胱氨酸(Hcy)水平,将患者分为Hcy<16μmol/L组(A组)45例,16μmol/L≤Hcy<30μmol/L组(B组)60例,Hcy≥30μmol/L组(C组)52例。使用Framingham评分(FRS)对心血管因素进行评定;采用简易精神状态量表(MMSE),蒙特利尔认知评估中文版(Mo CA)和日常生活能力量表(ADL)进行认知功能评估。结果与A组比较,B组的血浆Hcy水平显著升高(P<0.05),Mo CA评分显著降低(P<0.05),C组的血浆Hcy水平及FRS显著升高(均P<0.05),MMSE评分、Mo CA评分及ADL评分均显著降低(均P<0.05);与B组相比较,C组的血浆Hcy水平及FRS均显著升高(均P<0.05),MMSE评分及Mo CA评分均显著降低(均P<0.05);高Hcy血症患者的FRS与血浆Hcy水平呈显著正相关(均P<0.05),与MMSE评分及Mo CA评分均呈显著负相关(均P<0.05)。结论老年高同型半胱氨酸血症患者心血管危险因素与认知损害相关,血浆Hcy水平越高,FRS越高,认知功能评分越低。

Objective To study the relationship between cardiovascular risk factors and cognitive function in elderly patients with hyperhomocysteinemia.Methods 157 elderly patients (60~74 years old) were selected.According to the plasmatic homocysteine (Hcy) levels,the elderly patients were divided into 3 groups ( group A: Hcy<16 μmol/L,45 patients;group B:16 μmol/L≤Hcy<30 μmol/L,60 patients;group C:Hcy≥30 μmol/L,52 patients);the Framingham scale(FRS) was used to assess the vascular risk factors,and the mini-mental state examination (MMSE),Montreal Cognitive Assessment (MoCA) and the activities of daily living (ADL) were used to evaluate the cognitive function.Results In comparison to group A,the level of Hcy was increased significantly (P<0.05),and MoCA score was de-creased significantly (P<0.05) in group B;Hcy levels and FRS were increased significantly (P<0.05),MMSE score,MoCA score and ADL score were decreased significantly in group C (P<0.05).In comparison to group B,Hcy levels and FRS were increased significantly (P<0.05),MMSE score,and MoCA score were decreased significantly in group C (P<0.05).There was a positive correlation between FRS and plasmatic Hcy levels ,and there was a negative correlation between FRS and MoCA score in elderly hyperhomocysteinemia patients .Conclu-sions There is a correlation between cardiovascular risk factors and cognitive impairment in elderly patients with hyperhomocysteinemia . The higher the plasmatic Hcy levels as well as FRS ,the more severe the cognition impaired .