脑白质疏松相关性轻度认知功能障碍与血浆同型半胱氨酸的关系

Relationship between plasma homocysteine level and mild cognitive impairment in elderly patients with leukoaraiosis

摘要:

目的 探讨脑白质疏松（LA）患者合并轻度认知功能障碍（MCI）与血浆同型半胱氨酸（Hcy）的关系。方法 选择2011年8月～2013年1月在中国医科大学附属第一医院老年病科住院的LA患者110例和非LA患者（对照组）40例。将LA患者分为MCI组（LA+MCI，60例）与认知功能正常组（LA，50例）。LA患者根据Hcy水平分为低水平（Hcy＜16μmol/L，31例），中间水平（16μmol/L≤Hcy≤29μmol/L，45例），高水平（Hcy≥30μmol/L组，34例）。采用简易精神状态量表（MMSE），蒙特利尔认知评估中文版（MoCA）和日常生活能力量表（ADL）对各组患者进行认知功能评定。结果 与对照组相比较，LA组和LA+MCI组的Hcy水平显著升高（均为P＜0.01）。LA患者MoCA评分与空腹血糖水平及Hcy水平呈负相关（均为P＜0.01）。与Hcy低水平患者比较，中间水平和高水平患者MoCA评分值显著降低（P＜0.05），且高水平患者评分值较中间水平患者更低（P＜0.05）。结论 LA合并MCI患者的血浆Hcy水平升高，且Hcy的水平越高、认知功能评分越低。

Abstract:

Objective To investigate the relationship between plasma level of homocysteine and mild cognitive impairment (MCI) in elderly patients with leukoaraiosis (LA). Methods A total of 110 elderly inpatients with confirmed LA hospitalized in our department from August 2011 to Jan 2013 were enrolled in this study. And another 40 sex- and age-matched individuals served as normal control. The LA patients were divided into the MCI group (LA+MCI group, n＝60) and non MCI group (LA group, n＝50), and were also divided into another 3 groups according to the plasma level of homocysteine: low level group (＜16μmol/L, n＝31), middle level group (16μmol/L≤Hcy＜30μmol/L, n＝45), and high level group (≥30μmol/L, n＝34). 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 normal individuals, plasma level of homocysteine was higher in the LA patients with or without MCI (P＜0.01, for all). In all the LA patients, their score and fasting blood glucose was negatively correlated with the plasma level of homocysteine (P＜0.01, for all). Compared with the LA patients with lower homocysteine, those with middle and high levels had lower MoCA score (P＜0.05), and the patients of higher homocysteine had significantly lower score than those of middle level (P＜0.05). Conclusion LA patients accompanied with MCI have higher plasma level of homocysteine, and the higher the level is, the more severe MCI is.