蛋氨酸负荷试验对判断脑梗死后轻度血管性认知功能障碍的价值  

Research on the value of methionine loading test in the mild vascular cognitive impairment

作　　者：刘怀翔[1] 谈晓牧[2] 刘建国[3] 张静[4] 张哲成[4] 

机构地区：[1]天津医科大学第二医院神经内科,300211 [2]北京市潞河医院神经内科 [3]北京海军总医院神经内科 [4]天津市第三中心医院神经内科

出　　处：《中华老年医学杂志》2015年第10期1084-1087,共4页Chinese Journal of Geriatrics

基　　金：天津市自然科学基金资助项目（00360411）

摘　　要：目的研究蛋氨酸负荷试验（MLT）对判断急性脑梗死后患者轻度血管性认知功能障碍（VCI）的价值研究。方法回顾性分析，采用高压液相色谱法测定脑梗死患者血浆空腹和MLT后同型半胱氨酸（Hey）水平，选取空腹Hcy正常患者240例，负荷后Hey正常者159例，负荷后高Hcy症患者81例，空腹高Hcy患者112例。对患者分别行人院时、7d、14d和30d蒙特利尔认知评估量表（MoCA）和简易精神状态量表（MMSE）评分。结果Logistic回归分析结果显示，Hcy可能是轻度VCI的独立危险因素（OR=1．285，95％CI：1．038～1．265，P〈0．05）；空腹高Hcy和负荷后高Hcy患者7d、14d和30dMMSE和MoCA评分分别低于空腹Hey正常患者（P〈m01或。P〈0．05）；空腹高Hey患者人院时、7d、14d和30dMMSE和MoCA评分与负荷后高Hcy患者比较差异无统计学意义（P〉0．05）。结论Hey可能是轻度VCI的独立危险因素；MLT能发现隐匿的VCI的血管危险因素，为临床及早干预和预防提供有价值的一项检测方法。Objective To study the value of methionine loading test （MLT） in the mild vascular cognitive impairment （VCI） after acute cerebral infarction. Methods The fasting plasma homocystine （Hcy） level and homocystine level after MLT were measured by high-performance liquid chromatography methods. We chose 240 patients with normal level of fasting plasma Hcy （normal group）, 159 patients with normal level of Hcy after MLT, 81 patients with hyperhomucysteinemia after MLT （hyperhomocysteinemia group）, and 112 patients with fasting hyperhomocysteinemia （fasting hyperhomocysteinemia group） in this study. The Montreal Cognitive Assessment （MoCA） and Mini-Mental State Examination （MMSE） were conducted in normal, hyperhomocysteinemia and fasting hyperhomocysteinemia groups on admission, at 7d, 14 d, 30 d after treatment. Results Logistic regression analysis showed that the increased level of Hey might be an independent risk factor for VCI [OR：I. 285, 95%CI： 1. 038-1. 265, P〈0. 051. The scores of MMSE and MoCA were lower in patients with fasting hyperhomocysteinemia and patients with hyperhomoeysteinemia after MLT than in patients with normal fasting plasma Hcy at 7 d, 14 d and 30 d after treatment （P〈0.01 or 0.05）, while the scores had no significant differences among the three group on admission （P〉0.05）. There were no significant differences in MMSE and MoCA scores between patients with fasting hyperhomocysteinemia and patients with hyperhomocysteinemia after MLT on admission, 7 d, 14 d and 30 d after treatment （P〉0.05）. Conclusions Hey may be an independent risk factor for VCI. The MLT can discover the dormant vascular risk factors for VCI, which offers a valuable detection method for early intervention and prevention in the clinical medicine.

关 键 词：脑梗死 半胱氨酸 认知障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]