伴认知功能损害的帕金森病患者血浆同型半胱氨酸变化及意义  

The changes and significance of plasma level of homocysteine in Parkinson disease patients with cognitive function

作　　者：叶心国[1] 李翔[1] 李涛[1] 李承晏[1] 

机构地区：[1]武汉大学人民医院神经内科,430060

出　　处：《中国医师进修杂志》2016年第7期631-634,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：探讨帕金森病（PD）伴认知功能损害（CI）患者血浆同型半胱氨酸（Hcy）的变化及意义。方法入选PD患者92例，其中伴轻度CI 51例，无CI 41例；再入选40例健康体检者作为对照组。记录PD组患者的性别、年龄、病程、受教育年限以及Hoehn和Yahr分级（H-Y分级）。两组均采用蒙特利尔认知评估量表（MoCA）对认知功能进行评估，应用高效液相色谱法测定血浆Hcy水平，放射免疫法测定血浆叶酸、维生素B12水平。结果 PD组Hcy水平明显高于对照组[（16.72±5.52）μmol/L比（13.65±5.16）μmol/L]，伴CI患者[（18.13±4.67）μmol/L]和无CI患者[（15.44±3.71）μmol/L]Hcy水平也明显高于对照组，伴CI患者Hcy水平明显高于无CI患者，差异有统计学意义（P＜0.05）。PD组叶酸水平明显低于对照组[（7.15±3.54）μg/L比（8.73±3.78）μg/L]，伴CI患者[（7.11±3.95）μg/L]和无CI患者[（7.36±3.84）μg/L]叶酸水平明显低于对照组，差异有统计学意义（P＜0.05），但伴CI患者与无CI患者比较差异无统计学意义（P＞0.05）。两组维生素B12水平比较差异无统计学意义（P＞0.05）。血浆Hcy 水平与叶酸水平呈负相关（r=－0.576，P＜0.01）。早期PD患者Hcy水平明显低于中晚期PD患者[（15.14±5.31）μmol/L比（17.75±5.87）μmol/L]，差异有统计学意义（P＜0.05），两者叶酸和维生素B12水平比较差异无统计学意义（P＞0.05）。相关性分析结果显示，MoCA评分与受教育年限呈正相关（β=0.541，P=0.000），与病程、H-Y 分级和 Hcy 水平呈负相关（β=-0.417、-0.367、-0.515，P=0.026、0.037、0.000）；与年龄、叶酸和维生素B12水平无相关性（P＞0.05）。结论 Hcy水平的改变可能参与PD患者的发病机制；血浆Hcy水平的升高可能与PD患者的认知功能损害具有相关性，其可能为PD患者合并认知功能障碍的风险因子。Objective To investigate the changes and significance of plasma level of homocysteine （Hcy） in Parkinson disease （PD） patients with cognitive dysfunction. Methods Ninety-two PD patients were enrolled. Among them, 51 patients had mild cognitive impairment （CI）, and the other 41 had not CI. Forty healthy subjects were enrolled as control group. The information including gender, age, illness duration, years of education and Hoehn and Yahr （H-Y） stage were recorded. Cognitive function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment （MoCA） scale. Plasma levels of Hcy, folic acid and vitamin B12 were measured by high performance liquid chromatography or radioimmunoassay. Results The plasma level of Hcy in PD group was significantly higher than that in control group： （16.72 ± 5.52） μmol/L vs. （13.65 ± 5.16） μmol/L, there was statistical difference （P〈0.05）. The plasma level of Hcy in patients with CI was （18.13 ± 4.67）μmol/L, and the patients without CI was （15.44 ± 3.71） μmol/L, the plasma levels of Hcy in patients with CI and without CI were significantly higher than that in control group, furthermore the plasma levelof Hcy in patients with CI was significantly higher than that in patients without CI, there were statistical differences （P〈0.05）. The plasma level of folic acid in PD group was significantly lower than that in control group：（7.15 ± 3.54） μg/L vs. （8.73 ± 3.78） μg/L, there was statistical difference （P〈0.05）. The plasma level of folic acid in patients with CI was （7.11 ± 3.95） μg/L, and the patients without CI was （7.36 ± 3.84） μg/L, the plasma levels of folic acid in patients with CI and without CI were significantly lower than that in control group, there were statistical differences （P〈0.05）. But there was no statistical difference in the plasma of folic acid between patients with CI and patients without CI （P〉0.05）. There was no statistical difference

关 键 词：帕金森病 认知障碍 高同种半胱氨酸血症 叶酸 维生素B12 

分 类 号：R742.5[医药卫生—神经病学与精神病学]