高血浆高半胱氨酸和脂蛋白相关磷脂酶A2水平与痴呆的相关性  

Associations of plasma homocysteine and lipoprotein-associated phospholipase A2 levels with dementia

作　　者：蔡颖源 徐慧颖[2] 陆小伟 

机构地区：[1]南京医科大学第一附属医院老年神经内科,210029 [2]南京医科大学第一附属医院神经内科,210029

出　　处：《国际脑血管病杂志》2017年第4期342-346,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金青年科学基金（81100858）

摘　　要：目的探讨血浆高半胱氨酸（homocysteine, Hcy）和脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipase A2, Lp-PLA2）水平与痴呆的相关性。方法回顾性纳入住院的痴呆患者，根据Hachinski缺血量表分为血管性痴呆（vascular dementia, VaD）组、混合性痴呆（mixed dementia, MD）组和阿尔茨海默病（Alzheimer＇s disease, AD）组，同时根据简易精神状态检查量表将痴呆严重程度分为轻度、中度和重度。另选同时期住院的非痴呆患者作为对照组。比较各组人口统计学、血管危险因素以及血浆Hcy和Lp-PLA2水平。应用logistic回归分析确定血浆Hcy和Lp-PLA2水平与痴呆风险和严重程度的独立相关性。结果共纳入125例痴呆患者，VaD组52例（41.6%），MD组21例（16.8%），AD组52例（41.6%）；轻度组49例（39.2%），中度组51例（40.8%），重度组25例（20%）。40例非痴呆患者被纳入作为对照组。VaD组、MD组和AD组血浆Hcy及Lp-PLA2水平均显著高于对照组（P均〈0.001）。多变量logistic回归分析显示，高龄[优势比（odds ratio, OR）1.12，95%可信区间（confidence interval, CI）1.03～1.21；P＝0.010]、高血浆Hcy水平（OR 1.44，95% CI 1.21～1.71；P〈0.001）、高Lp-PLA2水平（OR 1.01，95% CI 1.00～1.02；P＝0.006）和既往卒中史（OR 4.29，95% CI 1.50～12.36；P＝0.007）是痴呆的独立危险因素；高Hcy水平（OR 1.48，95% CI 1.21～1.82；P〈0.001）、高Lp-PLA2水平（OR 1.01，95% CI 1.00～1.03；P＝0.002）和既往卒中史（OR 152.78，95% CI 20.41～999.97；P〈0.001）是VaD的独立危险因素；高龄（OR 1.10，95% CI 1.02～1.17；P＝0.008）和高Hcy水平（OR 1.41，95% CI 1.25～1.58；P〈0.001）是重度痴呆的独立危险因素。结论血浆Hcy和Lp-PLA2水平升高与痴呆相关，降低血浆Hcy和Lp-PLA2水平可能对治疗和预防痴呆有益。Objective To investigate the associations of plasma homocysteine （Hcy） and lipoprotein- associated phospholipase A2 （Lp-PLA2） levels with dementia. Methods The patients with dementia admitted to hospital were enrolled retrospectively. They were divided into a vascular dementia （VaD） group, a mixed dementia （MD） group, and an Alzheimer＇s disease （AD） group according to the Hachinski Ischemic Score, and the dementia severity was further divided into a mild group, a moderate group and a severe group according to the Mini-Mental State Examination. The non-demented patients hospitalized during the same period were selected as controls. The demographics, vascular risk factors, and plasma Hcy and Lp-PLA2 levels in each group were compared. Logistic regression analysis was used to determine the independent associations of the plasma Hcy and Lp-PLA2 levels with the risk of dementia and severity, Results A total of 125 patients with dementia were enrolled, including 52 （41.6%） in the VaD group, 21 （16. 8%） in the MD group, and 53 （41.6%） in the AD group. There were 49 patients （39. 2%） in the mild group, 51 （40. 8%） in the moderate group, and 25 （20%） in the severe group. A total of 40 non-demented patients were enrolled as control group. The plasma Hcy and Lp-PLA2 levels in VaD, MD and AD groups were significantly higher than those in the control group （all P 〈 0. 001 ）. Multivariable logistic regression analysis showed that the advanced age （odds ratio[ OR] 1. 12, 95% confidence interval [ CI] 1.03-1.21; P =0. 010）, high plasma Hcy level （OR 1.44, 95% CI 1.21-1.71 ; P 〈 0. 001 ）, high Lp-PLA2 level （OR 1.01, 95% CI 1.00-1.02; P =0. 006 ）, and previous stroke （OR 4.29, 95% CI 1.50-12.36; P = 0. 007） were the independent risk factors for dementia; high Hey level （OR 1.48, 95% CI 1.21-1.82; P〈0.001, high Lp-PLA2 level （OR 1.01, 95% CI 1.00-1.03; P= 0. 002）, and previous stroke （OR 152. 78, 95% CI 20. 41-999. 97; P〈 0. 001） were the independe

关 键 词：痴呆 痴呆 血管性 阿尔茨海默病 高半胱氨酸 1-烷基-2-乙酰甘油磷酸胆碱酯酶 生物标志物 

分 类 号：R749.16[医药卫生—神经病学与精神病学]