老年高血压患者同型半胱氨酸水平与脑白质病变分级及认知功能的相关性研究  

Correlations of plasma homocysteine with cerebral white matter lesion severity and cognitive impairment in elderly patients with hypertension

作　　者：陆冰[1] 潘晓东[1] 周林赟 胡秋菊 刘晔[1] 盛娟[1] 傅坤发[1] 欧阳晓俊[1] Lu Bing;Pan Xiaodong;Zhou Linyun;Hu Qiuju;Liu Ye;Sheng Juan;Fu Kunfa;Ouyang Xiaojun(Department of Geriatrics , Jiangsu Province Institute of Geriatrics , Nanjing 210024, China;Department of Radiology , Jiangsu Province Institute of Geriatrics , Nanjing 210024 , China)

机构地区：[1]江苏省老年医院干部保健科,南京210024 [2]江苏省老年医院放射科,南京210024

出　　处：《中华老年医学杂志》2019年第3期251-254,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年高血压患者血浆同型半胱氨酸(Hey)水平与脑白质病变(WML)程度及认知功能状况的相关性。方法回顾性病例对照研究,98例老年高血压患者按照Hey水平(Hcy≥10μmol/L的高血压患者定义为H型高血压)分为Hey正常组48例、H型高血压组50例。采用头颅MRhFazekas量表对患者WML病变程度分级.同时行简易智力状况检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评定认知功能,比较HCY正常组、H型高血压组患者WML病变分级程度及认知功能差异,分析Hey水平与WML程度及认知功能状况间的关系。结果H型高血压组患者与HCY正常组患者比较.Fazekas量表评分升高[(3.2+1.0)分比(2.5±1.0)分(P<0.05)],深部白质信号评分升高[(1.7±0.8)分比(1.3+0.7)分(P<0.05)];MMSE评分下降[(24.9±3.3)分比(27.7±1.8)分(P<0.05)].MoCA评分亦下降[(18.6+3.9)分比(25.0±3.1)分(P<0.05)]。Hey水平和WML评分呈正相关(r=0.430,P<0.01),与认知功能MMSE、MoCA评分均呈负相关(r值分别为-0.406、-0.663,均P<0.01)。多元Logistic回归分析结果显示,Hcy、血糖、深部白质病变、低密度脂蛋白胆固醇、年龄、收缩压是影响认知功能的因素(均PV0.01)。结论老年H型高血压患者脑白质病变较正常Hcy水平高血斥患者重,认知功能较差。老年高血压患者脑白质病变和认知功能减退程度随着血浆Hey水平升高而加重。血浆Hcy水平可能是反映老年高血压认知功能状况的指标之一。Objective To investigate the correlations of plasma homocysteine( Hcy) levels with cerebral white matter lesion( WML)severity and cognitive impairment in elderly hypertension patients.Methods A retrospective case-control study was conducted.Ninty-eight elderly patients with hypertension were enrolled.Based on the presenee or absence of hyperhomocysteinemia ( hypertension with plasma Hcy levels ≥10μmol/L was defined as H type hypertension),patients were divided into two groups;a control group( n=48) and an H-type hypertension group( n=50).The degree of WML was rated by the Fazekas scale using magnetic resonance imaging ( MRI) analysis, Neuropsychological examinations including mini-mental state examinati on ( MMSE ) a nd Montreal cognitive assessment (MoCA) were taken to assess cognitive function.The degree of WML and cognitive impairment were compared between the two groups.Correlations of plasma Hcy levels with the degree of WML and cognitive impairment were analyzed.Results Compared with the control group, scores of the Fazekas scale(3.2±1.0 vs.2.5±1.0 ,P<0.05)and deep white matter hyperintensity on MRK 1.7±0.8 vs.1.3±0.7,P<0.05)increased.and scores of MMSE(24.9±3.3 os.27.7±1.8, P<0.05)and MoCA( 18.6±3.9 vs.25.0±3.0,P<0.05)decreased in the H type hypertension group.Plasma Hcy levels were positively correlated with the degree of WML (r=0.430, P<0.01 ) and negatively correlated with cognitive function(r =-0.406 in MMSE and-0.663 in MoCA,P<0.01).Multivariate logistic regression showed that Hcy, fasting blood-glucose, deep WML, low-density lipoprotein cholesterolin,age and systolic pressure were influencing factors for cognitive impairment(P<0.01). Conclusions WML and cognitive function are worse in elderly H-type hypertension patients than in hypertension patients with normal Hcy levels. WML and cognitive impairment are aggravated with increased plasma Hcy levels. The plasma Hcy level may be an effective clinical indicator of cognitive function in elderly people with hypertension.

关 键 词：高血压 半胱氨酸 脑白质病 认知障碍 

分 类 号：R544.1[医药卫生—心血管疾病] R743[医药卫生—内科学]