脑小血管病患者Hcy水平与认知功能障碍病程进展的相关性分析  

Correlation Analysis of Hcy Level with Cognitive Dysfunction and Disease Progression in Patients with CSVD

作　　者：张芾[1] 孙贵祥[1] 高跃强 ZHANG Fu;SUN Guixiang;GAO Yueqiang(Rugao People's Hospital,Jiangsu Rugao 226000,China)

机构地区：[1]江苏省如皋市人民医院神经内科,江苏如皋226000

出　　处：《河北医学》2020年第12期1956-1961,共6页Hebei Medicine

基　　金：江苏省自然科学基金项目,(编号:BK20170820)。

摘　　要：目的:探究脑小血管病(CSVD)患者同型半胱氨酸(Hcy)水平与认知功能障碍、病程进展的相关性。方法:回顾性选取2016年12月至2018年12月本院诊治的CSVD患者78例为研究对象,根据蒙特利尔认知评估量表(MoCA)评分将其分为认知正常组(32例)及认知障碍组(46例),另选取同期健康体检者52例为健康对照组。比较三组患者临床资料、Hcy水平之间的差异,并分析Hcy水平与认知功能障碍、病程进展的相关性。结果:Hcy水平对照组为(10.12±3.45)umoL/L、认知正常组为(18.18±3.86)umoL/L、认知障碍组为(23.35±4.42)umoL/L,差异具有统计学意义(P<0.05)。认知正常组MoCA评分高于认知障碍组,差异具有统计学意义(P<0.05)。Pearson相关性显示,Hcy水平与MoCA总评分、视空间执行功能、记忆与注意、抽象思维及定向力呈负相关(r=-0.438、-0.264、-0.239、-0.333,P<0.05),而与命名、语言、延迟回忆不具有相关性(r=-0.005、-0.001、-0.083,P>0.05)。随访一年后,CSVD进展组占62.82%(49/78),无进展组占37.18%(29/78),且Pearson相关性显示,Hcy水平与CSVD患者影像学结果评分呈显著负相关(r=-0.351,P<0.01)。ROC曲线分析显示,Hcy预测CSVD病程进展的AUC为0.938,敏感度、特异度:87.8%、93.1%,准确性较高。结论:Hcy水平升高可能参与CSVD认知功能损害,且与CSVD病程进展呈显著负相关。Objective:To explore the correlation between homocysteine(Hcy)level and cognitive dysfunction and disease progression in patients with small cerebral vascular disease(CSVD).Methods:A total of 78 cases of CSVD patients diagnosed and treated in our hospital from December 2016 to December 2018 were retrospectively selected as the study objects.With the Montreal cognitive assessment scale(MoCA)score,they were divided into the cognitively normal group(32 cases)and the cognitively impaired group(46 cases),and another 52 cases of healthy physical examination patients were selected as the healthy control group.The differences in clinical data and Hcy level among the three groups were compared,and the correlation between Hcy level and cognitive dysfunction and disease progression was analyzed.Results:The control group of Hcy level was(10.12±3.45)umol/L,the cognitive normal group was(18.18±3.86)umol/L,and the cognitive impairment group was(23.35±4.42)umol/L,with statistically significant differences(P<0.05).MoCA score of cognitive normal group was higher than that of cognitive impairment group,and the difference was statistically significant(P<0.05).Pearson correlation showed that Hcy level was negatively correlated with MoCA total score,visual spatial executive function,memory and attention,abstract thinking,and directional force(r=-0.438,-0.264,-0.239,-0.333,P<0.05),but not with naming,language,and delayed recall(r=-0.005,-0.001,-0.083,P>,0.05).After a one-year follow-up,62.82%(49/78)in the CSVD progression group and 37.18%(29/78)in the non-progression group,and Pearson correlation showed that Hcy level was significantly negatively correlated with imaging outcome scores of CSVD patients(r=-0.351,P<0.01).According to ROC curve analysis,the AUC of Hcy in predicting the course of CSVD was 0.938,the sensitivity and specificity were 87.8% and 93.1%,respectively,showing high accuracy.Conclusion:The increased level of Hcy can be involved in the cognitive impairment of CSVD,and is negatively correlated with the progression of

关 键 词：脑小血管病 同型半胱氨酸 认知功能障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]