血浆同型半胱氨酸水平与维持性血液透析患者认知功能障碍的相关性及干预性治疗的临床研究  

Clinical study on the correlation between plasma homocysteine level and cognitive dysfunction in maintenance hemodialysis patients and interventional treatment

作　　者：谭小猛 刘舒放 TAN Xiaomeng;LIU Shufang(Department of Nephrology,Xi′an International Medical Center Hospital,Xi′an,Shaanxi 710100,China)

机构地区：[1]西安国际医学中心医院肾脏内科,陕西西安710100

出　　处：《检验医学与临床》2023年第10期1396-1400,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨血浆同型半胱氨酸(Hcy)水平与维持性血液透析(MHD)患者认知功能障碍的相关性及干预性治疗方案。方法选择2019年1月至2022年1月该院收治的186例MHD患者为观察组,根据患者血浆Hcy水平分为高Hcy组(血浆Hcy水平≥15μmol/L)和正常Hcy组(血浆Hcy水平<15μmol/L);另选取同期年龄和性别相匹配的120例健康体检者为健康对照组。统计各组基线资料,采用蒙特利尔认知评估量表(MoCA)评估各组认知功能,并分析血浆Hcy水平与MoCA评分的相关性。同时根据高Hcy组治疗方案的不同进一步分为A组(维生素B_(6)60 mg/d+维生素B120.5 mg/d)和B组(叶酸5 mg/d+维生素B_(6)60 mg/d+维生素B120.5 mg/d),统计两组基线资料并比较治疗前后血浆Hcy水平及MoCA评分。结果高Hcy组、正常Hcy组、健康对照组年龄、性别比例、体质量指数、吸烟史比例、白细胞计数、空腹血糖、血脂等基线资料比较,差异均无统计学意义(P>0.05);MoCA评分从低到高依次为高Hcy组、正常Hcy组、健康对照组,两两比较,差异均有统计学意义(P<0.05)。相关分析显示,MHD患者血浆Hcy水平与MoCA评分呈负相关(r=-0.438,P<0.05)。A组与B组年龄、性别比例、体质量指数、吸烟史比例、基础疾病比例、病因比例、透析龄、白细胞计数、空腹血糖、血脂比较,差异均无统计学意义(P>0.05);A组和B组治疗后血浆Hcy水平均明显低于治疗前,且A组治疗后血浆Hcy水平明显高于B组,差异均有统计学意义(P<0.05);A组和B组治疗后MoCA评分均明显高于治疗前,且A组治疗后MoCA评分明显低于B组,差异有统计学意义(P<0.05)。结论MHD患者血浆Hcy水平升高可能与认知功能障碍有关,而服用叶酸联合B族维生素可有效降低血浆Hcy水平,改善认知功能。Objective To investigate the correlation between plasma homocysteine(Hcy)level and cognitive dysfunction in maintenance hemodialysis(MHD)patients and the interventional treatment.Methods A total of 186 patients with MHD admitted to Xi′an International Medical Center Hospital from January 2019 to January 2022 were selected in observation group,according to the plasma Hcy level of patients,they were divided into high Hcy group(plasma Hcy level≥15μmol/L)and normal Hcy group(plasma Hcy level<15μmol/L).In addition,120 healthy subjects matched in age and gender were selected as healthy control group.The general data of each group were statistically analyzed.The cognitive function of each group was evaluated by Montreal Cognitive Assessment Scale(MoCA),and the correlation between plasma Hcy level and MoCA score was analyzed.At the same time,according to the treatment regimen of the high Hcy group,the patients were divided into group A(vitamin B_(6)60 mg/d+vitamin B 120.5 mg/d)and group B(folic acid 5 mg/d+vitamin B_(6)60 mg/d+vitamin B 120.5 mg/d),the general data of the two groups were statistically analyzed,the plasma Hcy level and MoCA score before and after treatment were compared.Results There was no statistically significant difference on age,gender proportion,body mass index,smoking history proportion,white blood cell count,fasting blood glucose and blood lipids among the high Hcy group,the normal Hcy group and the healthy control group(P>0.05).MoCA score in the high Hcy group,the normal Hcy group and the healthy control group were from low to high,and the differences were statistically significant(P<0.05).Correlation analysis showed that plasma Hcy level correlated negatively with MoCA score in MHD patients(r=-0.438,P<0.05).There was no statistically significant difference between group A and group B on age,gender proportion,body mass index,smoking history proportion,underlying diseases proportion,etiology proportion,dialysis age,white blood cell count,fasting blood glucose and blood lipids(P>0.05).After t

关 键 词：同型半胱氨酸 维持性血液透析 认知功能障碍 

分 类 号：R692.5[医药卫生—泌尿科学]