标题：血浆同型半胱氨酸水平与脑梗死后轻度认知功能障碍的相关性研究

      作者：张志坚，葛永琼，肖 静，邹耀兵，江思德，张建新，唐明山
    （重庆市巴南区人民医院神经内科，重庆 401320）

      卷次： 2014年25卷17期

      【摘要】 目的 探讨脑梗死(CI)后轻度认知功能障碍(MCI)与空腹血浆同型半胱氨酸(Hcy)水平的关系，并
分析影响认知功能障碍和血浆Hcy水平的相关因素。方法 收集重庆市巴南区人民医院2011年1月至2012年
12月门诊及住院的脑梗死后MCI患者76例(MCI组)，同期收集单纯脑梗死患者45例(CI组)，并设健康对照35例
(对照组)。检测入选对象的Hcy水平、C-反应蛋白(CRP)、血糖、血脂、糖化血红蛋白(HbA1c)、叶酸(FA)、维生素B12
(VitB12)、血肌酐(Scr)、血尿酸(UA)等指标。结果 FA、VitB12、UA均为Hcy影响因素(OR值分别为 0.74、0.86、
0.53，P<0.05)。MCI组患者的血浆Hcy水平为(17.65±5.6) ?mol/L，明显高于CI组的(10.75±3.5) ?mol/L和对照组的
(6.23±1.1) ?mol/L，差异均有统计学意义(P<0.05)；血浆Hcy水平对预测脑卒中患者是否发生MCI有一定的价值
(ROC曲线下面积为 0.825，95%CI为 0.758~0.893，P<0.01)；Logistic回归分析显示，SBP、血浆CRP、UA、LDL-C、
FA、VitB12、Hcy均是老年脑梗死后MCI的影响因素（OR值分别为：1.65、1.25、1.11、1.40、0.84、0.98、3.58，P<
0.05或P<0.01)。结论 老年脑梗死后MCI形成有多种影响因素，其中血浆同型半胱氨酸水平可能在其中占有
重要地位。

      【关键词】 同型半胱氨酸；老年人；认知障碍；脑梗死；多元回归分析

      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2014）17—2510—04


Correlation between plasma total homocysteine and mild cognitive impairment in senile patients with cerebral
infarction.
ZHANG Zhi-jian, GUO Yong-qiong, XIAO Jing, ZOU Yao-bing, JIANG Si-de, ZHANG Jian-xin, TANG
Ming-shan. Department of Neurology, the People's Hospital of Ba'nan District, Chongqing 401320, CHINA

【Abstract】 Objective To explore the correlation between fasting plasma total homocysteine (Hcy) level and
mild cognitive impairment (MCI) in senile patients with cerebral infarction (CI) and the relationship between MCI and
Hcy level. Methods Seventy-six senile CI patients with MCI in our hospital from January 2011 to December 2012
were recruited as the MCI group, while 45 senile CI patients were recruited as the CI group. 35 healthy elders were re-
cruited as the control group. The parameters of C-reactive protein (CRP), Hcy, total glyceride (TG), total cholesterol
(TC), low density lipoprotein-C (LDL-C), high density lipoprotein-C (HDL-C), Serun creatinine (SCr), Hemoglobin
A1c (HbA1c), fasting plasma glucose (FPG), 2 h plasma glucose (2 hPG), folic acid (FA) and vitamin B12 (VitB12) were
detected. Results Logistic regression analysis showed that FA, VitB12 and UA (OR value: 0.74, 0.86, 0.53, P<0.05)
were independent risk factors of Hcy. Patients in MCI group had a higher level of Hcy than that in CI group and con-
trol group [(17.65±5.6) μmol/L vs (10.75±3.5) ?mol/L and (6.23±1.1) ?mol/L, P<0.01]. ROC curve showed that Hcy
level was valuable in predicting the occurrence of mild cognitive impairment in senile patients with CI (AUC 0.825,
95%CI 0.758~0.893，P<0.01). Logistic regression analysis showed that SBP, CRP, UA, LDL-C, FA, VitB12 and Hcy
[OR value: 1.65, 1.25, 1.11, 1.40, 0.84, 0.98, 3.58, (P<0.05 or P<0.01) ] were independent risk factors of mild cogni-
tive impairment in senile CI patients. Conclusion There were multiple factors that could induce mild cognitive im-
pairment in senile patients with CI mellitus, in which Hcy level might play an important role.

      【Key words】 Homocysteine; Senile; Cognitive impairment; Cerebral infarction; Logistic regression analysis
基金项目：重庆市卫生局科研项目（编号：2011-2-527）；“天士力杯”脑血管病科学研究基金项目(编号：TSL2011040)