高同型半胱氨酸血症与帕金森病患者认知功能的相关性分析
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摘要
目的探讨同型半胱氨酸(homocysteine,Hcy)与帕金森病(Parkinson's disease,PD)患者认知障碍的相关性。方法选取2012年7月—2018年6月宁波市第九医院神经内科收治的228例PD患者,参照相关诊断标准和筛选方法分为PD认知正常组(78例)、PD轻度认知障碍组(76例)和PD痴呆组(74例),另选同期体检中心70例健康者作为对照。收集所有入选对象的一般信息(性别、年龄、受教育程度)、Hoehn-Yahr分级情况、病程、其他危险因素(高血压、糖尿病、高脂血症)、多巴丝肼和盐酸普拉克索的服用情况,检测所有入选者的血浆Hcy水平、血清叶酸和Vit B12水平,评估所有入选者的蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分。比较4组间的基线资料、血浆Hcy水平和MoCA评分,分析PD患者血浆Hcy水平与认知功能的相关性。结果对照组、PD认知正常组、PD轻度认知障碍组和PD痴呆组的血浆Hcy水平依次升高,MoCA评分依次降低(均P <0. 05); Pearson相关分析显示,PD患者血浆Hcy水平与MoCA评分呈负相关性(r=-0. 684,P=0. 017)。结论血浆Hcy水平与PD患者的认知障碍具有负相关性,血浆Hcy水平越高,MoCA评分越低,PD患者的认知障碍越严重。
Objective To investigate the relationship between homocysteine( Hcy) and cognitive impairment in patients with Parkinson's disease( PD). Methods Total 228 patients with PD admitted to our hospital were enrolled in the study,who were divided into cognitive normal group( 78 cases) and mild cognitive impairment group( 76 cases) and dementia group( 74 cases) according to the results of relevant diagnostic criteria and screening methods,and 70 healthy people from the physical examination center of our hospital as the control group. The general information( gender,age,education level),Hoehn-Yahr grading,duration of illness,other risk factors( hypertension,diabetes,hyperlipidemia),dopasine and pramipexole hydrochloride taking of all patients were collected. Plasma Hcy levels,serum folate and Vit B12 levels were measured,and the Montreal Cognitive Assessment( MoCA) scores were evaluated. Baseline data,plasma Hcy levels,and MoCA scores were compared among the four groups. Results Plasma Hcy levels in the control group,PD cognitive normal group,PD mild cognitive impairment group and PD dementia group increased in turn,and the MoCA scores decreased in turn( P < 0. 05). Pearson correlation analysis showed that plasma Hcy level was negatively correlated with MoCA score of PD patients( r =-0. 684,P = 0. 017). Conclusion Plasma Hcy levels were negatively correlated with cognitive impairment in PD patients. The higher the plasma Hcy level,the lower the MoCA score,and the more severe the cognitive dysfunction in PD patients.
Objective To investigate the relationship between homocysteine( Hcy) and cognitive impairment in patients with Parkinson's disease( PD). Methods Total 228 patients with PD admitted to our hospital were enrolled in the study,who were divided into cognitive normal group( 78 cases) and mild cognitive impairment group( 76 cases) and dementia group( 74 cases) according to the results of relevant diagnostic criteria and screening methods,and 70 healthy people from the physical examination center of our hospital as the control group. The general information( gender,age,education level),Hoehn-Yahr grading,duration of illness,other risk factors( hypertension,diabetes,hyperlipidemia),dopasine and pramipexole hydrochloride taking of all patients were collected. Plasma Hcy levels,serum folate and Vit B12 levels were measured,and the Montreal Cognitive Assessment( MoCA) scores were evaluated. Baseline data,plasma Hcy levels,and MoCA scores were compared among the four groups. Results Plasma Hcy levels in the control group,PD cognitive normal group,PD mild cognitive impairment group and PD dementia group increased in turn,and the MoCA scores decreased in turn( P < 0. 05). Pearson correlation analysis showed that plasma Hcy level was negatively correlated with MoCA score of PD patients( r =-0. 684,P = 0. 017). Conclusion Plasma Hcy levels were negatively correlated with cognitive impairment in PD patients. The higher the plasma Hcy level,the lower the MoCA score,and the more severe the cognitive dysfunction in PD patients.
引文
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[5]钟的灵,俞海,王卓尔,等.高血压患者血浆高同型半胱氨酸水平与认知功能的关系[J].中华高血压杂志,2015,23(12):1182-1184.
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[9]潘宁丰,叶民.帕金森痴呆的临床诊断相关指标的研究进展[J].临床神经病学杂志,2014,27(6):473-476.
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[11]孔伶俐,孙忠国,周田田,等.蒙特利尔认知评估量表在轻度认知功能障碍诊断中的应用[J].中国健康心理学杂志,2015,23(8):1212-1215.
[12] PETRELLI A,KAESBERG S,BARBE M T,et al. Effects of cognitive training in Parkinson’s disease:a randomized controlled trial[J].Parkinsonism Relat Disord,2014,20(11):1196-1202.
[13]刘勇.老年帕金森病患者血浆同型半胱氨酸水平与认知障碍相关性分析[J].脑与神经疾病杂志,2015,23(5):383-385.
[14] LAMBERTI P,ZOCCOLELLA S,ARMENISE E,et al. Hyperhomocysteinemia in L-dopa treated Parkinson’s disease patients:effect of cobalamin and folate administration[J]. Eur J Neurol,2015,12(5):365-368.
[15]郝美美,邓艳春.同型半胱氨酸与神经系统疾病关系的研究进展[J].临床神经病学杂志,2016,29(1):66-69.
[16]王蕾,陈哲萌,陈浩,等.高血压合并脑梗死患者同型半胱氨酸与颈动脉硬化相关性研究[J].中华全科医学,2015,13(8):1270-1272.
[17]许金鹏,刘洋,李靖,等. H型高血压合并颈动脉粥样硬化患者血清Hcy含量与炎症因子、斑块稳定性的相关性[J].中国现代医学杂志,2017,27(28):61-65.
[18]梁涛,向梦茜,张德太.氧化应激与高同型半胱氨酸血症的关系探讨[J].临床血液学杂志,2016,29(2):272-274.
[19]初海霞,杨文东.原发性高血压患者颈动脉粥样硬化与同型半胱氨酸及氧化应激的相关性研究[J].中国老年保健医学,2017,15(1):16-18.
[20]王永,王金福,陈洋.叶酸和维生素B12对高Hcy急性脑梗死患者血Hcy水平及神经功能的影响[J].中国实用神经疾病杂志,2016,19(21):21-23.
[21] TAKENO A,KANAZAWA I,TANAKA K,et al. Simvastatin rescues homocysteine-induced apoptosis of osteocytic MLO-Y4 cells by decreasing the expressions of NADPH oxidase 1 and 2[J]. Endocr J2016,63(4):389-395.
[22]郑莹莹,陈涛,吴佳力,等.联合检测缺血性脑卒中患者血清Hcy和NSE水平与神经功能缺损程度的关系研究[J].中国实验诊断学,2018,22(1):1-3.
[23]田丹丹,张程达,王连珂,等.亚甲基四氢叶酸还原酶基因及甲硫氨酸合成酶基因多态性与口服叶酸治疗高同型半胱氨酸血症疗效的关系研究[J].中国全科医学,2016,19(12):1396-1400.
[24]余小华,束晓梅.抗N-甲基-D-天门冬氨酸受体脑炎研究进展[J].中华实用儿科临床杂志,2016,31(16):1278-1280.
[2]陈伟贤,张赛.帕金森病的诊断和治疗[J].中华全科医学,2015,13(5):692-693.
[3] SEGURA B,BAGGIO H C,MARTI M J,et al. Cortical thinning associated with mild cognitive impairment in Parkinson’s disease[J]. Mov Disord,2015,29(12):1495-1503.
[4]赵连友.重视心血管疾病新危险因素高同型半胱氨酸血症的防治[J].中国实用内科杂志,2015,35(4):273-275.
[5]钟的灵,俞海,王卓尔,等.高血压患者血浆高同型半胱氨酸水平与认知功能的关系[J].中华高血压杂志,2015,23(12):1182-1184.
[6] CRIZZLE A M,CLASSEN S,LANFORD D N,et al. Postural/Gait and cognitive function as predictors of driving performance in Parkinson’s disease[J]. J Parkinsons Dis,2013,3(2):153-160.
[7] ZOCCOLELLA S,SAVARESE M,LAMBERTI P,et al. Sleep disorders and the natural history of Parkinson’s disease:the contribution of epidemiological studies[J]. Sleep Med Rev,2011,15(1):41-50.
[8]张克忠,王希希.国际运动障碍疾病协会帕金森病诊断新标准(2015)解读[J].重庆医科大学学报,2017,42(6):687-689.
[9]潘宁丰,叶民.帕金森痴呆的临床诊断相关指标的研究进展[J].临床神经病学杂志,2014,27(6):473-476.
[10] DIPASQUALE S,MERONI R,SASANELLI F,et al. Physical therapy versus a general exercise programme in patients with hoehn yahr stageⅡParkinson’s disease:a randomized controlled trial[J]. J Parkinsons Dis,2017,7(1):203-210.
[11]孔伶俐,孙忠国,周田田,等.蒙特利尔认知评估量表在轻度认知功能障碍诊断中的应用[J].中国健康心理学杂志,2015,23(8):1212-1215.
[12] PETRELLI A,KAESBERG S,BARBE M T,et al. Effects of cognitive training in Parkinson’s disease:a randomized controlled trial[J].Parkinsonism Relat Disord,2014,20(11):1196-1202.
[13]刘勇.老年帕金森病患者血浆同型半胱氨酸水平与认知障碍相关性分析[J].脑与神经疾病杂志,2015,23(5):383-385.
[14] LAMBERTI P,ZOCCOLELLA S,ARMENISE E,et al. Hyperhomocysteinemia in L-dopa treated Parkinson’s disease patients:effect of cobalamin and folate administration[J]. Eur J Neurol,2015,12(5):365-368.
[15]郝美美,邓艳春.同型半胱氨酸与神经系统疾病关系的研究进展[J].临床神经病学杂志,2016,29(1):66-69.
[16]王蕾,陈哲萌,陈浩,等.高血压合并脑梗死患者同型半胱氨酸与颈动脉硬化相关性研究[J].中华全科医学,2015,13(8):1270-1272.
[17]许金鹏,刘洋,李靖,等. H型高血压合并颈动脉粥样硬化患者血清Hcy含量与炎症因子、斑块稳定性的相关性[J].中国现代医学杂志,2017,27(28):61-65.
[18]梁涛,向梦茜,张德太.氧化应激与高同型半胱氨酸血症的关系探讨[J].临床血液学杂志,2016,29(2):272-274.
[19]初海霞,杨文东.原发性高血压患者颈动脉粥样硬化与同型半胱氨酸及氧化应激的相关性研究[J].中国老年保健医学,2017,15(1):16-18.
[20]王永,王金福,陈洋.叶酸和维生素B12对高Hcy急性脑梗死患者血Hcy水平及神经功能的影响[J].中国实用神经疾病杂志,2016,19(21):21-23.
[21] TAKENO A,KANAZAWA I,TANAKA K,et al. Simvastatin rescues homocysteine-induced apoptosis of osteocytic MLO-Y4 cells by decreasing the expressions of NADPH oxidase 1 and 2[J]. Endocr J2016,63(4):389-395.
[22]郑莹莹,陈涛,吴佳力,等.联合检测缺血性脑卒中患者血清Hcy和NSE水平与神经功能缺损程度的关系研究[J].中国实验诊断学,2018,22(1):1-3.
[23]田丹丹,张程达,王连珂,等.亚甲基四氢叶酸还原酶基因及甲硫氨酸合成酶基因多态性与口服叶酸治疗高同型半胱氨酸血症疗效的关系研究[J].中国全科医学,2016,19(12):1396-1400.
[24]余小华,束晓梅.抗N-甲基-D-天门冬氨酸受体脑炎研究进展[J].中华实用儿科临床杂志,2016,31(16):1278-1280.