合并高同型半胱氨酸血症的脑白质疏松症患者的认知功能评价及甲钴胺干预研究
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摘要
目的评价合并高同型半胱氨酸血症(Hhcy)的脑白质疏松症(LA)患者的认知功能,观察甲钴胺干预治疗后认知功能的变化。方法选择合并Hhcy的LA患者100例为甲组,无Hhcy的LA患者90例为乙组,甲组予基础治疗的同时,予甲钴胺干预治疗12周,乙组仅给予基础治疗12周,观察干预前后两组血浆Hcy水平及简易精神状态量表(MMSE)、Hachinski缺血积分(HIS)、临床痴呆评定量表(CDR)、日常生活能力量表(ADL)、总体衰退量表(GDS)评分的变化。结果随着LA程度的加重,甲乙两组患者的认知功能均下降(P<0.01),在中重度白质病变患者组,甲组MMSE、HIS、ADL、GDS评分与乙组相比较差异有统计学意义(P<0.01)。甲组经甲钴胺干预治疗12周后血浆Hcy水平下降至正常范围,认知障碍评分有好转趋势,中度白质病变患者组中HIS、GDS评分较干预治疗前下降(P<0.01),重度白质病变患者组中MMSE、ADL、GDS评分较干预治疗前下降(P<0.01)。结论随着LA程度的加重,合并Hhcy的LA患者较单纯LA患者的认知功能明显下降,予甲钴胺治疗后血浆Hcy水平降至正常范围,认知功能有所改善。
Objective To evaluate the cognitive function in patients with leukoaraiosis(LA) complicated with hyperhomocysteinemia(Hhcy),and to observe the changes of cognitive function after mecobalamin intervention.Methods 100 LA patients complicated with Hhcy were selected as group A,and 90 LA patients without Hhcy were selected as group B.The group A were treated with mecobalamin for 12 weeks on the basis of basic therapy,while the group B were only given basic therapy for 12 weeks.And then,the changes of plasma Hcy level and mini-mental state scale(MMSE),Hachinski ischemic score(HIS),clinical dementia rating scale(CDR),activity of daily living scale(ADL) and global decline scale(GDS) before and after intervention were observed between the two groups.Results The cognitive functions of both group A and group B decreased with the aggravation of LA(P<0.01).There was a statistically significant difference in MMSE,HIS,ADL and GDS scores between the group A and the group B in patients with moderate or severe white matter lesions(P<0.01).In the group A,the level of plasma Hcy decreased to normal range after 12 weeks of mecobalamin treatment,and the cognitive impairment score showed a trend of improvement,the HIS and GDS scores in patients with moderate white matter lesions were lower than those before intervention(P<0.01),and the MMSE,ADL and GDS scores in patients with severe white matter lesions were lower than those before intervention(P<0.01).Conclusion With the aggravation of LA,the cognitive function of LA patients with Hhcy was significantly lower than that of LA patients without Hhcy.After mecobalamin treatment,plasma Hcy level decreases to normal range,and the cognitive function improves.
Objective To evaluate the cognitive function in patients with leukoaraiosis(LA) complicated with hyperhomocysteinemia(Hhcy),and to observe the changes of cognitive function after mecobalamin intervention.Methods 100 LA patients complicated with Hhcy were selected as group A,and 90 LA patients without Hhcy were selected as group B.The group A were treated with mecobalamin for 12 weeks on the basis of basic therapy,while the group B were only given basic therapy for 12 weeks.And then,the changes of plasma Hcy level and mini-mental state scale(MMSE),Hachinski ischemic score(HIS),clinical dementia rating scale(CDR),activity of daily living scale(ADL) and global decline scale(GDS) before and after intervention were observed between the two groups.Results The cognitive functions of both group A and group B decreased with the aggravation of LA(P<0.01).There was a statistically significant difference in MMSE,HIS,ADL and GDS scores between the group A and the group B in patients with moderate or severe white matter lesions(P<0.01).In the group A,the level of plasma Hcy decreased to normal range after 12 weeks of mecobalamin treatment,and the cognitive impairment score showed a trend of improvement,the HIS and GDS scores in patients with moderate white matter lesions were lower than those before intervention(P<0.01),and the MMSE,ADL and GDS scores in patients with severe white matter lesions were lower than those before intervention(P<0.01).Conclusion With the aggravation of LA,the cognitive function of LA patients with Hhcy was significantly lower than that of LA patients without Hhcy.After mecobalamin treatment,plasma Hcy level decreases to normal range,and the cognitive function improves.
引文
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[16] 李霖,张晗,张翕,等.血管性痴呆与亚甲基四氢叶酸还原酶基因多态性研究进展[J].中国老年学杂志,2016,36(18):4638-4640.
[17] 付慧霄,张建任,兆波.老年脑白质疏松患者认知功能损害相关因素[J].中国老年学杂志,2016,36(15):3705-3707.
[18] 冯志霞,许哲通,吕志坤,等.200例青年脑梗死患者CISS分型与高同型半胱氨酸的关系[J].卒中与神经疾病杂志,2016,33(3):242-244.
[19] 傅朝晖,吴娟,陈登容.叶酸联合甲钴胺对脑小血管病合并高同型半胱氨酸血症患者认知功能的影响[J].重庆医学,2014,43(9):1055-1057.
[20] 朱炬,张哲成,张静,等.B族维生素对高同型半胱氨酸血症脑梗死患者神经功能的影响[J].天津医药,2013,41(8):744-746.
[21] 薛艺东,师宁,高晓嵘.甲钴胺治疗急性脑梗死伴高同型半胱氨酸血症和卒中后抑郁的疗效[J].中华老年医学杂志,2013,32(7):720-722.
[2] 吕雅静,孙虹,赵娇,等.脑小血管病非传统危险因素与其影像学指标研究新进展[J].中华老年心脑血管病杂志,2017,19(4):442-444.
[3] Poggesi A,Pantoni L,Inzitari D,et al.2001-2011:A Decade of the LADIS(Leukoaraiosis And DISability)Study:What Have We Learned about White Matter Changes and Small-Vessel Disease [J].Cerebrovasc Dis,2011,32(6):577-588.
[4] 王杰,毛姗.脑小血管病引发的脑白质疏松与认知功能障碍的相关性研究[J].中国实用神经疾病杂志,2017,20(18):43-45.
[5] Schmidt R,Petrovic K,Ropele S,et al.Progression of leukoaraiosis and cognition[J].Stroke,2007,38(9):2619-2625.
[6] 刘怀翔,谈晓牧,刘建国,等.负荷后同型半胱氨酸水平在脑梗死再发缺血性血管事件的随访研究[J].中华老年医学杂志,2014,33(3):246-249.
[7] 戴书华,廖翠薇,杨柳,等.CT及MRI对脑白质疏松症的诊断价值探讨[J].第三军医大学学报,2008,30(9):71-873.
[8] Bohnen NI,Müller ML,Kuwabara H,et al.Age-associated leukoaraiosis and cortical cholinergic deafferentation[J].Neurology,2009,72(16):1411-1416.
[9] 李倩,赵路清,胡风云.脑白质疏松症患者认知功能损害的特点及其静息态功能磁共振观察[J].中华医学杂志,2017,97(45):3529-3533.
[10] 杨茜,廖书胜,陈红,等.脑白质疏松症患者脑血流动力学研究[J].中风与神经疾病杂志,2010,27(4):338-340.
[11] 李海华,李雪莲,代政伟,等.不同程度脑白质疏松症患者认知功能的对比研究[J].重庆医学,2014,43(17):2132-2136.
[12] 胡新国,李娜,程玲,等.高龄患者缺血性脑白质疏松症与血浆同型半胱氨酸的关系[J].中华老年心脑血管病杂志,2011,13(7):624-626.
[13] Setién-Suero E,Suárez-Pinilla M,Suárez-Pinilla P,et al.Homocysteine and cognition:A systematic review of 111 studies[J].Neurosci Biobehav Rev,2016,69:280-298.
[14] Rhodehouse BC,Mayo JN,Beard RS Jr,et al.Opening of the blood-brain barrier before cerebral pathology in mild hyperhomocysteinemia[J].PLoS One,2013,8(5):e63951.
[15] 尹顺雄,闵连秋.高血压、高同型半胱氨酸血症与血管性认知障碍[J].中国卒中杂志,2014,9(6):516-520.
[16] 李霖,张晗,张翕,等.血管性痴呆与亚甲基四氢叶酸还原酶基因多态性研究进展[J].中国老年学杂志,2016,36(18):4638-4640.
[17] 付慧霄,张建任,兆波.老年脑白质疏松患者认知功能损害相关因素[J].中国老年学杂志,2016,36(15):3705-3707.
[18] 冯志霞,许哲通,吕志坤,等.200例青年脑梗死患者CISS分型与高同型半胱氨酸的关系[J].卒中与神经疾病杂志,2016,33(3):242-244.
[19] 傅朝晖,吴娟,陈登容.叶酸联合甲钴胺对脑小血管病合并高同型半胱氨酸血症患者认知功能的影响[J].重庆医学,2014,43(9):1055-1057.
[20] 朱炬,张哲成,张静,等.B族维生素对高同型半胱氨酸血症脑梗死患者神经功能的影响[J].天津医药,2013,41(8):744-746.
[21] 薛艺东,师宁,高晓嵘.甲钴胺治疗急性脑梗死伴高同型半胱氨酸血症和卒中后抑郁的疗效[J].中华老年医学杂志,2013,32(7):720-722.