痴呆与血浆同型半胱氨酸水平的关系及干预措施的研究
摘要
目的探讨痴呆与血浆同型半胱氨酸(homocysteine, Hey)水平的关系；针对高Hcy血症给与干预措施后,评价干预措施对痴呆患者智能损害和行为精神症状的影响。
方法对临床确诊的80例痴呆患者及年龄匹配的正常对照者,采用高压液相色谱方法检测不同组别的血浆同型半胱氨酸(homocysteine, Hey)水平,同时使用简易智力状态检查量表(Mini-Mental State Examination, MMSE)、日常生活能力量表(Activity of Daily Living Scale, ADL)、阿尔茨海默病病理行为评分表(the Behavior Pathology in Alzheimer's Disease Rating Scale, BEHAVE-AD)对其进行临床心理评定,然后对高Hcy的痴呆患者予口服叶酸及B族维生素进行6个月的干预治疗,并评定干预措施的效果。
结果痴呆患者Hcy水平(16.98±6.40μmol/L)高于正常对照组(13.08±3.37μmol/L),有显著性差异；高Hcy的痴呆患者与正常Hcy的痴呆患者比较,BEHAVE-AD评分有显著性差异；干预组痴呆患者和非干预组痴呆患者的MMSE.ADL和BEHAVE-AD评分比较,在治疗后无显著性差异。
结论血浆Hcy水平与痴呆的发生发展密切相关；高Hcy可能在痴呆患者的行为和精神症状(behavioral and psychological symptoms of Alzheimer's disease,BPSD)的发病机制中起重要作用。但未能证实在短期内辅助补充叶酸和B族维生素可改善对痴呆疗效。
Objectives To study the relationship between homocyteine(Hcy) and dementia and the intervention effect of vitamin B and folacin.
Methods 80 dementia patients and 80 healthy controls were enrolled and examined by Mini-Mental State Examination(MMSE), Activity of Daily Living Scale(ADL), the Behavior Pathology in Alzheimer's Disease Rating Scale(BEHAVE-AD). The plasma Hey levels were tested by high pressure liquid chromatography (HPLC). Folacin combined with vitamin B6 and B12 were given to the patients with hyperhomocyteine for six months.
Results The plasma Hey in dementia patients was significantly higher than in the controls. The total score of BEHAVE-AD in the patients with hyperhomocyteine was significantly higher than that in the patients with normal plasma Hey. No improvement was found in cognitive function comparing the treatment and the controls.
Conclusions The elevated plasma Hey level is involved in dementia, but vitamin B and folacin treatment did not improve cognitive function at least in the short term.
方法对临床确诊的80例痴呆患者及年龄匹配的正常对照者,采用高压液相色谱方法检测不同组别的血浆同型半胱氨酸(homocysteine, Hey)水平,同时使用简易智力状态检查量表(Mini-Mental State Examination, MMSE)、日常生活能力量表(Activity of Daily Living Scale, ADL)、阿尔茨海默病病理行为评分表(the Behavior Pathology in Alzheimer's Disease Rating Scale, BEHAVE-AD)对其进行临床心理评定,然后对高Hcy的痴呆患者予口服叶酸及B族维生素进行6个月的干预治疗,并评定干预措施的效果。
结果痴呆患者Hcy水平(16.98±6.40μmol/L)高于正常对照组(13.08±3.37μmol/L),有显著性差异；高Hcy的痴呆患者与正常Hcy的痴呆患者比较,BEHAVE-AD评分有显著性差异；干预组痴呆患者和非干预组痴呆患者的MMSE.ADL和BEHAVE-AD评分比较,在治疗后无显著性差异。
结论血浆Hcy水平与痴呆的发生发展密切相关；高Hcy可能在痴呆患者的行为和精神症状(behavioral and psychological symptoms of Alzheimer's disease,BPSD)的发病机制中起重要作用。但未能证实在短期内辅助补充叶酸和B族维生素可改善对痴呆疗效。
Objectives To study the relationship between homocyteine(Hcy) and dementia and the intervention effect of vitamin B and folacin.
Methods 80 dementia patients and 80 healthy controls were enrolled and examined by Mini-Mental State Examination(MMSE), Activity of Daily Living Scale(ADL), the Behavior Pathology in Alzheimer's Disease Rating Scale(BEHAVE-AD). The plasma Hey levels were tested by high pressure liquid chromatography (HPLC). Folacin combined with vitamin B6 and B12 were given to the patients with hyperhomocyteine for six months.
Results The plasma Hey in dementia patients was significantly higher than in the controls. The total score of BEHAVE-AD in the patients with hyperhomocyteine was significantly higher than that in the patients with normal plasma Hey. No improvement was found in cognitive function comparing the treatment and the controls.
Conclusions The elevated plasma Hey level is involved in dementia, but vitamin B and folacin treatment did not improve cognitive function at least in the short term.
引文
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[13]蔡琰.老年性痴呆研究进展.国内外医学科学进展.卫生部科技教育司上 海市医学科学技术情报研究所.2001：96-99.
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[15]Sachdev P.Homocysteine and neuropsychiatric disorders.Rev Bras Psiquiatr,2004 Mar;26(l)50-6
[16]Bell IR,Edman JS,Selhub J,et al.Plasma homocysteine in vascular disease and in nonvascular dementia of depressed elderly people.Acta Psychiatr Scand,1992 Nov;86(5):386-90
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[23]Ho PI,Collins SC,Dhitavat S,et al. Homocysteine potentiates beta-amyliod neurotoxicity:role of oxidative stress. J Neurochem.2001 Jul;78(2):249-53.
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