腔隙性脑梗死患者认知障碍与高同型半胱氨酸血症、梗死灶数目及体积的相关性

doi:10.6040/j.issn.1671-7554.0.2015.922

摘要/Abstract

摘要： 目的探讨腔隙性脑梗死患者血管性认知障碍(VCI)程度与血浆同型半胱氨酸(Hcy)水平、梗死灶数目及总体积的相关性。方法选择2011年10月至2013年10月,在滕州市中医医院神经内科首次住院的腔隙性脑梗死患者196例,采用简易精神状态检查表(MMSE)评分,将患者分为认知功能正常组(155例)、轻度认知障碍组(35例)和痴呆组(6例),以201名健康体检者为对照组。所有入选患者均进行血Hcy检测及头颅MRI检查,计算腔隙梗死灶数目及每个腔隙梗死灶体积(mm³)及总体积;对腔隙性脑梗死患者认知功能与血Hcy水平、腔隙梗死病灶数目及总体积之间的相关性进行多元线性回归分析。结果腔隙性脑梗死患者中Hcy≥10 μmol/L者比率高于对照组(91.84% vs 65.67%, P<0.01);痴呆组血Hcy水平［(51.37±8.12)μmol/L］与轻度认知障碍组［(28.06±7.56)μmol/L］、认知正常组［(21.70±6.92)μmol/L］、对照组［(11.58±3.73)μmol/L ］比较,差异均有统计学意义(P<0.01);痴呆组、轻度认知障碍组和认知功能正常组梗死灶数目［(8.00±1.67)、(4.77±0.77)、(3.52±0.81)个］及总体积［(27.42±9.34)、(14.96±6.89)、(8.81±3.71)mm³］分别进行组间比较,差异均有统计学意义(P<0.01)。结论腔隙性脑梗死患者认知功能MMSE评分与血Hcy水平呈负相关,与梗死灶数目及梗死灶总体积亦呈负相关。

关键词: 磁共振成像, 同型半胱氨酸, 腔隙性脑梗死, 认知功能障碍

Abstract: Objective To investigate the correlation between the extent of the vascular cognitive impairment(VCI)and the level of homocystein(HCY)in plasma as well as the number and volume of infarct in patients with lacunar cerebral infarction. Methods A total of 196 lacunar infarction patients who were hospitalized in Tengzhou Traditional Chinese Hospital, from Oct. 2011 to Oct. 2013, for the first time and 201 healthy volunteers(control group)were included in this study. Levels of plasma Hcy were detected in all subjects. The number and total volume of lacunar infarct(mm³)were determined by using MRI detection. Patients were divided into normal cognitive group(n=155), mild VCI group 山东大学学报 (医学版)54卷10期 -董芳,等.腔隙性脑梗死患者认知障碍与高同型半胱氨酸血症、梗死灶数目及体积的相关性 \=-(n=35)and dementia group(n=6), according to the cognitive function score of Minimum Mental State Examination(MMSE). The levels of plasma Hcy were compared between patients and control group. Spearman correlation was used to analyze the correlations among the cognitive function and the levels of plasma Hcy, the number and total volume of lacunar infarction. Results The proportion of subjects with plasma Hcy levels ≥10 μmol/L in patients with lacunar infarction(91.84%)was higher than that in the controls(65.67%). The levels of plasma Hcy in dementia group ［(51.37±8.12 )μmol/L］, mild VCI group ［(28.06±7.56)μmol/L］ and normal cognitive group ［(21.70±6.92)μmol/L］ were significantly higher than that in control group(P<0.01). The differences in total number and volume of lacunar infarcts between dementia group ［number 8.00±1.67; total volume(27.42±9.34)mm³］ and mild VCI group ［number 4.77±0.77; total volume(14.96±6.89)mm³］ as well as normal cognitive group ［number 3.52±0.81; total volume(8.81±3.71)mm³］ were statistically significant(P<0.01). Conclusion There is negative correlation between the cognitive level detected by MMSE and HCY, and also between the number and the total volume of infarction in patients with cerebral lacunar infarction.

Key words: Vascular cognitive impairment(VCI), Lacunar infarction, Homocysteine, Magnetic resonance imaging(MRI)

中图分类号:

R743.3

董芳,杜怡峰. 腔隙性脑梗死患者认知障碍与高同型半胱氨酸血症、梗死灶数目及体积的相关性[J]. 山东大学学报（医学版）, 2016, 54(10): 46-49.

DONG Fang, DU Yifeng. Correlation among cognitive impairment and high homocysteinemia as well as the number and volume of infarct in patients with lacunar cerebral infarction[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(10): 46-49.

参考文献

[1] 贾建平. 神经病学[M]. 6版.北京:人民卫生出版社, 2011: 187.
[2] 张海霞, 任延德, 刘峰. MRI在脑微出血与腔隙性脑梗死相关性研究中的应用[J].中国中西医结合影像学杂志, 2012, 10(3):202-205. ZHANG Haixia, REN Yande, LIU Feng. Role of MRI in cerebral microbleeds and lacunar infarction[J]. Chinese Imaging Journal of Integrated Traditional and Western Medicine, 2012, 10(3):202-205.
[3] Makin SD, Turpin S, Dennis MS, et al. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes[J]. J Neurol Neurosurg Psychiatr, 2013, 84(8): 893-900.
[4] 胡大一,徐希平.控制“H 型”高血压—预防卒中的新思路[J].中华内科杂志,2008,47(12):976-977.
[5] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中国临床医生,2011,14(12B):4013-4017.
[6] 血管性认知功能损害专家共识组. 血管性认知功能损害的专家共识[J]. 中华内科杂志,2007,46(12): 1052-1055.
[7] 高素荣. 失语症[M]. 北京:北京医科大学中国协和医科大学联合出版社, 1993: 135-139.
[8] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华高血压杂志,2011,19(8): 701-743.
[9] Squire LR, Zola SM. Memory, memory impairment, and the medial temporal lobe[J]. Cold Spring Harb Symp Quant Biol, 1996, 61:185-195.
[10] Tekin S, Cummings JL. Frontal-subcortical neuronal circuits and clinical neuropsychiatry[J]. J Psychosom Res, 2002, 53(2):647-654.
[11] Baddeley AD, Kopelman MD, Wilson BA. The handbook of memory disorders[M]. London: John Wiley & Sons, 2002.
[12] 邢立红, 翟飞, 张敬, 等. 脑微出血灶与认知功能相关性的磁共振研究[J]. 中华老年心脑血管病杂志, 2014, 16(3):287-290. XING Lihong, ZHAI Fei, ZHANG Jing, et al. MRI in cerebral microbleeds associated with cognitive function[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2014, 16(3):287-290.
[13] 王世凯. 脑桥腔隙性梗死60例临床特征与头颅MRI分析[J]. 中国当代医药,2011,18(12): 162-163. WANG Shikai. Clinical features and MRI outcomes of 60 patients with pontine lacuna infarctions[J]. China Modern Medicine, 2011, 18(12):162-163.
[14] 邓宝华,魏忠光,胡锡衷.高血压伴腔隙性脑梗死262例临床分析[J]. 中国实用内科杂志,2001,21(11):657.
[15] Jacques PF, Bostom AG, Wilson PW, et al. Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort[J]. Am J Clin Nutr, 2001, 73(3):613-621.
[16] Boysen G, Brander T, Christensen H, et al. Homocysteine and risk of recurrent stroke[J]. Stroke, 2003, 34(5):1258-1261.
[17] 张哲成, 高海凤, 刘建国, 等. 高同型半胱氨酸血症及相关因子与脑梗死相关性的研究[J]. 中国临床神经科学, 2003, 11(3):272-274. ZHANG Zhecheng, GAO Haifeng, LIU Jianguo, et al. The associative study of hyperhomocystinemia related factors and cerebral infarction[J]. Chinese Journal of Clinical Neurosciences, 2003, 11(3):272-274.
[18] 李保华, 毛利忠, 王克义, 等. 脑梗死与高同型半胱氨酸血症的相关性研究[J].中国实用神经疾病杂志, 2006, 9(1):8-10. LI Baohua, MAO Lizhong, WANG Keyi, et al. The relationship between cerebral infarction and hyperhomocysteinemia[J]. Chinese Journal of Practical Nervous Diseases, 2006, 9(1):8-10.
[19] Hassan A, Hunt BJ, OSullivan M, et al. Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction[J]. Brain, 2004, 127(Pt 1):212-219.

相关文章 15

[1]	王玉红,张丽红,王林省,陈月芹,王彦辉,王皆欢,李传福. 消化道颗粒细胞瘤的影像学表现[J]. 山东大学学报（医学版）, 2017, 55(8): 66-70.
[2]	许玉军,柳明,何祥萌,李成利. 1.0T开放型磁共振引导经皮穿刺¹²⁵I放射性粒子植入治疗晚期胰腺癌[J]. 山东大学学报（医学版）, 2017, 55(2): 21-25.
[3]	王光彬. MRI在凶险性前置胎盘诊断中的价值[J]. 山东大学学报（医学版）, 2016, 54(9): 7-9.
[4]	董金叶,林祥涛,曹金凤,吴勇,赵慧,谢辉辉,肖连祥. 16~42周胎儿脊髓颈膨大发育的MRI分析[J]. 山东大学学报（医学版）, 2016, 54(5): 74-78.
[5]	张湛,许相丰,刘海东,王玮. MRI在宫颈癌T分期中的诊断价值[J]. 山东大学学报（医学版）, 2016, 54(5): 70-73.
[6]	杨博,李平,孟立平,周昌钻,潘孙雷,池菊芳,郭航远. 依那普利抑制大鼠血管平滑肌细胞表型转化及可能的信号通路[J]. 山东大学学报（医学版）, 2016, 54(2): 21-26.
[7]	俞璐,刘强. 体素内不相干运动磁共振成像对糖尿病患者肾脏功能的评价作用[J]. 山东大学学报（医学版）, 2016, 54(11): 68-71.
[8]	孟祥水,柴相君,马祥兴,任庆国,杨志成. CT、MRI对喉癌治疗方案选择的价值[J]. 山东大学学报（医学版）, 2016, 54(10): 76-79.
[9]	宓特,屈传强,王翔,尹苓,薛媛,杜怡峰. 血清淀粉样蛋白A与脑梗死急性期认知功能的相关性[J]. 山东大学学报（医学版）, 2016, 54(10): 40-45.
[10]	张扬, 李万湖, 宋惟阳, 刘春蕾, 张权. 健康中老年人脑血管反应能力分布特征的屏气功能磁共振成像研究[J]. 山东大学学报（医学版）, 2015, 53(5): 85-88.
[11]	韩潇, 刘锟, 史加海, 高福民, 尤庆生. 醒脑静在体外循环心脏手术中对脑功能的保护[J]. 山东大学学报（医学版）, 2015, 53(1): 54-57.
[12]	翟栋材, 张申杰, 张博, 张涛. 超声造影与增强MRI评价聚焦超声消融治疗子宫腺肌症的对照研究[J]. 山东大学学报（医学版）, 2014, 52(S1): 112-113.
[13]	董栋, 王新怡. 磁共振体素内不相干运动在轻度认知功能障碍诊断中的初步研究[J]. 山东大学学报（医学版）, 2014, 52(8): 68-71.
[14]	Hasan Akhtar, 王茜，李传福. 中枢神经系统表面含铁血黄素沉积症的影像表现(附1例报道)[J]. 山东大学学报（医学版）, 2014, 52(5): 111-112.
[15]	郝雯，赵斌，王翠艳，李慧华，邱秀玲. 乳腺MRI在预测导管内癌早期浸润中的价值[J]. 山东大学学报（医学版）, 2014, 52(4): 102-106.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed