文章摘要
马红妮,颜飞,李再利,邓美英,屈秋民,代表中国阿尔茨海默病及相关疾病协作组.社区脑卒中高危人群同型半胱氨酸水平与认知功能调查[J].中华流行病学杂志,2014,35(7):769-772
社区脑卒中高危人群同型半胱氨酸水平与认知功能调查
Investigation on plasma homocysteine level and cognition in population at high risk for stroke in Xi’an
收稿日期:2014-01-12  出版日期:2014-09-01
DOI:10.3760/cma.j.issn.0254-6450.2014.07.003
中文关键词: 脑卒中筛查  高同型半胱氨酸血症  认知功能障碍  危险因素
英文关键词: Stroke screening  Hyperhomocysteinemia  Cognitive impairment  Risk factors
基金项目:卫生部脑卒中筛查与防治项目;国家科技重大专项(2012ZX09303-005-002)
作者单位E-mail
马红妮 西安交通大学医学院第一附属医院神经内科, 710061  
颜飞 西安交通大学医学院第一附属医院神经内科, 710061  
李再利 西安交通大学医学院第一附属医院神经内科, 710061  
邓美英 西安交通大学医学院第一附属医院神经内科, 710061  
屈秋民 西安交通大学医学院第一附属医院神经内科, 710061 quqiumin@medmail.com.cn 
代表中国阿尔茨海默病及相关疾病协作组 西安交通大学医学院第一附属医院神经内科, 710061  
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中文摘要:
      目的 分析脑卒中高危患者血浆同型半胱氨酸(Hcy)水平与认知功能状态及与认知功能障碍的关系。方法 在2012 年8-12 月西安市雁塔区参加“卫生部脑卒中筛查与防治项目”中发现的脑卒中高危人群测定血浆Hcy 浓度。血浆Hcy 浓度>15 μmol/L 为高Hcy 血症, 其中16~30 μmol/L 为轻度Hcy 增高, ≥31 μmol/L 为中重度Hcy 增高。应用简易精神状态量表(MMSE)评价认知功能, 以MMSE得分低于正常分界值作为认知功能障碍的标准。结果 共纳入脑卒中高危患者393 例, 其中男性173 例(44.0%), 女性220 例(56.0%)。血浆Hcy 增高220 例(56.0%), 存在认知功能障碍70 例(17.8%)。Hcy 增高组与Hcy 正常组认知功能障碍发生率的差异无统计学意义(16.8% vs. 19.1%, P>0.05)。Hcy轻度增高组与中重度增高组认知功能障碍发生率的差异无统计学意义(17.0% vs. 16.3%, P>0.05)。轻度认知功能障碍组与中重度认知功能障碍组血浆Hcy 水平的差异无统计学意义[(20.54±16.44)μmol/L vs.(17.71±6.37)μmol/L, P>0.05]。Spearman秩相关分析显示, MMSE评分与血浆Hcy浓度无相关性(rs=-0.01, P=0.85)。单因素分析显示, 认知功能障碍发生率吸烟组高于非吸烟组(21.3% vs. 7.8%, P<0.01), 高血压组高于非高血压组(21.7% vs. 8.0%, P<0.01), 有脑卒中史组高于无脑卒中史组(25.3% vs. 15.4%, P<0.05)。逐步非条件logistic 回归分析显示, 与认知功能障碍相关的因素包括受教育程度(OR=0.90, 95%CI:0.81~0.98, P=0.02)、高血压(OR=1.02, 95%CI:1.01~1.04, P=0.01)和脑卒中史(OR=1.86, 95%CI:1.04~3.33, P=0.04), 而血浆Hcy 水平未进入回归方程(OR=0.90, 95%CI:0.51~1.58, P=0.71)。结论 血浆Hcy水平可能不是认知功能障碍的独立危险因素。
英文摘要:
      Objective To investigate the relationship between plasma homocysteine(Hcy)and cognitive impairment so as to provide basis for dementia prevention. Methods Subjects at high risk for stroke were selected from the Screening and Prevention Program of Stroke(organized by the Ministry of Health, from August to December, 2012) in Yanta area, Xi’an. Fasting blood was taken from cubital vein to measure Hcy. When Hcy>15 μmol/L was defined as hyperhomocysteinmia, Hcy in the range of 16-30 μ mol/L was considered mild, ≥31 μ mol/L as moderate-severe hyperhomocysteinemia. The cognitive function was evaluated by the Mini Mental State Examination (MMSE). MMSE grades under normal value were defined as cognitive impairment. Results 393 subjects were randomly recruited, including 173 men(44.0%)and 220 women(56.0%). Number of cases with cognitive impairment was 70(17.8% of the total subjects), with hyperhomocysteinmia was 220(56.0% of the total subjects). The prevalence of cognitive impairment did not show significant difference with hyperhomocysteinemia or normal Hcy group(16.8% vs. 19.1%, P>0.05), neither with mild and moderate-severe hyperhomocysteinemia group(17.0% vs. 16.3% , P>0.05). Results from Spearman correlation analysis indicated that there was no correlation between MMSE grades and Hcy(rs=-0.01, P=0.85). Prevalence of cognitive impairment in the smoking group was higher than that in the non-smoking group(21.3% vs. 7.8%, P<0.01), but higher in hypertension group than that in the normal blood pressure group(21.7% vs. 8.0%, P<0.01). In the stroke group, prevalence of cognitive impairment was seen higher than that in the non-stroke group(25.3% vs. 15.4%, P<0.05).Based on the results from Binary logistic regression, cognitive impairment appeared to be associated with the levels of education(OR=0.90, 95% CI:0.81-0.98, P=0.02), histories of hypertension(OR=1.02, 95%CI:1.01-1.04, P=0.01) and stroke(OR=1.86, 95%CI:1.04-3.33, P=0.04), but there was no correlation seen between Hcy and cognitive impairment(OR=0.90, 95% CI:0.51-1.58, P=0.71).Conclusion Plasma homocysteine did not seem a risk factor for cognitive impairment.
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