【作者】 王亚男；

【导师】 韩迪；

【作者基本信息】 青岛大学 ， 全科医学（专业学位）， 2021， 硕士

【摘要】 目的:探讨脑小血管病患者认知功能与血液指标同型半胱氨酸、高密度脂蛋白水平的相关性,为及早诊断和发现脑小血管病患者发生轻度认知功能障碍提供临床依据。方法:收集2018年9月-2019年12月符合纳排标准的脑小血管病患者335例,收集受试者的一般资料,采用日常生活能力量表评估入选者的日常生活能力是否受损,由受过统一培训的人员应用北京版蒙特利尔认知评估表对入选者进行认知评定,根据总分将入选者分为MCI组、对照组。采集入选者静脉血样,由检验科医师进行生化指标检测。采用SPSS26.0统计软件进行数据整理及分析,符合正态分布的计量资料用(±)表示,组间比较采用独立样本t检验;计数资料用百分率表示,采用卡方检验进行比较;采用二元logistic回归分析各影响因素与认知功能之间的关联;采用Pearson检验进行相关性分析。P<0.05差异有统计学意义。结果:(1)一般资料比较:纳入本项研究的患者共335例,年龄60~80岁,平均年龄(66.18±5.29)岁,其中男性140例(41.79%),女性195例(58.21%),吸烟者75例(22.39%),饮酒者81例(24.18%),冠心病患者37例(11.04%),糖尿病患者57例(17.01%),高血压患者113例(33.73%)。根据入选者是否患有认知功能障进行分组,MCI组253例,对照组82例。与对照组比较,MCI组在年龄、糖尿病及冠心病比例方面明显升高(P<0.05);但是两组受试者在性别、吸烟、饮酒、高血压比例、BMI等基线特征分布上差异均无统计学意义(P>0.05)。(2)血液指标比较:MCI组患者的血清同型半胱氨酸(Hcy)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)结果分别为14.45±6.23μmol/L、5.08±1.14 mmol/L、2.07±1.36 mmol/L、2.97±0.80 mmol/L、1.16±0.33 mmol/L,对照组上述各项指标结果分别为10.06±3.21μmol/L、5.33±0.97 mmol/L、2.22±1.48mmol/L、3.05±0.70 mmol/L、1.46±0.37 mmol/L。与对照组比较,MCI组患者血清Hcy升高,HDL降低(P<0.05)。(3)二元logistic回归分析:控制其他影响因素后,血清同型半胱氨酸(OR=0.722,95%CI:0.644-0.809)、高密度脂蛋白(OR=7.560,95%CI:2.977-19.204)及年龄(OR=0.899,95%CI:0.833-0.969)是患者发生MCI的影响因素(P<0.05)。(4)两组受试者认知评估结果:MCI组MoCA总分及各认知域结果分别为20.89±3.23、3.06±1.28、2.53±0.59、3.60±1.17、1.78±0.81、1.42±0.62、3.17±1.16、5.34±0.89;对照组的上述各项结果分别为26.79±1.04、4.43±0.69、2.89±0.32、5.28±0.76、2.34±0.55、1.83±0.38、3.88±0.78、5.93±0.31。差异具有统计学意义(P<0.05)。(5)Pearson相关性分析结果显示:血清同型半胱氨酸水平与Mo CA量表评分总分、视空间及执行能力、注意力、语言、抽象思维评分呈现负相关(r=-0.237、-0.136、-0.174、-0.150、-0.201,P<0.05),与命名、延迟回忆、定向力则无明显相关性(r=-0.174、-0.085、-0.054,P>0.05);高密度脂蛋白水平与Mo CA量表评分总分、视空间及执行能力、注意力、语言、抽象思维、命名及延迟回忆、定向力评分均呈现正相关(r=0.424、0.286、0.130、0.338、0.151、0.265、0.176、0.263,<0.05)。结论:血清同型半胱氨酸和高密度脂蛋白水平与脑小血管病患者合并轻度认知功能障碍之间存在关联,血清同型半胱氨酸可能为脑小血管病患者发生轻度认知功能损害的重要危险因素,高水平高密度脂蛋白可能是患者发生轻度认知功能障碍的保护因素,检测患者血清同型半胱氨酸、高密度脂蛋白水平可能有助于预防患者认知功能障碍的发生,从而改善其生活质量及疾病预后。更多还原

【Abstract】 Objective: To explore the correlation between cognitive impairment and serum homocysteine(Hcy)and high-density lipoprotein(HDL)levels in cerebral small vessel disease(CSVD)patients,in order to provide clinical basis for early diagnosis and detection of mild cognitive impairment in patients with cerebral small vessel disease.Methods: From September 2018 to December 2019,335 CSVD patients who met the inclusion and exclusion criteria were collected.The general data of subjects were collected.The activities of daily living scale was used to evaluate the impairment of activities of daily living.The selected subjects were cognitive assessed by the uniformly trained personnel using the Beijing version of Montreal Cognitive Assessment form.According to the total score,the selected patients were divided into the MCI group and the control group.The venous blood samples of the subjects were collected and the biochemical indexes were tested by laboratory physicians.SPSS26.0 statistical software was used for data collation and analysis.The measurement data in accordance with normal distribution were expressed by(±),the independent sample t-test was used for comparison between groups,the counting data were expressed as percentage and compared with Chi-square test;the correlation between influencing factors and cognitive function was analyzed by binary logistic regression;and Pearson test was used for correlation analysis.The difference was statistically significant(P < 0.05).Results:(1)Clinical data comparison: A total of 335 subjects were enrolled in this study,aged 60 to 80 years,with an average age of(66.18±5.29)years,including 140 males(41.79%),195 females(58.21%),75 smokers(22.39%)and 81 drinkers(24.18%).There were 37 patients with coronary heart disease(11.04%),57 patients with diabetes(17.01%)and 113 patients with hypertension(33.73%).The subjects are divided into groups according to whether they have cognitive impairment or not,MCI group(n = 253)and control group(n = 82).Compared with the control group,the age,the proportion of diabetes and coronary heart disease in the MCI group were significantly higher(P<0.05),but there was no significant difference in the distribution of baseline characteristics such as sex,smoking,drinking,hypertension and BMI between the two groups(P > 0.05).(2)Comparison of biochemical indexes: The results of serum homocysteine,total cholesterol,triglyceride,low density lipoprotein and high-density lipoprotein in MCI group were 14.45±6.23 μmol/L,5.08±1.14 mmol/L,2.07±1.36 mmol/L,2.97±0.80mmol/L and 1.16±0.33 μmol/L,respectively.The results of the above indexes in the control group were 10.06±3.21 μmol/L,5.33±0.97 mmol/L,2.22±1.48 mmol/L,3.05±0.70 mmol/L,1.46±0.37 mmol/L,respectively.Compared with the control group,serum Hcy increased and HDL decreased in MCI group(P < 0.05).(3)Logistic Regression Analysis: After controlling other influencing factors,serum Hcy(OR = 0.722,95%CI: 0.644-0.809),HDL(OR = 7.560,95%CI: 2.977-19.204)and age(OR = 0.899,95%CI: 0.833-0.969)were the influencing factors of MCI(P < 0.05).(4)Cognitive assessment results of two groups of subjects: The total score of MoCA and the results of cognitive domain analysis in MCI group were 20.89±3.23,3.06±1.28,2.53±0.59,3.60±1.17,1.78±0.81,1.42±0.62,3.17±1.16,5.34±0.89;the above results of the control group were as follows were 26.79±1.04,4.43±0.69,2.89±0.32,5.28±0.76,2.34±0.55,1.83±0.38,3.88±0.78,5.93±0.31.The difference is statistically significant(P <0.05).(5)Pearson Correlation Analysis: The level of serum homocysteine was negatively correlated with the total score of Mo CA scale,visual space and executive ability,attention,language and abstract thinking(r = 0.237,-0.136,-0.174,-0.150,-0.201,P <0.05),but not with naming,delayed recall and orientation(r =0.174,-0.085,-0.05,P >0.05).The level of high-density lipoprotein was positively correlated with the total score of Mo CA scale,visual space and executive ability,attention,language,abstract thinking,naming and delayed recall,orientation score(r = 0.424,0.286,0.130,0.338,0.151,0.265,0.176,0.263,P<0.05).Conclusion: There is a correlation between the levels of serum homocysteine and high-density lipoprotein and mild cognitive impairment in patients with cerebrovascular disease.Serum homocysteine may be an important risk factor for mild cognitive impairment in patients with cerebral microvascular disease.High level of high-density lipoprotein may be a protective factor for mild cognitive impairment in patients with cerebral microvascular disease.The detection of serum homocysteine and high-density lipoprotein may help to prevent the occurrence of cognitive dysfunction and improve the quality of life and prognosis of patients.更多还原