【摘要】 目的:观察血管性痴呆患者甲状腺功能及其血浆同型半胱氨酸水平。方法:所有病例均为2004-02/2005-12期间郧阳医学院附属人民医院神经内科住院患者,其中血管性痴呆组患者38例(简易精神状态检查量表按文化程度,文盲≤17分,小学文化(教育年限≤6年)≤20分,中学及以上文化(教育年限>6年)≤24分);对照组为同期收治非痴呆脑梗死患者40例(均经脑CT证实)。两组性别、年龄构成差异无统计学意义。采用放射免疫检测法测定所有患者的甲状腺激素水平。应用高效液相色谱电化学检测法测定血浆同型半胱氨酸含量。由接受培训的专职人员对血管性痴呆组患者进行简易精神状态检查量表、Hachinski缺血量表和老年抑郁量表量表评分,评分在入院后24h内完成,根据简易精神状态检查量表评分划分血管性痴呆患者严重程度,分为轻度(20～24分)、中度(10～19分)、重度(10分以下)。结果:血管性痴呆患者38例和非痴呆脑梗死对照组患者40例均测得各项指标,并完成量表评定,全部进入结果分析。①血管性痴呆组T3(三碘甲状腺原氨酸)、T4(甲状腺素)、FT3(游离三碘甲状腺原氨酸)水平明显低于对照组[T3:(0.9±0.4),(1.3±0.3)μg/L,t=5.0129,P=0.0000];[T4:(92.9±26.4),(110.2±28.7)μg/L,t=2.7666,P=0.0071];[FT3:(3.9±1.8),(7.2±2.1)pmol/L,t=7.4336,P=0.0000],血浆同型半胱氨酸水平高于对照组[(29.57±7.12),(24.53±4.98)μmol/L,t=3.6377,P=0.0005];两组间FT4(游离甲状腺素)、TSH(促甲状腺激素)水平差异无显著性意义(P>0.05)。②轻、中、重不同程度血管性痴呆患者之间的FT3(游离三碘甲状腺原氨酸)、T3(三碘甲状腺原氨酸)和血浆同型半胱氨酸差异有显著性意义[FT3:(4.7±0.4),(3.5±0.5),(3.1±0.3)pmol/L,F=32.4,P=0.0000];[T3:(1.0±0.2),(0.9±0.1),(0.8±0.1)μg/L,F=5.91,P=0.0061];[血浆同型半胱氨酸:(26.52±4.84),(29.59±5.56),(32.71±6.17)μmol/L,F=3.59,P=0.0380];T4(甲状腺素)、FT4(游离甲状腺素)、TSH(促甲状腺激素)水平差异无显著性意义(P>0.05)。结论:血管性痴呆患者的甲状腺激素水平降低、血浆同型半胱氨酸水平升高,甲状腺激素和血浆同型半胱氨酸水平可作为血管性痴呆严重程度的间接指标。更多还原

【Abstract】 AIM: To study the relationship between thyroid function and plasma homocysteine (Hcy) levels in patients with vascular dementia (VD). METHODS: Totally 38 VD patients and 40 nondemented patients with cerebral infarction detected by CT,who hospitalized in the Department of Neurology,Affiliated Renmin Hospital of Yunyang Medical College between February 2004 and December 2005,were recruited in the study. The VD patients and controls matched each other well in gender and age. And the VD patients were graded with Mini-Mental State Examination (MMSE) scores as illiteracy (≤ 17 points),primary educated (education time ≤ 6 years,≤ 20 points) and secondary educated or above (education time > 6 years,≤ 24 points). Their thyroiodine and plasma Hcy levels were measured by using radioimmunoassay and high-performance liquid chromatography with electrochemical detection,respectively. All the VD patients were tested by the professional researchers with MMSE,Hanchinski Ischemic Score (HIS) and Geriatric Depression Scale (GDS) within 24 hours after hospitalization. The severity of cognition impairment in VD patients was classified by MMSE’s scores: mild (20-24 points),moderate (10-19 points) and severe (< 10 points). RESULTS: All the 38 VD patients and 40 controls completed the detections and entered the result analysis.①The levels of triiodothyronine (T3),thyroxine (T4) and free T3 (FT3) were all obviously lower in VD patients than in controls T3: (0.9±0.4),(1.3±0.3) μg/L,t=5.012 9,P=0.000 0; T4: (92.9±26.4),(110.2±28.7) μg/L,t=2.766 6,P=0.007 1; FT3: (3.9±1.8),(7.2±2.1) pmol/L,t=7.433 6,P=0.000 0. However,total plasma Hcy levels were higher in VD patients,compared with the patients with nondemented cerebral infarction (29.57±7.12),(24.53±4.98) μmol/L,t=3.637 7,P =0.000 5. There was no significant difference in the levels of free thyroxin (FT4) and thyroid-stimulating hormone (TSH) between the two groups (P > 0.05).②Plasma Hcy,FT3 and T3 concentrations were different significantly in VD patients with different severities of cognition impairment FT3: (4.7±0.4),(3.5±0.5),(3.1±0.3) pmol/L,t=32.4,P=0.000 0; T3: (1.0±0.2),(0.9±0.1),(0.8±0.1) μg/L,t=5.91,P=0.006 1; Hcy: (26.52±4.84),(29.59±5.56),(32.71±6.17) μmol/L,F=3.59,P=0.038 0. While the levels of T4,FT4 and TSH were similar in the two groups (P > 0.05). CONCLUSION: The reduction of thyroiodine and increased levelsof Hcy occur in VD patients,and they may be indicative factors for VD’s severity.更多还原