中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2014年
7期
769-772
,共4页
马红妮%颜飞%李再利%邓美英%屈秋民
馬紅妮%顏飛%李再利%鄧美英%屈鞦民
마홍니%안비%리재리%산미영%굴추민
脑卒中筛查%高同型半胱氨酸血症%认知功能障碍%危险因素
腦卒中篩查%高同型半胱氨痠血癥%認知功能障礙%危險因素
뇌졸중사사%고동형반광안산혈증%인지공능장애%위험인소
Stroke screening%Hyperhomocysteinemia%Cognitive impairment%Risk factors
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.
目的 分析腦卒中高危患者血漿同型半胱氨痠(Hcy)水平與認知功能狀態及與認知功能障礙的關繫.方法 在2012年8-12月西安市雁塔區參加“衛生部腦卒中篩查與防治項目”中髮現的腦卒中高危人群測定血漿Hcy濃度.血漿Hcy濃度＞15 μmol/L為高Hcy血癥,其中16～ 30 μmol/L為輕度Hcy增高,≥31 μmol/L為中重度Hcy增高.應用簡易精神狀態量錶(MMSE)評價認知功能,以MMSE得分低于正常分界值作為認知功能障礙的標準.結果 共納入腦卒中高危患者393例,其中男性173例(44.0％),女性220例(56.0％).血漿Hcy增高220例(56.0％),存在認知功能障礙70例(17.8％).Hcy增高組與Hcy正常組認知功能障礙髮生率的差異無統計學意義(16.8％vs..19.1％,P＞0.05).Hcy輕度增高組與中重度增高組認知功能障礙髮生率的差異無統計學意義(17.0％ vs.16.3％,P＞0.05).輕度認知功能障礙組與中重度認知功能障礙組血漿Hcy水平的差異無統計學意義[(20.54±16.44)μmol/L vs.(17.71±6.37) μmol/L,P＞0.05].Spearman秩相關分析顯示,MMSE評分與血漿Hcy濃度無相關性(rs=-0.01,P=0.85).單因素分析顯示,認知功能障礙髮生率吸煙組高于非吸煙組(21.3％ vs.7.8％,P＜0.01),高血壓組高于非高血壓組(21.7％ vs.8.0％,P＜0.01),有腦卒中史組高于無腦卒中史組(25.3％ vs.15.4％,P＜0.05).逐步非條件logistic迴歸分析顯示,與認知功能障礙相關的因素包括受教育程度(OR=0.90,95％CI:0.81～0.98,P=0.02)、高血壓(OR=1.02,95％CI:1.01～ 1.04,P=0.01)和腦卒中史(OR=1.86,95％CI:1.04～ 3.33,P=0.04),而血漿Hcy水平未進入迴歸方程(OR=0.90,95％CI:0.51 ～ 1.58,P=0.71).結論 血漿Hcy水平可能不是認知功能障礙的獨立危險因素.
목적 분석뇌졸중고위환자혈장동형반광안산(Hcy)수평여인지공능상태급여인지공능장애적관계.방법 재2012년8-12월서안시안탑구삼가“위생부뇌졸중사사여방치항목”중발현적뇌졸중고위인군측정혈장Hcy농도.혈장Hcy농도＞15 μmol/L위고Hcy혈증,기중16～ 30 μmol/L위경도Hcy증고,≥31 μmol/L위중중도Hcy증고.응용간역정신상태량표(MMSE)평개인지공능,이MMSE득분저우정상분계치작위인지공능장애적표준.결과 공납입뇌졸중고위환자393례,기중남성173례(44.0％),녀성220례(56.0％).혈장Hcy증고220례(56.0％),존재인지공능장애70례(17.8％).Hcy증고조여Hcy정상조인지공능장애발생솔적차이무통계학의의(16.8％vs..19.1％,P＞0.05).Hcy경도증고조여중중도증고조인지공능장애발생솔적차이무통계학의의(17.0％ vs.16.3％,P＞0.05).경도인지공능장애조여중중도인지공능장애조혈장Hcy수평적차이무통계학의의[(20.54±16.44)μmol/L vs.(17.71±6.37) μmol/L,P＞0.05].Spearman질상관분석현시,MMSE평분여혈장Hcy농도무상관성(rs=-0.01,P=0.85).단인소분석현시,인지공능장애발생솔흡연조고우비흡연조(21.3％ vs.7.8％,P＜0.01),고혈압조고우비고혈압조(21.7％ vs.8.0％,P＜0.01),유뇌졸중사조고우무뇌졸중사조(25.3％ vs.15.4％,P＜0.05).축보비조건logistic회귀분석현시,여인지공능장애상관적인소포괄수교육정도(OR=0.90,95％CI:0.81～0.98,P=0.02)、고혈압(OR=1.02,95％CI:1.01～ 1.04,P=0.01)화뇌졸중사(OR=1.86,95％CI:1.04～ 3.33,P=0.04),이혈장Hcy수평미진입회귀방정(OR=0.90,95％CI:0.51 ～ 1.58,P=0.71).결론 혈장Hcy수평가능불시인지공능장애적독립위험인소.
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.
