CAJ | 학술논문

目的研究蛋氨酸负荷试验(MLT)对判断急性脑梗死后患者轻度血管性认知功能障碍(VCI)的价值研究. 方法回顾性分析,采用高压液相色谱法测定脑梗死患者血浆空腹和MLT后同型半胱氨酸(Hcy)水平,选取空腹Hcy正常患者240例,负荷后Hcy正常者159例,负荷后高Hcy症患者81例,空腹高Hcy患者112例.对患者分别行入院时、7d、14 d和30 d蒙特利尔认知评估量表(MoCA)和简易精神状态量表(MMSE)评分. 结果 Logistic回归分析结果显示,Hcy可能是轻度VCI的独立危险因素(OR=1.285,95％cI:1.038～1.265,P＜0.05);空腹高Hcy和负荷后高Hcy患者7d、14 d和30 d MMSE和MoCA评分分别低于空腹Hcy正常患者(P＜0.01或P＜0.05);空腹高Hcy患者入院时、7d、14 d和30 d MMSE和MoCA评分与负荷后高Hcy患者比较差异无统计学意义(P＞0.05). 结论 Hcy可能是轻度VCI的独立危险因素;MLT能发现隐匿的VCI的血管危险因素,为临床及早干预和预防提供有价值的一项检测方法.
목적 연구단안산부하시험(MLT)대판단급성뇌경사후환자경도혈관성인지공능장애(VCI)적개치연구. 방법 회고성분석,채용고압액상색보법측정뇌경사환자혈장공복화MLT후동형반광안산(Hcy)수평,선취공복Hcy정상환자240례,부하후Hcy정상자159례,부하후고Hcy증환자81례,공복고Hcy환자112례.대환자분별행입원시、7d、14 d화30 d몽특리이인지평고량표(MoCA)화간역정신상태량표(MMSE)평분. 결과 Logistic회귀분석결과현시,Hcy가능시경도VCI적독립위험인소(OR=1.285,95％cI:1.038～1.265,P＜0.05);공복고Hcy화부하후고Hcy환자7d、14 d화30 d MMSE화MoCA평분분별저우공복Hcy정상환자(P＜0.01혹P＜0.05);공복고Hcy환자입원시、7d、14 d화30 d MMSE화MoCA평분여부하후고Hcy환자비교차이무통계학의의(P＞0.05). 결론 Hcy가능시경도VCI적독립위험인소;MLT능발현은닉적VCI적혈관위험인소,위림상급조간예화예방제공유개치적일항검측방법.
Objective To study the value of methionine loading test (MLT) in the mild vascular cognitive impairment (VCI) after acute cerebral infarction.Methods The fasting plasma homocystine (Hcy) level and homocystine level after MLT were measured by high-performance liquid chromatography methods.We chose 240 patients with normal level of fasting plasma Hcy (normal group),159 patients with normal level of Hcy after MLT,81 patients with hyperhomocysteinemia after MLT (hyperhomocysteinemia group),and 112 patients with fasting hyperhomocysteinemia (fasting hyperhomocysteinemia group) in this study.The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were conducted in normal,hyperhomocysteinemia and fasting hyperhomocysteinemia groups on admission,at 7d,14 d,30 d after treatment.Results Logistic regression analysis showed that the increased level of Hcy might be an independent risk factor for VCI [OR:1.285,95％CI:1.038-1.265,P＜0.05].The scores of MMSE and MoCA were lower in patients with fasting hyperhomocysteinemia and patients with hyperhomocysteinemia after MLT than in patients with normal fasting plasma Hcy at 7 d,14 d and 30 d after treatment (P＜0.01 or 0.05),while the scores had no significant differences among the three group on admission (P＞0.05).There were no significant differences in MMSE and MoCA scores between patients with fasting hyperhomocysteinemia and patients with hyperhomocysteinemia after MLT on admission,7 d,14 d and 30 d after treatment (P＞0.05).Conclusions Hcy may be an independent risk factor for VCI.The MLT can discover the dormant vascular risk factors for VCI,which offers a valuable detection method for early intervention and prevention in the clinical medicine.