轻中度血管性痴呆患者血浆同型半胱氨酸水平与精神行为症状的关系
경중도혈관성치태환자혈장동형반광안산수평여정신행위증상적관계
Correlation between plasma homocysteine levels and behavioral and psychological symptoms in patients with mild to moderate vascular dementia
  • 万方数据
    中华行为医学与脑科学杂志 중화행위의학여뇌과학잡지
    Chinese Journal of Behavioral Medicine and Brain Science
    2015年 9期 800-804 ,共5页

    李芳%李秀英%王东玉%赵瑞颜

    리방%리수영%왕동옥%조서안

    血管性痴呆%精神行为学症状%神经精神问卷%同型半胱氨酸 血管性癡呆%精神行為學癥狀%神經精神問捲%同型半胱氨痠
    혈관성치태%정신행위학증상%신경정신문권%동형반광안산
    Vascular dementia%Behavioral and psychological symptom%Neuropsychiatric inventory%Homocysteine
    目的 探讨血浆高同型半胱氨酸(homocysteine,Hcy)水平与轻中度血管性痴呆(vascular de-mentia,VaD)患者的精神行为症状(behavioral and psychological symptom of dementia,BPSD)的关系.方法 筛选2012年1月至2015年1月辽宁医学院附属第一医院神经内科≥40岁的轻中度VaD患者293例,所有患者符合美国国立神经病与卒中研究所/瑞士神经科学研究国际协会(NINDS-AIREN)很可能的VaD诊断标准(1993),简易精神状态检查(mini-mental state examination,MMSE) 10≤MMSE≤26分,Hachinski缺血评分(Hachinski ischemic scale,HIS)总分≥4分,临床痴呆评定(clinical dementia rating,CDR)为轻中度1≤CDR≤2.根据血浆Hcy水平分为Hcy升高组(Hcy≥15 μmol/L,n=188)和对照组(Hcy＜ 15 μmol/L,n=105).应用神经精神问卷(neuropsychiatric inventory,NPI)评价两组患者的BPSD,采用比较统计方法针对2组NPI的总分以及NPI的12项功能域评分进行分析.结果 (1)轻中度VaD患者(n=293)中Hcy升高组患者(n=188)占64.16％.(2) Hcy升高组BPSD发生率(80.9％)高于对照组(57.1％),差异有统计学意义(x2=18.932,P＜0.01).(3) Hcy升高组NPI总分[(27.95±5.04)分]高于对照组[(16.87±1.87)分],差异有统计学意义(t=3.753,P＜0.01).(4) Hcy升高组与对照组NPI的12项功能域评分比较,Hcy升高组的睡眠障碍、高涨、易激惹/情绪不稳、异常行为、脱抑制、激越6项功能域的评分[(2.99± 1.40)分,(2.10±0.53)分,(2.64±1.43)分,(1.74±0.52)分,(1.40±0.43)分,(2.02±0.74)分]高于对照组[(1.85±0.37)分,(0.21±0.05)分,(1.80±0.56)分,(0.36±0.09)分,(0.45±0.07)分,(0.68±0.23)分],均差异有统计学意义(t=2.327,t=2.012,t=2.136,t=2.066,t=2.050,t=2.007,均P＜0.05).(5)二分类Logistic回归分析显示轻中度VaD患者NPI总分与Hcy水平呈正相关性(OR=1.164,95％ CI:1.052～ 1.288,P=0.003).(6)轻中度VaD患者Hcy升高组与对照组脑梗死部位比较,额叶、顶叶、颞叶、枕叶、基底节、脑干、小脑均差异无统计学意义(x2=0.528,x2=0.043,x2=0.630,x2=0.166,x2=0.657,x2=1.010,x2=0.019,均P＞0.05).结论 高Hcy水平与轻中度VaD患者的以下精神行为症状有关,包括睡眠障碍、高涨/欣快、情绪不稳、异常行为、脱抑制、激越症状,并且Hcy水平越高,精神行为症状越重,高Hcy水平与VaD患者的脑梗死病灶部位无关.
    목적 탐토혈장고동형반광안산(homocysteine,Hcy)수평여경중도혈관성치태(vascular de-mentia,VaD)환자적정신행위증상(behavioral and psychological symptom of dementia,BPSD)적관계.방법 사선2012년1월지2015년1월료녕의학원부속제일의원신경내과≥40세적경중도VaD환자293례,소유환자부합미국국립신경병여졸중연구소/서사신경과학연구국제협회(NINDS-AIREN)흔가능적VaD진단표준(1993),간역정신상태검사(mini-mental state examination,MMSE) 10≤MMSE≤26분,Hachinski결혈평분(Hachinski ischemic scale,HIS)총분≥4분,림상치태평정(clinical dementia rating,CDR)위경중도1≤CDR≤2.근거혈장Hcy수평분위Hcy승고조(Hcy≥15 μmol/L,n=188)화대조조(Hcy＜ 15 μmol/L,n=105).응용신경정신문권(neuropsychiatric inventory,NPI)평개량조환자적BPSD,채용비교통계방법침대2조NPI적총분이급NPI적12항공능역평분진행분석.결과 (1)경중도VaD환자(n=293)중Hcy승고조환자(n=188)점64.16％.(2) Hcy승고조BPSD발생솔(80.9％)고우대조조(57.1％),차이유통계학의의(x2=18.932,P＜0.01).(3) Hcy승고조NPI총분[(27.95±5.04)분]고우대조조[(16.87±1.87)분],차이유통계학의의(t=3.753,P＜0.01).(4) Hcy승고조여대조조NPI적12항공능역평분비교,Hcy승고조적수면장애、고창、역격야/정서불은、이상행위、탈억제、격월6항공능역적평분[(2.99± 1.40)분,(2.10±0.53)분,(2.64±1.43)분,(1.74±0.52)분,(1.40±0.43)분,(2.02±0.74)분]고우대조조[(1.85±0.37)분,(0.21±0.05)분,(1.80±0.56)분,(0.36±0.09)분,(0.45±0.07)분,(0.68±0.23)분],균차이유통계학의의(t=2.327,t=2.012,t=2.136,t=2.066,t=2.050,t=2.007,균P＜0.05).(5)이분류Logistic회귀분석현시경중도VaD환자NPI총분여Hcy수평정정상관성(OR=1.164,95％ CI:1.052～ 1.288,P=0.003).(6)경중도VaD환자Hcy승고조여대조조뇌경사부위비교,액협、정협、섭협、침협、기저절、뇌간、소뇌균차이무통계학의의(x2=0.528,x2=0.043,x2=0.630,x2=0.166,x2=0.657,x2=1.010,x2=0.019,균P＞0.05).결론 고Hcy수평여경중도VaD환자적이하정신행위증상유관,포괄수면장애、고창/흔쾌、정서불은、이상행위、탈억제、격월증상,병차Hcy수평월고,정신행위증상월중,고Hcy수평여VaD환자적뇌경사병조부위무관.
    Objective To explore the correlation between serum homocysteine(Hcy) levels and behavioral and psychological symptoms dementia (BPSD) in patients with mild to moderate vascular dementia (VaD).Methods Two hundred and ninety-three patients with mild to moderate vascular dementia (aged 40 or over) admitted to the department of neurology of the First Affiliated Hospital of Liaoning Medical College from January 2012 to January 2015.Patients were diagnosed with dementia by NINDS-AIREN criteria,MMSE scores ≤26,Hachinski ischemic scale(≥4) and clinical dementia rating(1≤ C DR ≤ 2).VaD patients were divided into high Hcy(HHcy) group (Hcy≥ 15 μ,mol/L,n=188) and control group(Hcy＜15 μmol/L,n=105).The total scores and the scores of 12 functional domains of behavioral and psychological symptoms in NPI were analyzed by using comparative statistical methods.Results Prevalence of high homocysteine was 64.16％ (n=188) among mild to moderate VaD (n=293).The incidence of BPSD in HHcy group(80.9％) was significantly higher than that in the control group (57.1％),the difference was statistically significant (x2=18.932,P＜0.01).HHcy patients (27.95±5.04) had a significantly higher total score of NPI compared with control patients (16.87± 1.87),the difference was statistically significant (t=3.753,P＜0.01).In terms of scores in 12 functional domains in NPI,the scores in sleep disorders (2.99± 1.40),high (2.10±0.53),irritability/mood swings (2.64± 1.43),abnormal behavior (1.74±0.52),disinhibition (1.40±0.43),agitation (2.02±0.74) were higher than those in control groups (1.85±0.37,0.21±0.05,1.80 ±0.56,0.36±0.09,0.45±0.07,0.68±0.23),all the difference were significant(t=2.327,t=2.012,t=2.136,t=2.066,t=2.050,t=2.007,all P＜0.05).Binary logistic regression analysis showed that there were positive correlation between scores of NPI and plasma Hcy levels (OR=1.164,95％ CI:1.052-1.288,P=0.003).Compared with HHcy group and control group,there were no statistical significance in regard to infarcted brain focus including the frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia,brain stem and cerebellum (x2=0.528,x2=0.043,x2=0.630,x2=0.166,x2=0.657,x2=1.010,x2=0.019,allP＞0.05).Conclusion High homocysteine levels are correlated with behavioral and psychological symptoms in patients with mild to moderate VaD,including performance of sleep disorders,high,irritability/mood swings,abnormal behavior,disinhibition and agitation.Moreover,the severity of BPSD is positively associated with homocysteine levels.The higher the homocysteine level,the more severe the BPSD.The serum homocysteine levels are no correlated with infarcted brain focus.
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