老年轻度认知功能障碍患者血浆同型半胱氨酸与甲状腺激素水平的关系研究

摘要

目的：探讨老年轻度认知功能障碍（MCI）患者血浆同型半胱氨酸（Hcy）与甲状腺激素水平的关系及其临床意义。方法选取2013年1月—2014年12月石河子大学医学院第一附属医院收治的老年 MCI 患者187例，其中 MCI 合并高 Hcy 血症者114例作为 MCI 合并高 Hcy 组，将 Hcy 水平正常的 MCI 者73例作为 MCI 组。另选取同期在本院体检健康者92例作为对照组。收集受试者一般资料，并对其进行简易精神状态评价量表（ MMSE）、日常生活能力量表（ADL）评分；采集受试者血液，测定 Hcy、甲状腺激素〔包括三碘甲状腺原氨酸（ T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）〕、空腹血糖、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平。结果3组性别、年龄、吸烟率、饮酒率、体质指数（BMI）、糖尿病病史、高血压病史、ADL 得分比较，差异均无统计学意义（P >0.05）；3组文化程度、MMSE 得分比较，差异均有统计学意义（P <0.05）；其中 MCI 组和 MCI 合并高 Hcy 组 MMSE 得分低于对照组， MCI 合并高 Hcy 组 MMSE 得分低于 MCI 组（P <0.05）。3组 FT3、TSH、空腹血糖、TG、TC、LDL-C、HDL-C水平比较，差异均无统计学意义（P >0.05）；3组 Hcy、T3、T4、FT4水平比较，差异均有统计学意义（P <0.05）；其中 MCI合并高 Hcy 组 Hcy、FT4水平高于对照组和 MCI 组，MCI 合并高 Hcy 组 T3水平低于对照组，T4水平高于 MCI 组（P <0.05）。MCI 合并高 Hcy 组 Hcy 水平与 MMSE 得分呈负相关（ r =-0.566，P <0.001），T3、T4、FT3、FT4水平与MMSE 得分均呈正相关（r =0.484，P <0.001；r =0.281，P =0.002；r =0.257，P =0.006；r =0.198，P =0.034）， TSH 水平与 MMSE 得分无直线相关关系（ r =0.257，P =0.078）。MCI 组 Hcy 水 平与 MMSE 得分呈负相关（ r=-0.452，P <0.001），FT3、TSH 水平与 MMSE 得分呈正相关（r =0.292，P =0.017；r =0.264，P =0.031），T3、T4、FT4水平与 MMSE 得分无直线相关关系（ r =0.194，P =0.119；r =0.186，P =0.177；r =0.319，P =0.129）。MCI 患者 T3水平与 Hcy 水平呈负相关（r =-0.394，P <0.001），T4、FT3、FT4、TSH 水平与 Hcy 水平无直线相关关系（r =-0.007，P =0.932；r =0.002，P =0.979；r =0.101，P =0.203；r =0.068，P =0.392）。结论老年 MCI 患者血浆 Hcy 水平升高，T3水平降低，且两者呈负相关，提示 Hcy、甲状腺激素水平与老年 MCI 的形成和发展可能有关，对揭示老年 MCI 的病理机制具有一定的参考价值，也可为临床上老年 MCI 患者病情进展及预后评估提供一定的参考依据。%Objective To explore the correlation between plasma homocysteine(Hcy)and thyroid hormone level of elderly patients with mild cognitive impairment(MCI)and its clinical significance. Methods From January 2013 to December 2014,we enrolled 187 elderly patients with MCI who were treated in the First Affiliated Hospital of the Medical College,Shihezi University. We assigned 114 patients with MCI combined high Hcy into MCI combined high Hcy group,73 MCI patients with normal Hcy level into MCI group,and 92 healthy people who received physical examination in the hospital during the same period into control group. General data of the subJects were collected,and the scores of the Mini Mental State Examination(MMSE) and Activity of Daily Living Scales(ADL) were given. We collected the blood samples of the subJects,and measured Hcy, thyroid hormones(T3 ,T4 ,FT3 ,FT4 and TSH),FBG,TG,TC,LDL-C and HDL-C levels. Results The three groups were not significantly different in gender,age,smoking rate,drinking rate,body mass index(BMI),history of diabetes and hypertension and ADL score(P > 0. 05);educational level,MMSE score of the three groups were significantly different(P <0. 05);and MCI group and MCI combined high Hcy group MMSE scored lower than that of control group,MCI combined high Hcy group MMSE scored lower than that of MCI group(P < 0. 05). The three groups were not significant different in FT3 ,TSH, FBG,TG,TC,LDL-C and HDL-C levels( P > 0. 05);there were significant differences in Hcy,T3 ,T4 and FT4 levels among the three groups(P < 0. 05);MCI combined high Hcy group had higher Hcy and FT4 levels than those of control group and MCI group,lower T3 level than control group,higher T4 level than MCI group(P < 0. 05). Hcy level of MCI combined high Hcy group was negatively correlated with MMSE score(r = - 0. 566,P < 0. 001),and T3 ,T4 ,FT3 and FT4 levels were positively correlated with MMSE score(r = 0. 484,P < 0. 001;r = 0. 281,P = 0. 002;r = 0. 257,P = 0. 006;r = 0. 198,P= 0. 034),and there was no linear correlation between TSH level and MMSE score(r = 0. 257,P = 0. 078). Hcy level was negatively related with MMSE score in MCI group(r = - 0. 452,P < 0. 001),the FT3 and TSH levels were positively correlated with MMSE score(r = 0. 292,P = 0. 017;r = 0. 264,P = 0. 031),and there were no linear correlation between T3 ,T4 ,FT4 levels and MMSE score( r = 0. 194,P = 0. 119;r = 0. 186,P = 0. 177;r = 0. 319,P = 0. 129). T3 level was negatively correlated with Hcy level of MCI patients(r = - 0. 394,P < 0. 001),and there were no linear correlation among T4 ,FT3 , FT4 ,TSH and Hcy levles( r = - 0. 007,P = 0. 932;r = 0. 002,P = 0. 979;r = 0. 101,P = 0. 203;r = 0. 068,P= 0. 392). Conclusion The higher plasma Hcy level of elderly patients with MCI is,the lower thyroid hormone level is,and the two are negatively correlated,which indicates that Hcy and thyroid hormone levels may be associated with the formation and development of the elderly patients with MCI and provides referential value for revealing the pathology mechanism and offers referential basis for disease progress and prognosis of elderly patients with MCI.