目的：探讨脑梗死合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者血清同型半胱氨酸（ homocysteine，Hcy）水平与卒中后认知功能的关系，并观察叶酸及维生素B12（ VitB12）干预下患者血浆Hcy水平变化及认识功能改善情况。方法选择87例急性首发脑梗死合并COPD患者为研究对象，记录一般临床资料、测定血液学指标（ Hcy、叶酸、VitB12）并用简易精神状态量表（minimum mental state examination，MMSE）评估认知功能。根据血浆Hcy水平将纳入病例分为Hcy正常组（n＝21）与Hcy增高组（ n＝66），比较2组间患者的认知功能。再将Hcy增高组随机分为干预组（常规治疗＋叶酸片2.5 mg＋VitB12片0.5 mg）和对照组（常规治疗）。6个月后复测血浆Hcy水平并进行MMSE评估，比较2组间血浆Hcy浓度变化及认知功能改善情况。结果 Hcy增高组患者血叶酸、VitB12水平较Hcy正常组明显降低（P＜0.05），且血浆Hcy浓度与叶酸（r＝－0.351，P＝0.000）、VitB12（r＝－0.242，P＝0.015）水平呈负性相关。此外，MMSE总分、定向力及延迟回忆在Hcy增高组较Hcy正常组得分低（P＜0.05），给予叶酸、VitB12干预6月后，Hcy水平较基线水平明显下降（ P＜0.05），MMSE总分及评估认知功能的亚项目得分均有所上升，但差异无统计学意义。结论血浆Hcy水平与脑梗死合并COPD患者的认知功能损害相关，叶酸及VitB12干预有助于减缓患者卒中后近期认知功能障碍。%Objective To investigate the relationship between serum homocysteine ( Hcy ) and cognitive impairment in patients with cerebral infarction combined chronic obstructive pulmonary disease (COPD) after stroke, and observe the plasma Hcy levels and cognitive function improvement when treated with folic acid and vitamin B12 .Methods 87 acute cerebral infarction combined with COPD patients as the research object, then the general clinical data were recorded, hematology indexes ( Hcy, folic acid, vitamin B12 ) were determined, and their cognitive function with a simple mental state scale (MMSE) was assayed.According to the plasma Hcy levels, the subjects were divided into Hcy-normal group (n =21) and Hcy-increased group (n=66), then compare the cognitive function between the two groups.Hcy-increased subjects were randomly divided into intervention group (conventional treatment +folic acid 2.5 mg +VitB12 0.5 mg) and control group (conventional treatment).After six months follow-up, we retested plasma Hcy levels and MMSE assessment, comparison of plasma Hcy concentration change and cognitive function improvement between two groups.Results Compared with Hcy-normal group, plasma folic acid, VitB12 levels significantly decreased in Hcy-increased group (P<0.05).And Hcy concentration was negatively correlated with folic acid(r=-0.351,P =0.000)and VitB12(r=-0.242,P=0.015)levels.In addition, the MMSE, directional force and delayed recall score decreased in Hcy-increased group compared with the Hcy-normal group ( P<0.05 ).Hcy levels were significantly lower than the baseline level (P<0.05), MMSE and the sub-project of cognitive function score increased after treated with folic acid and VitB12 for six months, although there was no statistically significant difference.Conclusion Plasma Hcy level is associated with cognitive impairment in patients with cerebral infarction combined chronic obstructive pulmonary disease (COPD), patients treated with folic acid and VitB12 may help slow the recent cognitive dysfunction after stroke in the near future.
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