卒中后抑郁患者的认知功能与血浆同型半胱氨酸水平的关系

摘要

目的:了解卒中后抑郁患者(PSD)认知功能障碍的发生比例,了解卒中后抑郁患者的认知功能与血浆同型半胱氨酸(Hcy)的关系.方法:选取卒中后抑郁患者152例,脑梗死患者150例和正常对照组140例作为研究对象,分别抽取空腹静脉血3ml,离心后分离血浆,用高效液相色谱法(HPLC)测量Hcy值,用简易精神状态检查(MMSE)评定各组患者的认知功能,分析认知功能障碍在卒中后抑郁患者中间的发生比例,分析PSD患者的认知功能与Hcy的关系.结果:用MMSE评定PSD组认知功能障碍89例(58.55％),脑梗死组认知功能障碍78例(52.00％),正常组认知功能障碍36例(25.71％),三组MMSE总分分别为(17.42 ± 5.20)分、(21.31±2.32)分和(23.37 ± 10.29)分,差异具有显著性(P＜0.05).其中在记忆力和注意力计算力方面PSD组明显低于脑梗死组和正常对照组.PSD组Hcy水平(23.68±10.29)μmol/L明显高于脑梗死组(16.31±6.40) μmol/L和正常组(12.41±4.63)μ mol/L,差异具有显著性(P＜0.01).Hcy水平与PSD组MMSE总分、性别、记忆力和注意力计算力呈负相关,相关系数分别为-1.236、-0.709、-0.680和-2.064.结论:卒中后抑郁患者存在认知功能障碍且发生比例较高,Hcy水平升高可能是PSD认知功能障碍的危险因素,其中对PSD患者的记忆力和注意力计算力有着较大的影响.%Objective: To understand the incidencerate of cognitive dysfunction in patients with post-stroke depression(PSDI), and the relationship between cognitive function and plasma homocysteine (Hcy) in patients with PSD. Method: In this study, 152 cases with PSD, 150 cases with cerebral infarction and 140 cases as normal control were observed. In all the subjects plasma homocysteine(Hcy) were measured and the cognitive function of patients were evaluated with MMSE, the incidencerate of cognitive dysfunction in patients with PSD, and the relationship between PSD patients cognitive dys function and Hey were analysed.Result: MMSE assessment showed in PSD group 89 cases(58.55%) performed cognitive dysfunction, in cerebral infarction group 78 cases (52.00%) revealed cognitive dysfunctions, in normal group 36 cases (25.71%) performed cognitive dysfunction. MMSE total scores of three groups were (17.42 ± 5.20) points, (21.31 ± 2.32) points and (23.25 ± 3.68) points, respectively, difference was significant (P<0.05). The abilities of memory, attention and calou- lation in PSD group were significantly lower than those in cerebral infarction group and normal control group. In PSD group Hcy levels (23.68 ± 10.29)μmol/L, were significantly higher than that in cerebral infarction group (16.31 ± 6.40)μmol/L and normal group (12.41 ± 4.63)μmol/L, the difference was significant (P<0.01). Hey level and PSD group MMSE total score,sex, abilities of memory, calculation and attention were negatively correlated and the correlation coefficients were -1.236,-0.709,-0.680,-2.064 respectively.Conclusion: In PSD patients had a higher proportion of cognitive dysfunction. Hey increasing may be a risk factor for PSD cognitive dysfunction, especially in abilities of memory, calculation and attention.