摘要
目的 探讨皮质下缺血性血管病（SIVD）患者血清胆红素和尿酸水平的变化及其与认知损害之间的关系.方法 将161例SIVD患者按认知损害程度分为皮质下血管性轻度认知损害组（SVMCI,n =79）及皮质下血管性痴呆组（SVaD,n=82）,77名认知功能正常的老年人作为对照组.测定其血清直接胆红素（DBIL）、间接胆红素（IBIL）、总胆红素和尿酸水平;进行简易精神状态检查（MMSE）及剑桥老年认知检查表-中国修订版（CAMCOG-C）等神经心理学评价;依据头颅MRI表现对SIVD患者白质疏松程度进行分级.比较各组间血清胆红素和尿酸水平的变化,并将认知功能评分（MMSE评分）与胆红素、尿酸及血管危险因素进行多元回归分析.结果 SVaD和SVMCI患者MMSE评分（17.9±5.01、24.84±1.57）及CAMCOG-C评分（59.87±12.89、83.66±4.79）均低于对照组（28.19±1.03、91.66 ±4.93）,差异均具有统计学意义（Z=197.63,P=0.000;Z=186.54,P=0.000）.在校正性别、年龄及体重指数等因素后,SVaD患者的血清DBIL、IBIL和总胆红素水平均显著低于对照组;SVMCI组IBIL水平低于对照组,差异具有统计学意义.SVMCI和SVaD患者血清尿酸水平均显著高于对照组.对SIVD患者进行相关分析发现,胆红素与CAMCOG-C评分子项中语言及近记忆得分呈正相关（r=0.130,P=0.045;r =0.160,P=0.014）;尿酸与MMSE、CAMCOG-C评分呈负相关（r=-0.180,P=0.005;r=-0.203,P=0.002）.在控制性别、年龄、受教育程度、体重指数及高血压、糖尿病、吸烟等相关血管危险因素后,尿酸与MMSE之间仍存在一定的负性相关关系（β=-0.121,P=0.044）,当进一步校正白质疏松分级后,尿酸与MMSE之间的关系并不显著.结论 SIVD患者血清胆红素水平显著降低,且与认知功能呈正相关;而尿酸水平显著增高,与认知功能呈负相关,尿酸对SIVD患者认知损害的影响与白质疏松程度密切相关.
Objective To detect the levels of serum bilirubin and uric acid as well as their relationship with cognitive function in patients with subcortical ischemic vascular disease （SIVD）.Methods Serum direct bilirubin （DBIL）,indirect bilirubin （IBIL）,total bilirubin （TBIL）,uric acid （UA） and vascular risk factors were analyzed in 238 individuals comprising 161 patients with SIVD and 77 controls with normal cognitive function.SIVD patients were divided into two subgroups：those with cognitive impairment （SVMCI） and those with dementia （SVaD）.All of them were subject to the cognitive assessment including Mini-mental State Examination（MMSE）,the Cambridge Cognitive Examination-Chinese Version （CAMCOGC） and Clinical Demential Rating （CDR）.Leukoaraiosis was graded according to the severity by their MRI scan appearances.Results MMSE and CAMCOG scores were significant lower in SVMCI and SVaD groups （17.9 ± 5.01,59.87 ± 12.89 ; 24.84 ± 1.57,83.66 ± 4.79） when compared to those in the controls （28.19 ± 1.03,91.66-± 4.93 ; Z =197.63,P =0.000 ; Z =186.54,P =0.000）.In comparison with the controls,serum levels of DBIL,IBIL,and TBIL in SVaD group were significant lower （（2.85 ± 1.09） μmol/L vs （3.24 ± 1.30） iμmol/L; （7.50 ±3.27） μmol/L vs （9.06 ±3.52） μmol/L; （10.37 ±4.10） μ mol/L vs （12.31 ±4.64） μmol/L; P =0.035,P =0.005,P =0.006）.Also,serum IBIL level was significant lower in SVMCI group compared to the controls （（7.86 ± 3.28） μmol/L vs （9.06 ± 3.52） μmol/L,P =0.034）.While serum level of UA was significantly higher in SVMCI （（341.47 ± 92.80） μmol/L） and SVaD （（356.34 ±80.89） μmol/L） groups as compared to those in controls（（310.52 ±79.85） μmol/L;P =0.025 ;P =0.001）.The UA level was negatively correlated with MMSE scores and CAMCOG-C scores （r =-0.180,P =0.005; r =-0.203,P =0.002）,while the bilirubin level was positively correlated with language （r =0.130,P =0.045） and recent memory （r =0.160,P =0.014） scores in CAMCOG-C.The UA level remained associated with MMSE after controlling for age,sex,education,hypertension,diabetes,smoking,and BMI （β =-0.121,P =0.044）.While,after adjusting grading of a leukoaraiosis,UA has no significant association with MMSE.Conclusions The bilirubin level is decreased while the UA level is elevated in SIVD patients.The serum TBIL is negatively correlated with cognition dysfunction,while UA is strongly related to cognition dysfunction in SIVD patients.Cognitive dysfunction resulting from UA might have close association with leukoaraiosis.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2014年第5期305-310,共6页
Chinese Journal of Neurology
关键词
脑缺血
大脑皮质
痴呆
血管性
胆红素
尿酸
认知障碍
Brain ischemia
Cerebral cortex
Dementia, vascular
Bilirubin
Uric acid
Cognition disorders
