目的 探讨降低同型半胱氨酸血症(homocysteine,Hcy)是否可延缓血管性脑病伴认知障碍患者认知水平的下降速度。方法 选取2015-07至2018-06收治的血管性脑病合并认知障碍患者77例,按患者Hcy测定水平分为正常组(45例)和升高组(32例),分别在治疗后6、12、18个月对两组进行简易精神状态检查(mini-mental state examination,MMSE)和蒙特利尔认知评估(montreal cognitive assessment,MoCA)分析,评估患者认知障碍变化情况。结果 正常组治疗6、12、18个月 MMSE评分的下降速度明显低于升高组,差异有统计学意义(P<0.05)。两组患者治疗6、12、18个月MoCA评分均呈下降速度,但正常组对定向力、延迟回忆、视知觉、命名、注意及总分6项评分均高于升高组,且下降速度较慢,差异有统计学意义(P<0.05)。结论 降低血浆Hcy水平至正常可减缓血管性脑病合并认知障碍患者认知损害的发展,叶酸及B族维生素的治疗也对减缓认知障碍有一定作用。

Objective To find out whether reducing homocysteine (Hcy) levels can delay the cognitive decline in patients with vascular encephalopathy and cognitive impairment. Methods Between July 2015 and June 2018, 77 patients with vascular encephalopathy and cognitive impairment were selected. According to the Hcy level of patients, 45 patients were assigned to the normal group and 32 to the elevation group. After 6, 12 and 18 months of treatment, the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)were carried out in the two groups respectively. The results of both types of examination were analyzed to evaluate the change of patients' cognitive impairment. Results The decrease rate of the MMSE score in the normal group was significantly lower than that in the elevation group (P<0.05). The MOCA scores of the two groups decreased at 6, 12 and 18 months after treatment, but the scores of orientation, delayed recall, visual perception, naming, attention and total scores of the normal group were higher than those of the elevation group, and the decrease rate was slower. The difference was statistically significant (P<0.05). Conclusions Lowering Hcy levels to normal can slow down the development of cognitive impairment in patients with vascular encephalopathy and cognitive impairment, and the treatment with folic acid and B vitamins can also slow down cognitive impairment.