血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系Correlation between levels of serum uric acid,bilirubin in patients with vascular dementia and their cognitive impairment
白静;李宇辉;
摘要(Abstract):
目的评价血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系。方法选取2015-01—2018-12在郑州大学第五附属医院神经内科住院治疗的血管性痴呆患者197例,同时,选取95名健康老年人作为对照组,收集2组患者一般资料,对2组患者肝功能、肾功能及血脂水平进行检测,利用量表对2组患者神经心理功能进行测验,比较2组患者血清尿酸和胆红素水平的变化,并研究其与神经心理功能评分的相关性。结果血管性痴呆组患者简易智力状态检查量表(MMSE评分)、剑桥老年认知检查表-中国修订版(CAMCOG-C)评分和画钟试验(CDT)评分均低于对照组,而日常生活能力(ADL)和临床痴呆评定量表(CDR)评分均高于对照组,差异均具有统计学意义(P<0.05);血管性痴呆组患者血清总胆红素、直接胆红素和间接胆红素水平均低于对照组,而尿酸水平高于对照组,差异均具有统计学意义(P<0.05);Pearson相关分析显示,血清尿酸水平与MMSE评分、CAMCOG-C评分和CDT评分均呈负相关(r=-0.217,-0.196和-0.264,均P<0.05),而与ADL评分呈正相关(r=0.302,P<0.05),总胆红素水平与CAMCOG-C评分和CDT评分均呈负相关(r=-0.167和-0.205,均P<0.05),与ADL评分呈正相关(r=0.215,P<0.05);Logistic回归分析显示,MMSE评分与患者教育年限、高血压史及尿酸水平相关(P<0.05)。结论血管性痴呆患者血清尿酸水平升高,且与患者认知功能评分呈负相关,而与患者日常生活能力评分呈正相关;总胆红素水平降低,且与患者认知功能评分呈负相关,而与日常患者生活能力评分呈正相关。高尿酸水平可能与血管性痴呆的发生有关,为血管性痴呆发生的独立危险因素之一。
关键词(KeyWords): 血管性痴呆;危险因素;尿酸;胆红素;认知功能
基金项目(Foundation): 河南省科技攻关计划项目,(编号:184126510007)
作者(Authors): 白静;李宇辉;
参考文献(References):
- [1] SENGUPTA P,GANGULY J,PAL S,et al.Pattern of cognitive deficits in vascular dementia[J].Indian J Med Res,2019,149(4):503-507.DOI:10.4103/ijmr.IJMR_1336_17.
- [2] SMITH E E.Clinical presentations and epidemiology of vascular dementia[J].Clin Sci(Lond),2017,131(11):1059-1068.DOI:10.1042/CS20160607.
- [3] O'BRIEN J T,THOMAS A.Vascular dementia[J].Lancet,2015,386(10004):1698-1706.DOI:10.1016/S0140-6736(15)00463-8.
- [4] LAM S M,WANG Y,DUAN X,et al.The brain lipidom-es of subcortical ischemic vascular dementia and mixed dementia[J].Neurobiol Aging,2014,35(10):2369-2381.DOI:10.1016/j.neurobiolaging.2014.02.025.
- [5] COJOCARU I M,COJOCARU M,SAPIRA V,et al.Could pro-BNP,uric acid,bilirubin,albumin and transferrin be used in making the distinction between stroke subtypes?[J].Rom J Intern Med,2013,51(3-4):188-195.DOI:10.1016/j.jns.2013.07.717.
- [6] MARKAKI I,FRANZN I,TALANI C,et al.Longterm survival of ischemic cerebrovascular disease in the acute inflammatory stroke study,a hospital-based cohort described by TOAST and ASCO[J].Cerebrovasc Dis,2013,35(3):213-219.DOI:10.1159/000346094.
- [7] DE LEEUW F A,VAN DER FLIER W M,TIJMS B M,et al.Specific Nutritional Biomarker Profiles in Mild Cognitive Impairment and Subjective Cognitive Decline Are Associated With Clinical Progression:The NUDAD Project[J].J Am Med Dir Assoc,2020Jan 27.pii:S1525-8610(19)30869-2.DOI:10.1016/j.jamda.2019.12.009.
- [8] LIU M,LI Y,LI J,et al.Elevated serum total bilirubin levels are negatively associated with major diabetic complications among Chinese senile diabetic patients[J].J Diabetes Complications,2017,31(1):213-217.DOI:10.1016/j.jdiacomp.2016.08.023.
- [9] ZHOU X,WANG L,LIU H,et al.Serum antioxidant levels associated with subcortical ischemic vascular disease[J].Can J Neurol Sci,2014,41(3):375-381.DOI:10.1017/s0317167100017339.
- [10] HATANAKA H,HANYU H,FUKASAWA R,ET AL.Differences in peripheral oxidative stress markers in Alzheimer's disease,vascular dementia and mixed dementia patients[J].Geriatr Gerontol Int,2015,15Suppl 1:53-58.DOI:10.1111/ggi.12659.
- [11] CHAMORRO A,AMARO S,CASTELLANOS M,et al.Safety and efficacy of uric acid in patients with acute stroke(URICO-ICTUS):a randomised,double-blind phase 2b/3trial[J].Lancet Neurol,2014,13(5):453-460.DOI:10.1016/S1474-4422(14)70054-7.
- [12] WU H,JIA Q,LIU G,et al.Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients,but not in cerebral hemorrhage patients[J].J Stroke Cerebrovasc Dis,2014,23(3):469-475.DOI:10.1016/j.jstrokecerebrovasdis.2013.04.007.
- [13] WU J X,XUE J,ZHUANG L,et al.Plasma parameters and risk factors of patients with post-stroke cognitive impairment[J].Ann Palliat Med,2020,9(1):45-52.DOI:10.21037/apm.2019.12.05.
- [14] XU Y,WANG Q,CUI R,et al.Uric acid is associated with vascular dementia in Chinese population[J].Brain Behav,2016,7(2):e00617.DOI:10.1002/brb3.617.
- [15] SUZUKI K,KOIDE D,FUJII K,et al.Elevated Serum Uric Acid Levels Are Related to Cognitive Deterioration in an Elderly Japanese Population[J].Dement Geriatr Cogn Dis Extra,2016,6(3):580-588.DOI:10.1159/000454660.
- [16] KHAN A A,QUINN T J,HEWITT J,et al.Serum uric acid level and association with cognitive impairment and dementia:systematic review and meta-analysis[J].Age(Dordr),2016:38(1):16.DOI:10.1007/s11357-016-9871-8.
- [17]王自豪,李素娟,王淑辉,等.老年高血压合并血管性痴呆患者血压变异性分析[J].中国实用神经疾病杂志,2015,18(2):79-80.
- [18] SHIINO A,WATANABE T,SHIRAKASHI Y,et al.The profile of hippocampal metabolites differs between Alzheimer's disease and subcortical ischemic vascular dementia,as measured by proton magnetic resonance spectroscopy[J].J Cereb Blood Flow Metab,2012,32(5):805-815.DOI:10.1038/jcbfm.2012.9.
- [19] YOO DH,HONG D G,LEE J S.The Standardization of the Clock Drawing Test(CDT)for People with Stroke Using Rasch Analysis[J].J Phys Ther Sci,2013,25(12):1587-1590.DOI:10.1589/jpts.25.1587.
- [20] PERRI R,FADDA L,CALTAGIRONE C,et al.Word list and story recall elicit different patterns of memory deficit in patients with Alzheimer's disease,frontotemporal dementia,subcortical ischemic vascular disease,and Lewy body dementia[J].J Alzheimers Dis,2013,37(1):99-107.DOI:10.3233/JAD-130347.
- [21] FUHUA P,XUHUI D,ZHIYANG Z,et al.Antioxidant status of bilirubin and uric acid in patients with myasthenia gravis[J].Neuroimmunomodulation,2012,19(1):43-49.DOI:10.1159/000327727.
- [22] CERVELLATI C,ROMANI A,SERIPA D,et al.Oxidative balance,homocysteine,and uric acid levels in older patients with Late Onset Alzheimer's Disease or Vascular Dementia[J].J Neurol Sci,2014,337(1/2):156-161.DOI:10.1016/j.jns.2013.11.041.
- [23] SPITSIN S,KOPROWSKI H.Role of uric acid in Alzheimer's disease[J].J Alzheimers Dis,2010,19(4):1337-1338.DOI:10.3233/JAD-2010-1336.
- [24] WU Y,ZHANG D,PANG Z,et al.Association of serum uric acid level with muscle strength and cognitive function among Chinese aged 50-74years[J].Geriatr Gerontol Int,2013,13(3):672-677.DOI:10.1111/j.1447-0594.2012.00962.x.
- [25] LI H,KLETT D E,LITTLETON R,et al.Role of insulin resistance in uric acid nephrolithiasis[J].World J Nephrol,2014,3(4):237-242.DOI:10.5527/wjn.v3.i4.237.
- [26] KAYA E B,YORGUN H,CANPOLAT U,et al.Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography[J].Atherosclerosis,2010,213(1):178-183.DOI:10.1016/j.atherosclerosis.2010.08.077.