无症状性脑梗死患者血清同型半胱胺酸水平与P300的关系

目的 研究无症状性脑梗死(ACI)患者血清同型半胱胺酸(Hcy)与事件相关电位P300及临床症状之间的关系,探讨叶酸治疗与认知功能改变的关系.方法 采用丹麦KeyPoint型肌电/诱发点位仪对68名首发ACI患者及62名正常对照进行P300测查,酶联免疫吸附法测定血清同型半胱氨酸浓度,蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)评定患者临床症状.结果 与健康对照组相比,患者组血清Hcy水平明显增高,差异有统计学意义(P＜0.01),患者组P300潜伏期明显延长,波幅明显降低,差异有统计学意义(P＜0.01).相关分析显示,患者血清Hcy水平与P300波幅负相关,与P300潜伏期正相关,与MoCA量表评分负相关,未发现与MMSE评分存在相关性；MoCA量表评分与P300波幅负相关,与P300潜伏期正相关,未发现与MMSE评分存在相关性；患者组经过8周叶酸和维生素岛B12治疗,血清Hcy水平明显降低(P＜0.01),P300潜伏期和波幅及MoCA评分均无明显变化；经过12周的治疗,P300波幅明显增加(P＜0.01),P300潜伏期无明显变化(P＞0.05),MoCA量表评分无明显变化(P＞0.05).结论 ACI患者Hcy水平升高,其认知功能损害可能与血清Hcy增高相关,叶酸和维生素B12治疗可能会改善患者认知功能；P300和MoCA可作为评价认知功能的敏感指标.

Serum level of homocysteine in the asymptomatic cerebral infarction and its correlation with P300

Objective To explore the correlations among the serum level of homocysteine, P300 and symptoms. Methods P300 were obtained from 68 firstepisode asymptomatic cerebral infarction （ACI） and 62 health controls （HC）, the serum level of homocysteine was measured by enzyme-linked immunosorbent assay, and Clinical symptoms were assessed with Montreal Cognitive Assessment （Mo- CA） Scale and Mini-Mental State Examination（MMSE） at the same time. Results The serum level of homocysteine was significantly higher in ACI group than in HC group （P 〈 0.01）, Compared with HC group, P300 latency was significantly prolonged and P300 amplitude significantly decreased. The serum level of homocysteine in ACI group was negatively correlated with P300 amplitudes, but positively correlated with the latency. The serum level of homocysteine in ACI group was negatively correlated with the score of MoCA scale and no correlated with the score of MMSE scale. The score of MoCA scale was negatively correlated with P300 amplitudes, but positively correlated with the latency,no correlated with the score of MMSE scale. The serum level of homocysteine decreased significantly and no significant change in P300 latency, amplitude after treatment by Folic acid and Vitamin B12 for. eight weeks in ACI group. The P300 amplitude was increased significantly （P ; 0.01） and no significantly change in P300 latency and the score of MoCA scale after twelve week treatment （P 〉 0.05）. Conclusions The serum level of homocysteine in the first-episode ACI was increased, and cognitive dysfunctions may be related to high serum level of homocysteine. The treatment with Folio acid and Vitamin B12 might improve cognitive function in ACI patients. P300 and MoCA Scale were sensitive index for evaluation of cognitive function.