高同型半胱氨酸血症对高海拔地区阿尔茨海默病影响的观察

目的：探讨高同型半胱氨酸（Hey）水平对高原地区阿尔茨海默病（AD）的影响以及干预治疗。方法：选取30例高海拔地区（西宁海拔2260m）AD患者，28例同龄同一地区健康老年人为对照组。测定血清Hcy、叶酸、维生素B12水平，并对AD患者进行了12周叶酸5mg及维生素B12 500μg干预治疗。主要疗效指标为神经量表MMSE、ADAS—cog和ADL。结果：AD患者血清Hcy水平高于对照组（P〈0．01），血清叶酸水平低于对照组（P〈0．05），VitB12在2组间变化不大。AD组有18例（60．0％）患者有高同型半胱氨酸血症，而对照组6例（21．0％），P〈0．01。治疗12周后AD患者MMSE、ADAS—00g和ADL差别有统计学意义（P〈0．01和P〈0．05），血清Hcy水平较治疗前明显下降（P〈0．01）。结论：高海拔AD患者血清Hcy水平明显增高，而高Hcy与高海拔AD患者饮食中叶酸摄入不足有密切关系。经干预治疗可降低AD患者血清Hcy水平，有效地改善AD患者认知功能、社会活动以及日常生活能力。

Effects of Hyperhomocysteinemia on Patients with Alzheimer's Diseases at High Altitude

Objective： To study the relationship between homocystein （Hey） and Alzheimer＇s disease （AD） at high altitude. Methods：30 patients of AD at middle altitude （MA） of 2 260m consisted of the AD group; 28 healthy elderly from the same high altitude served as the control group. Serum Hey, Vitamin B12 and folicacid （FA） level were measured by the Fluorescence Polarization Immunoassay （FPIA）, and the AD group was treated with FA and vitamin B12 for 12 weeks. The treatment efficacy was evaluated by using Mini Mental State Examination （MMSE）, Alzheimer＇s disease Assessment Scale--cognitive subscale （ADAS--cog） and Activity of Daily Living Scale （ADL）. Results： Hcy was significantly increased in patients with AD before treatment as compared with that in controls （P〈0. 01）, on contrast, FA level between AD and control group （P〈0. 05）. Vitamin B12 had no change in the two groups. 18 cases （60%） had hyperhomocysteinemia in the AD group, and 6 cases （21%） in the control group. After 12 weeks treatment Hey level was lower than that before treatment. The scores of MMSE, ADAS--cog and ADL were significantly improved （P〈0. 01, P〈0. 05）. Conelusiorts： Hcy level is higher, and it is a important risk factor and associates with lower FA income for patients with AD at high altitude. Treatment of AD is effective with Vitamin B12 and FA at high altitude.