目的：探讨腔隙性脑梗死早期患者认知功能的特点以及同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)与认知功能障碍的相关性。方法选取2014年5月~2015年4月在北京航天总医院就诊的患者或体检者共50例，其中26例腔隙性脑梗死患者作为病例组，24例同期住院的无缺血性脑卒中患者或门诊健康志愿者作为对照组，测定两组Hcy和hs-CRP的含量，分析两项指标与腔隙性脑梗死的关系；对受试者进行全面的神经心理学测试，包括蒙特利尔认知评估量表(MoCA)、视空间能力、记忆力(包括听觉记忆、视觉记忆和逻辑记忆)、执行能力、结构能力、信息处理速度检查等，比较两组测试结果有无差别，分析影响腔隙性脑梗死的相关因素，并分析血浆Hcy和hs-CRP水平与受试者MoCA得分的相关性。结果病例组血浆Hcy和hs-CRP水平较对照组显著增高，差异有统计学意义(P<0.05)；病例组MoCA评分视觉记忆、听觉记忆(即刻记忆、长延迟回忆)、执行能力、结构能力(积木测试、画钟测试)、视空间能力较对照组显著降低，差异有统计学意义(P<0.05)。影响腔隙性脑梗死的相关因素包括高脂血症、冠心病、高hs-CRP(P<0.05)。血浆Hcy和hs-CRP水平与受试者MoCA得分呈负相关，差异有统计学意义(r=-0.327、-0.117，P=0.021、0.397)。结论血浆Hcy和hs-CRP增高可能是腔隙性脑梗死的危险因素；腔隙性脑梗死患者早期已经存在不同程度的认知功能障碍，且与高Hcy和高hs-CRP存在一定的相关性。%Objective To investigate the features of cognitive function of patients with early acute lacunar infarction and the correlation of homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP) and cognitive dysfunction. Methods Fifty cases of patients or physical examinees in the Department of Neurology of Beijing Aerospace General Hospital from May 2014 to April 2015 were selected, among which, 26 patients with lacunar cerebral infarction were chosen as case group, and 24 cases of patients without ischemic stroke or outpatient healthy volunteers were chosen as control group. The content of plasma Hcy and hs-CRP of two groups was determined, the relationship of the two indi-cators with the lacunar infarction was analyzed, and a comprehensive neuropsychological test was conducted to the sub-jects, including the Montreal cognitive assessment scale (MoCA), visual spatial ability, memory (including auditory memory, visual memory and logic memory), executive ability, ability structure and information processing speed check, etc, then the test results of two groups were compared. The related factors influencing acute lacunar infarction were analyzed. And the correlation of plasma Hcy, hs-CRP levels with MoCA score of subjects was analyzed. Results The plasma Hcy, hs-CRP levels in case group were significantly higher than those in control group, the differences were statistically significant (P<0.05). The MoCA scores, visual memory, auditory memory (immediate memory, long delayed recall), executive ability, ability to structure (building blocks, draw the clock testing), visual spatial ability in case group were significantly lower than those in control group, the differences were statistically significant (P< 0.05). The related factors of acute lacunar infarction included hyperlipidemia, coronary heart disease, hs-CRP (P < 0.05). The plasma Hcy, hs-CRP level and MoCA score had a negative correlation (r =-0.327, -0.117, P= 0.021, 0.397). Con-clusion The high Hcy and hs-CRP maybe the risk factors of lacunar infarction. The early acute lacunar infarction pa-tients already have a different degree of cognitive dysfunction and cognitive dysfunction, which has some relationship with high Hcy and hs-CRP.
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