高血压、高同型半胱氨酸血症与血管性
认知障碍

摘要/Abstract

摘要：

血管性认知障碍是认知疾病中的常见类型，通常认为导致卒中的血管性危险因素即是血管性认知障碍的危险因素，其中高血压和高同型半胱氨酸血症不仅是卒中的独立危险因素，也是血管性认知障碍的重要危险因素。高血压引起血管性认知障碍主要通过小动脉内皮损害及脑内血管动脉硬化造成；而高同型半胱氨酸血症主要通过对血管损害作用、影响凝血纤溶过程和神经毒性导致。血管性认知障碍的高发病率、相对可干预性等特点决定了对其早期认识、早期发现的必要性。本文对高血压、高同型半胱氨酸血症与血管性认知障碍的关系进行了综述，以期为预防血管性痴呆提供依据。

文章导读： 通过介绍高血压、高同型半胱氨酸血症与血管性认知障碍的研究进展，为预防血管性痴呆提供理
论依据

关键词: 血管性认知障碍; 高血压; 高同型半胱氨酸血症; 卒中

Abstract:

Vascular cognitive impairment is a common type of cognitive disorders. It is generally thought that the vascular risk factor for stroke is a risk factor for vascular cognitive impairment. Hypertension and hyperhomocysteinemia are not only the independent risk factors in stroke, but also the important risk factors in vascular cognitive impairment. The vascular cognitive impairment caused by hypertension mainly through the damages of arteriolar endothelium and the sclerosis of blood vessels in cerebrum; but hyperhomocysteinemia mainly through the role of vascular damage, influencing cruor-fibrinolysis process and neurotoxicity. The vascular cognitive impairment can be intervened relatively and has a high incidence. These characteristics show the necessity of early understanding and detection. This article aims to summarize the correlation between vascular cognitive impairment with hypertension and hyperhomocysteinemia and to provide evidences for the prevention of vascular dementia.

Key words: Vascular cognitive impairment; Hypertension; Hyperhomocysteinemia; Stroke

尹顺雄1，2，闵连秋1. 高血压、高同型半胱氨酸血症与血管性
认知障碍[J]. 中国卒中杂志, 2014, 9(06): 516-521.

YIN Shun-Xiong*, MIN Lian-Qiu.. Correlational Study of Vascular Cognitive Impairment with Hypertension and
Hyperhomocysteinemia[J]. Chinese Journal of Stroke, 2014, 9(06): 516-521.

参考文献

1 Errkinjuntti T, Kurz A, Gauthier S, et al. Efficacy

of galantamine in probable vascular dementia and

Alzheimer′s disease combined with cerebrovascular

disease:a randomised trial[J]. Lancet, 2002, 359:1283-

1290.

2 Ro ckwo o d K, Howa r d K, Ma cKn ig ht C, e t

al. Spect r um of disease in vascular cognitive

impairment[J]. Neuroepidemiology, 1999, 18:248-254.

3 高国栋, 林凯, 黎映兰. 高同型半胱氨酸血症与缺血

性脑卒中的关系及成因分析[J]. 南方医科大学学报,

2007, 27:1769-1770.

4 马永兴, 俞卓伟. 现代痴呆学[M]. 北京:科学技术文献

出版社, 2008:225-229.

5 Manolio TA, Olson J, Longstreth WT. Hypertension

and cognitive function:pathophysiologic effects of

hypertension on the brain[J]. Curr Hypertension Rep,

2003, 5:255-261.

6 Erkinjuntti T. Diagnosis and management of vascular

cognitive impairment and dementia[J]. J Neurol

Transm Suppl, 2002, suppl:91-109.

7 Hachinski V, Iadecola C, Petersen RC, et al. National

Institute of Neurological Disorders and Stroke-

Canadian st roke network va scula r cog nit ive

impairment harmonization standards[J]. Stroke, 2006,

37:2220-2241.

8 Bowler JV. Modern concept of vascular cognitive

impairment[J]. Br Med Bull, 2007, 83:291-305.

9 Sierra C, Coca A. White matter lesions and cognitive

impairment as silent cerebral disease in hypertension[J].

Scientific World Journal, 2006, 6:494-501.

10 刘元德, 欧春梅, 卞荣兵, 等. 高同型半胱氨酸血症与

认知功能障碍[J]. 实用医学杂志, 2009, 25:2405-2407.

11 中华医学会神经病学分会痴呆与认知障碍学组写作

组. 血管性认知障碍诊治指南[J]. 中华神经科杂志,

2011, 44:142-147.

12 Petrovitch H, White LR, Izmirilian G, et al. Midlife

blood pressure and neuritic plaques, neurofibrillary

tangles, and brain weight at death:the HAAS.

Honolulu-Asia aging study[J]. Neurobiol Aging, 2000,

21:57-62.

13 Tzourio C, Dufouil C, Ducimetiere P, et al. Cognitive

decline in individuals with high blood pressure:a

longitudinal study in the elderly. EVA Study Group.

Epidemiology of Vascular Aging[J]. Neurology, 1999,

53:1948-1952.

14 张钰聪, 汤哲. 北京市社区老年人群血压水平与认

知功能变化的4年纵向研究[J]. 中华流行病学杂志,

2004, 25:833-836.

15 Launer LJ, Masaki K, Petrovitch H, et al. The

association between midlife blood pressure levels and

late-life cognitive function:The Honolulu-Asia aging

study[J]. JAMA, 1995, 274:1846-1851.

16 Kilander L, Nyman H, Boberg M, et a1. Hypertension

is related to cognitive impairment:a 20-year follow-up

of 999 men[J]. Hypertension, 1998, 31:780-786.

17 Cacciatore F, Abete P, Ferrara N, et a1. The role of

blood pressure in cognitive impairment in an elderly

population[J]. J Hypertens, 1997, 15:135-142.

18 Forette F, Seux ML, Staessen JA, et al. Prevention

of dementia in randomised double-blind placebocontrolled

systolic hypertension in Europe (Syst-Eur)

tria1[J]. Lancet, 1998, 352:1347-1351.

19 Peters R, Beckett N, Forette F, et a1. Incident dementia

and blood pressure lowering in the Hypertension in

the Very Elderly Trial cognitive function assessment

(HYVET-COG):a double, blind, placebo controlled

tria1[J]. Lancet Neurol, 2008, 7:683-689.

20 Gelber RP, Ross GW, Petrovitch H, et a1. Antihypertensive

medication use and risk of cognitive impairment:the

Honolulu-Asia Aging Study[J]. Neurology, 2013,

81:888-895.

21 张广森. 高同型半胱氨酸血症与血栓病[J]. 中华医学

杂志, 2004, 84:874-875.

22 Sacco RL, Adams R, Albers C, et a1. Guidelines

for prevention of stroke in patients with ischemic

stroke or transient ischemic attack:a statement for

healthcare professionals from the American Heart

Association/American Stroke Association Council on

Stroke:co-sponsored by the Council on Cardiovascular

Radiology and Intervention:the American Academy

of Neurology affirms the value of this guideline[J].Circulation, 2006, 113:e409-e449.

23 Haan MN, Miller JW, Aiello AE, et al. Homocysteine,

B vitamins, and the incidence of dementia and

cognitive impairment:results from the Sacramento

Area Latino Study on Aging[J]. Am J Clin Nutr, 2007,

85:511-517.

24 Tay SY, Ampil ER, Chen CP, et al. The relationship

between homocysteine, cognition and stroke subtypes

in acute stroke[J]. J Neurol Sci, 2006, 250:58-61.

25 Ravaglia G, Forti P, Maioli F, et al. Homocysteine

and cognitive function in healthy elderly community

dwellers in Italy[J]. Am J Clin Nutr, 2003, 77:668-673.

26 洪玉娥, 夏明武, 陈清军, 等. 皮质下缺血性血管病患

者同型半胱氨酸与认知功能障碍的关系[J]. 中华老年

心脑血管病杂志, 2010, 12:494-496.

27 金晓晴, 章军建. 血管性认知损害与血浆同型半胱氨

酸的关系及临床意义[J]. 中国行为医学科学, 2007,

16:109-110.

[1]	鲁燕, 杨保荣, 黄向萍, 杨冠桂, 陈圣文, 李建荣, 曾小明. 县级医院急性缺血性卒中超时间窗经MRI筛选溶栓的病例对照研究 [J]. 中国卒中杂志, 2022, 17(12): 1321-1326.
[2]	楚悦琪, 周凯云, 王田燕, 王炯彬, 李真. 卒中后吞咽障碍应用耳穴压豆治疗效果的meta分析 [J]. 中国卒中杂志, 2022, 17(12): 1327-1334.
[3]	周甜甜, 苏文杰, 连松勇, 林友聪. 丰富环境对卒中后血管性痴呆患者认知功能的影响 [J]. 中国卒中杂志, 2022, 17(12): 1343-1349.
[4]	宋彦丽, 林杰, 武一平, 李晓晶, 刘改芬, 夏文静, 张玉英, 张晓林, 吕晨冉, 周红, 李凯, 薛斌, 陈玲玲, 张忠波, 彭晓. 邯郸市居民心脑血管病危险因素的流行现状及高血压知晓率、治疗率和控制率的影响因素研究 [J]. 中国卒中杂志, 2022, 17(12): 1360-1365.
[5]	吴娱倩, 张玉梅, 范小伟, 王安心, 逄文斌. 运动想象-动觉治疗对缺血性卒中患者手功能康复效果的研究[J]. 中国卒中杂志, 2022, 17(12): 1366-1371.
[6]	蒋林, 李靖. 基于知识图谱分析人工智能用于卒中研究的现状及趋势 [J]. 中国卒中杂志, 2022, 17(12): 1372-1380.
[7]	梁潇, 钱海兵. 水通道蛋白4与卒中后认知障碍的关系研究进展[J]. 中国卒中杂志, 2022, 17(12): 1385-1390.
[8]	吴晓莉, 刘丽旭. 肥胖对卒中预后的影响[J]. 中国卒中杂志, 2022, 17(12): 1391-1395.
[9]	郑占军, 赵性泉. 脑小血管病影像学标志物与自发性高血压脑出血的相关性研究进展[J]. 中国卒中杂志, 2022, 17(12): 1396-1402.
[10]	伊珞, 周宏宇, 仇鑫, 李子孝, 王拥军. 动脉粥样硬化性疾病的DNA甲基化改变[J]. 中国卒中杂志, 2022, 17(11): 1163-1170.
[11]	王誉博, 李子孝, 王拥军. 表观遗传学与缺血性卒中后氧化应激的相关性研究进展[J]. 中国卒中杂志, 2022, 17(11): 1171-1177.
[12]	闫然, 闵妍, 全柯华, 李子孝. 脑源性神经营养因子和血清素再摄取转运体编码基因甲基化与卒中预后的关系[J]. 中国卒中杂志, 2022, 17(11): 1178-1182.
[13]	崔凌云, 仇鑫, 周宏宇, 李子孝, 王拥军. DNA甲基化与2型糖尿病的相关性研究进展[J]. 中国卒中杂志, 2022, 17(11): 1183-1188.
[14]	邓宇含, 刘爽, 王子尧, 汪雨欣, 刘宝花. 基于结构化数据和机器学习模型预测普通人群卒中发病风险的系统评价和meta分析 [J]. 中国卒中杂志, 2022, 17(11): 1189-1197.
[15]	刘光亮, 韩凯月, 苏文龙, 张皓. 不同强度有氧踏车训练对不同病程缺血性卒中患者运动和心肺适能的影响 [J]. 中国卒中杂志, 2022, 17(11): 1203-1208.