Wang Li, Chen Jianduan, Li Junpei, Hu Feng, Xie Yanyou, Zhou Xinlei, Shen Si, Zhou Wei, Zhu Lingjuan, Wang Tao, Tu Jianglong, Bao Huihui, Cheng Xiaoshu
Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China.
Front Neurol. 2022 Aug 18;13:890499. doi: 10.3389/fneur.2022.890499. eCollection 2022.
Increased plasma total homocysteine (tHcy) is an influencing factor of cognitive impairment in the general population. However, studies on the relationship between the risk of cognitive impairment and plasma tHcy levels in patients with hypertension are limited. This study aimed to explore the association between plasma tHcy levels and cognitive function assessed by MMSE scores among hypertensive patients in China.
A total of 9,527 subjects from the Chinese Hypertension Registry Study participated in this study. Plasma tHcy levels were quantified by high-performance liquid chromatography using a fluorescence detector. Cognitive assessment was performed using the Mini-Mental State Examination (MMSE). Linear regression models, two piecewise linear regression models, and smoothing curve fitting were applied to determine the relationship between plasma tHcy levels and cognitive function.
This analysis included 9,527 Chinese hypertensive adults. Based on the results of linear regression models, a negative relationship was identified between plasma tHcy levels and MMSE scores [beta coefficient (β) per standard deviation (SD) increase: -0.26, 95% confidence interval (CI) -0.35, -0.16, < 0.001]. The fully adjusted smooth curve fitting presented a nonlinear between plasma tHcy levels and MMSE scores. The threshold effect analysis showed that the inflection point of tHcy was about 27.1 μmol/L. The effect size [β (95% CI)] per SD increase in plasma tHcy concentrations on MMSE scores was -0.93 (-1.24, -0.6) on the left side and -0.07 (-0.24, 0.10) on the right side of the inflection point (-value for log-likelihood ratio (LLR) test was <0.001). Moreover, subgroup analyses revealed that sex could influence the negative association between plasma tHcy levels and MMSE scores up to a specific threshold (-value for interaction <0.001). Linear regression models indicated that there was an enhanced inverse association between tHcy levels and MMSE scores in female patients with tHcy concentrations less than 26.9 μmol/L compared to male patients with tHcy concentrations less than 32.0 μmol/L.
Plasma tHcy levels had a threshold effect on MMSE scores among hypertensive patients in China. Increased plasma tHcy levels were independently inversely associated with cognitive decline among hypertensive patients with tHcy concentrations <27.1 μmol/L.
血浆总同型半胱氨酸（tHcy）升高是普通人群认知障碍的一个影响因素。然而，关于高血压患者认知障碍风险与血浆tHcy水平之间关系的研究有限。本研究旨在探讨中国高血压患者血浆tHcy水平与通过简易精神状态检查表（MMSE）评分评估的认知功能之间的关联。
共有9527名来自中国高血压注册研究的受试者参与了本研究。采用高效液相色谱法结合荧光检测器对血浆tHcy水平进行定量。使用简易精神状态检查（MMSE）进行认知评估。应用线性回归模型、两个分段线性回归模型和平滑曲线拟合来确定血浆tHcy水平与认知功能之间的关系。
该分析纳入了9527名中国高血压成年人。基于线性回归模型的结果，确定血浆tHcy水平与MMSE评分之间存在负相关关系[每标准差（SD）增加的β系数（β）：-0.26，95%置信区间（CI）-0.35，-0.16，P<0.001]。完全调整后的平滑曲线拟合显示血浆tHcy水平与MMSE评分之间呈非线性关系。阈值效应分析表明，tHcy的拐点约为27.1μmol/L。在拐点左侧，血浆tHcy浓度每增加一个标准差（SD）对MMSE评分的效应量[β（95%CI）]为-0.93（-1.24，-0.6），在拐点右侧为-0.07（-0.24，0.10）（对数似然比（LLR）检验的P值<0.001）。此外，亚组分析显示，性别可在特定阈值之前影响血浆tHcy水平与MMSE评分之间的负相关关系（交互作用的P值<0.001）。线性回归模型表明，与tHcy浓度低于32.0μmol/L的男性患者相比，tHcy浓度低于26.9μmol/L的女性患者中，tHcy水平与MMSE评分之间的负相关关系更强。
在中国高血压患者中，血浆tHcy水平对MMSE评分有阈值效应。血浆tHcy水平升高与tHcy浓度<27.1μmol/L的高血压患者认知功能下降独立相关。
