2026 年第 9 期 第 21 卷

老年缺血性脑小血管病患者维生素B12和同型半胱氨酸水平与血管内皮功能的相关性及对血管性认知障碍发生的预测价值

Correlation of vitamin B12 and homocysteine levels with vascular endothelial function and their predictive value for vascular cognitive impairment in elderly patients with ischemic cerebral small vessel disease

作者：王莉刘岩

英文作者：Wang Li Liu Yan

单位：北部战区总医院老年医学中心干二科国家老年疾病临床研究中心，沈阳110016

英文单位：Second Department of Cadre Geriatric Medicine Center General Hospital of Northern Theater Command National Clinical Research Center for Geriatric Diseases Shenyang 110016 China

关键词：老年缺血性脑小血管病；维生素B12；同型半胱氨酸；血管内皮功能；血管性认知障碍

英文关键词：Elderlyischemiccerebralsmallvesseldisease;VitaminB12;Homocysteine;Vascularendothelialfunction;Vascularcognitiveimpairment

• 摘要：

• 目的 探讨老年缺血性脑小血管病（CSVD）患者维生素B12、同型半胱氨酸（Hcy）水平与血管内皮功能的相关性，并分析其对血管性认知障碍（VCI）发生的预测价值。方法 选取北部战区总医院2022年12月至2025年12月收治的180例老年缺血性CSVD患者。蒙特利尔认知评估量表（MoCA）<26分为VCI组（102例），MoCA≥26分为非VCI组（78例）。根据血清维生素B12水平，将患者分为正常组（>300 ng/L，56例）、轻度缺乏组（200~300 ng/L，99例）、中重度缺乏组（<200 ng/L，25例）。采用多因素Logistic回归模型分析VCI发生的影响因素。基于似然比检验比较Hcy线性和自然样条模型，判断效应是否为非线性。采用双因素方差分析比较不同维生素B12及Hcy水平对血管内皮功能指标的影响。使用广义线性模型评估维生素B12对Hcy水平与VCI发生风险间回归关系的影响。采用受试者工作特征曲线（ROC）及曲线下面积（AUC）评估维生素B12、Hcy水平及血管内皮功能指标对VCI发生的预测效能。结果 多因素Logistic回归分析结果显示，糖尿病、Hcy、内皮素均为老年缺血性CSVD患者发生VCI的独立危险因素，维生素B12、一氧化氮、血管内皮生长因子（VEGF）均为独立保护因素（均P<0.05）。ROC曲线分析结果显示，维生素B12、Hcy、内皮素、一氧化氮、VEGF联合预测VCI的AUC为0.954，高于各指标单独预测。线性关联结果显示，Hcy每增加1 μmol/L，维生素B12正常组、轻度缺乏组、中重度缺乏组发生VCI的超额风险值分别升高2.19%（95%置信区间：1.74%~2.83%）、2.58%（95%置信区间：2.05%~3.21%）、3.04%（95%置信区间：2.31%~3.76%）。双因素方差分析显示，无论患者Hcy水平如何，不同维生素B12组间的内皮素、一氧化氮、VEGF水平比较差异均有统计学意义（均P<0.001）。随着维生素B12水平的升高，Hcy水平与VCI之间的正关联关系逐渐减弱。结论 老年缺血性CSVD患者维生素B12、Hcy水平与血管内皮功能密切相关，Hcy对VCI的致病风险随维生素B12缺乏程度加重而升高，维生素B12、Hcy水平联合血管内皮功能指标对老年缺血性CSVD患者VCI的发生具有良好的预测效能。

• Objective To explore the correlation of serum vitamin B12 and homocysteine (Hcy) levels with vascular endothelial function in elderly patients with ischemic cerebral small vessel disease (CSVD), and analyze their predictive value for the occurrence of vascular cognitive impairment (VCI). Methods A total of 180 elderly patients with ischemic CSVD admitted to General Hospital of Northern Theater Command from December 2022 to December 2025 were enrolled. Patients with Montreal cognitive assessment (MoCA) score <26 were assigned to VCI group (102 cases), and those with MoCA score ≥26 were divided into non-VCI group (78 cases). According to serum vitamin B12 levels, the patients were classified into normal group (>300 ng/L, 56 cases), mild deficiency group (200-300 ng/L, 99 cases) and moderate to severe deficiency group (<200 ng/L, 25 cases). Multivariate Logistic regression model was used to analyze the influencing factors of VCI. Likelihood ratio test was adopted to compare linear model and natural spline model of Hcy to determine whether the effect was non-linear. Two-way analysis of variance was performed to compare the effects of different vitamin B12 and Hcy levels on vascular endothelial function indicators. Generalized linear model was used to evaluate the influence of vitamin B12 on the regression relationship between Hcy level and VCI risk. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the predictive efficiency of vitamin B12, Hcy and vascular endothelial function indicators for VCI. Results Multivariate Logistic regression analysis showed that diabetes mellitus, Hcy and endothelin were independent risk factors for VCI in elderly patients with ischemic CSVD, while vitamin B12, nitric oxide and vascular endothelial growth factor (VEGF) were independent protective factors (all P<0.05). ROC curve analysis revealed that the AUC of combined detection of vitamin B12, Hcy, endothelin, nitric oxide and VEGF for predicting VCI was 0.954, which was higher than that of single indicator. Linear correlation analysis indicated that per 1 μmol/L increase in Hcy, the excess risk of VCI increased by 2.19% ［95% confidence interval(CI): 1.74%-2.83%］, 2.58%(95%CI: 2.05%-3.21%) and 3.04%(95%CI: 2.31%-3.76%) in normal vitamin B12 group, mild deficiency group and moderate to severe deficiency group, respectively. Two-way analysis of variance demonstrated that regardless of Hcy levels, there were statistically significant differences in endothelin, nitric oxide and VEGF levels among groups with different vitamin B12 status (all P<0.001). The positive correlation between Hcy and VCI was gradually weakened with the elevation of vitamin B12 level. Conclusion Vitamin B12 and Hcy levels are closely correlated with vascular endothelial function in elderly patients with ischemic CSVD. The pathogenic risk of Hcy for VCI rises with the aggravation of vitamin B12 deficiency. The combination of vitamin B12, Hcy and vascular endothelial function indicators presents favorable predictive efficiency for VCI in elderly patients with ischemic CSVD.