个体化他汀治疗对症状性颈动脉粥样硬化性狭窄老年患者认知的影响
| 作者: |
1陈小容,
1喻明,
2贺美文,
1刘莉,
1徐磊,
1何晓菲,
1张运伟,
3张晓云
1 遂宁市中心医院神经内科，四川 遂宁 629000 2 成都市第七人民医院神经内科，成都 610021 3 成都中医药大学附属医院急诊科，成都 610072 |
| 通讯: |
张晓云
Email: timeless678@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.09.010 |
摘要
目的：载脂蛋白E(apolipoprotein E，ApoE)和溶质载体有机阴离子转运蛋白家族1B1(solutecarrier organic anion transporter family member 1B1，SLCO1B1)基因多态性指导下个体化他汀治疗对症状性颈动脉粥样硬化性狭窄老年患者认知的影响。方法：对85例经头颅影像学检查和颈部血管彩超检查证实的颈动脉粥样硬化性狭窄50%~99%所致短暂性脑缺血发作(transient ischemic attack，TIA)/缺血性卒中老年患者进行回顾性分析，研究对象分为强化他汀组(n=42)和试验组(n=43)。强化他汀组给予阿托伐他汀40 mg进行干预，1次/d。试验组在ApoE及SLCO1B1基因多态性指导下给予不同强度和类型的他汀药物。对两组治疗后6个月的三酰甘油(triglyceride，TG)、血清总胆固醇(serum total cholesterol，TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholestero，LDL-C)、超敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP)、颈动脉内膜斑块面积和斑块的厚度、蒙特利尔认知评估量表(Montreal cognitive assessment，MoCA)评分、简易智力状态检查(mini-mental state examination，MMSE)评分、日常生活能力量表(activity of daily living，ADL)评分、汉密顿抑郁量表(Hamilton depression scale，HAMD)评分及安全性进行评估。结果：两组治疗后血脂、颈动脉内膜斑块面积和斑块的厚度、hs-CRP均较基线水平下降，其中试验组下降更显著(均P<0.05)；强化他汀组MMSE、MoCA有显著下降，但试验组下降不明显，二者比较，差异有统计学意义(P<0.05)；试验组与强化他汀组HAMD和ADL评分均有改善，但试验组更优，差异有统计学意义(P<0.05)；相较于强化组，试验组不良反应发生率较低(P<0.05)，无不良脑血管事件发生。结论：针对ApoE基因型和SLCO1B1基因的差异，对症状性颈动脉粥样硬化不同表型老年患者给予不同药物和选择合适剂量，能最大程度降低药物不良反应发生率，有减少卒中后认知障碍(post-stroke cognitive impairment，PSCI)的发生和程度的作用。
关键词：
基因多态性；他汀；症状性颈动脉粥样硬化性狭窄；认知
Effect of individual statin therapy on cognition in elderly patients with symptomatic carotid atherosclerotic stenosis
CorrespondingAuthor: ZHANG Xiaoyun Email: timeless678@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.09.010
Abstract
Objective: To investigate the effect of apolipoprotein E (ApoE) combined with solutecarrier organic anion transporter family member 1B1 (SLCO1B1) gene polymorphism on the cognition of elderly patients with symptomatic carotid atherosclerotic stenosis. Methods: Retrospective analysis was performed on 85 elderly patients with transient ischemic attack (TIA)/ischemic stroke caused by 50%~99% of carotid atherosclerotic stenos, which confirmed by cranial imaging examination and cervical vascular ultrasonography. The subjects were divided into 2 groups: an enhanced statin group (n=42) and an experimental group (n=43). In the intensive statin group, atorvastatin 40 mg was given for intervention. The experimental group was given different intensities and types of statins under the guidance of ApoE and SLCO1B1 gene polymorphisms. After treatment for 6 months, triglyceride (TG), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive protein (hs-CRP), carotid intima plaque area and plaque thickness, Montreal cognitive assessment scale (MoCA) score, mini-mental state examination (MMSE) score, activity of daily living (ADL) score, Hamilton depression (HAMD) score and safety assessment were compared between the 2 groups. Results: After the treatment, the area of plasma carotid intima plaque, plaque thickness and hs-CRP in both groups decreased compared with the baseline, the decrease was more significant in the experimental group (all P<0.05). MMSE and MoCA scores were significantly decreased in the intensive statin group, but not in the experimental group (P<0.05). The scores of HAMD and ADL in both groups were improved, but the experimental group was better (P<0.05). Compared with the intensive group, the incidence of adverse reactions in the experimental group was lower (P<0.05), and no adverse cerebrovascular events occurred. Conclusion: According to the differences of ApoE genotype and SLCO1B1 gene, the administration of different drugs and the selection of appropriate dosage to elderly patients with symptomatic carotid atherosclerosis in different phenotypes can minimize the incidence of drug toxicity and side effects, and can reduce the occurrence and degree of post-stroke cognitive impairment (PSCI).
Keywords：
gene polymorphism; statins; symptomatic carotid atherosclerosis stenosis; cognition