西酞普兰和血清NSE、CRP对脑卒中后认知功能障碍影响

The clinical study of the effect of SSRIs/citalopram and serum NSE, CRPon cognitive dysfunction after stroke

目的探讨选择性血清素再吸收抑制剂(SSRIs)/西酞普兰及血清神经元特异性烯醇化酶(NSE)、C-反应性蛋白(CRP)对脑卒中后认知功能障碍影响的研究。方法选取2015年1月至2015年12月本院所收治的神经内科脑卒中后认知障碍患者60例,随机分为两组对照组给予常规治疗,治疗组在常规治疗基础上加用西酞普兰,对比两组患者脑卒中后认知功能障碍改善情况。另选取同期脑卒中后无认知障碍的患者60例及同期健康体检者20例,对三组研究对象的血清NSE及CRP浓度进行测定,进而探讨血清NSE及CRP对脑卒中后认知功能障碍的影响。结果治疗3个月后治疗组MMSE分值与对照组相比显著升高(P<0.05),治疗组P300潜伏期、HAMD分值与对照组相比显著减少(P<0.05),治疗组BI分值明显改善(P<0.05),但两组在NHISS指标上的比较,差异无统计学意义(P>0.05);且治疗组的乙酰胆碱(Ach)、5-羟色胺(5-HT)、电敏感性神经核(NE)均较对照组及治疗前显著增高(P<0.05)。此外,脑卒中后无认知障碍组及脑卒中后认知障碍组患者的血清CRP和NSE浓度均高于正常体检者(P<0.05),同时脑卒中后认知障碍组CRP及NSE浓度显著高于脑卒中后无认知障碍组,差异有统计意义(P<0.05)。患者血清CRP和NSE浓度随患者认知障碍的严重程度而增高,各组之间差异有统计学意义(P<0.05),且脑卒中后MMSE评分与CRP浓度呈负相关(r=-0.651,P<0.01),与NSE浓度呈负相关(r=-0.718,P<0.01)。结论西酞普兰可有效促进脑卒中后认知功能障碍患者神经功能的恢复,其机制可能与其能够提高脑内NE、5-HT、Ach水平及改善抑郁有关。脑卒中后认知功能障碍患者血清CRP及NSE高于脑卒中后无认知障碍患者,提示血清CRP及BES浓度可作为脑卒中后认知功能障碍的检测指标之一,且血清NSE及CRP浓度能够反映脑卒中患者认知功能障碍的严重程度。

Objective To investigate the effect of SSRIs/citalopram and serum NSE, CRP on cognitiveimpairment after stroke. Method 60 cases of patients during January 2015 to December 2015 were randomlydivided into treatment group and control group( 30 cases for each group). All the patients received routine treatment,desides the treatment group were given citalopram for 3 months.Then the clinical effect of two groups were compared.Besides other 60 cases of non-cognitive impairment patients and 20 healthies during the same prroid were chose tomeasure the concentrations of NSE and CRP of cognitive impairment patients, non-cognitive patients and healthies.Results After the treatment of 3 months,MMSE score of treatment group improved significantly as compared withthe control group( P<0.05). The mean P300 latency and HAMD score of the treatment group was significantly shorterthan that of control group( P<0.05).The BI scores of treatment group was significantly different from the control group(P<0.05 ).The content of 5-hydroxytryptamine(5-HT) in treatment group increased significantly compared with the control group.Serum NSE and CRP levelof cognitive impairment patients were higher than non-cogbitive impairmentpatients and healthies(P<0.05).There was asignificantly negative correlation between serum NSE and CRP and theMMS E score of cognitive impairment after stroke. Conclusion Citalopram can relieve neurological function deficitsand then promote the recovery of cognitive impairment in patients with stroke.Besides cognitive impairment after strokewere closely related with serum CRP and NSE level, and level of serum CRP and NSE can reflect the degree of cognitiveimpairment of patients with stroke.