血浆Hcy、ApoE基因多态性对血管性痴呆患者认知功能及治疗效果的影响

Effects of plasma Hcy and ApoE gene polymorphisms on cognitive function and therapeutic effect in patients with vascular dementia

目的探讨血清同型半胱氨酸(homocysteine,Hcy)、载脂蛋白E(apolipoprotein E,ApoE)基因多态性对血管性痴呆患者认知功能的影响。方法回顾性分析于医院接受治疗的100例血管性痴呆患者病例资料作为研究对象,使用简易智力状态检查量表(mini-mental state examination,MMSE)评估患者认知功能,将MMSE评分为21~26分患者纳入轻度组,将10~20分患者纳入中度组,将0~9分患者纳入重度组。参照《中国痴呆与认知障碍诊治指南》给予患者常规治疗,治疗前主要检查项目包括血浆Hcy、ApoE基因多态性,治疗3个月后记录患者临床疗效;分析ApoE基因多态性、Hcy与血管性痴呆患者认知功能障碍及临床疗效的关系。结果100例血管性痴呆患者MMSE评分为16.50(9.00,20.00)分,其中轻度24例,中度49例,重度27例;重度组ApoE基因表型为ε2/4、ε4/4患者占比高于轻度组、中度组,入院时血浆Hcy水平高于轻度组、中度组,差异有统计学意义(P<0.05);行多元Logistic回归分析结果显示,血浆Hcy、ApoE基因是导致血管性痴呆患者认知功能障碍加重的危险因素(P<0.05);100例血管性痴呆患者,治疗3个月后,显效47例,好转30例,无效23例,总有效率为77.00%;行二元Logistic回归分析显示,血浆Hcy、ApoE基因均是影响血管性痴呆患者治疗效果的危险因素(P<0.05)。结论ApoE基因多态性、Hcy与血管性痴呆患者认知功能障碍病情严重程度及临床关系密切,未来临床可通过检测患者ApoE基因多态性、Hcy水平,评估患者认知障碍严重程度及治疗无效风险,针对病情严重治疗无效风险较高者,采取针对性干预,以改善患者临床疗效。

Objective To investigate the effect of serum homocysteine(Hcy)and apolipoprotein E(ApoE)gene polymorphisms on cognitive function in patients with vascular dementia.Methods Retrospective analysis was performed on 100 patients with vascular dementia treated in hospitals as research subjects.The cognitive function of the patients was evaluated by the mini-mental state examination(MMSE).Patients with MMSE score of 21-26 were included in the mild group,those with MMSE score of 10-20 were included in the moderate group,and those with MMSE score of 0-9 were included in the severe group.According to the Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Dysfunction,the patients were given conventional treatment.The main examination items before treatment included plasma Hcy and ApoE gene polymorphisms,and the clinical efficacy was recorded at 3 months after treatment.The relationship of ApoE gene polymorphism and Hcy with cognitive impairment and clinical efficacy in patients with vascular dementia was analyzed.Results The MMSE score of 100 patients with vascular dementia was 16.50(9.00,20.00),including 24 mild cases,49 moderate cases and 27 severe cases;the proportion of patients with APOE gene phenotype ofε2/4 andε4/4 in the severe group was higher than that in the mild and moderate group,and the plasma Hcy level at admission was higher than that in the mild and moderate group,suggesting significant difference(P<0.05).Multivariate logistic regression analysis showed that plasma Hcy and ApoE genes were risk factors for exacerbation of cognitive impairment in patients with vascular dementia(P<0.05).In 100 patients with vascular dementia,at 3 months after treatment,47 cases showed significant improvement,30 cases were improved,23 cases were ineffective,and the total effective rate was 77.00%.Binary logistic regression analysis showed that plasma Hcy and ApoE genes could affect the therapeutic effect of patients with vascular dementia(P<0.05).Conclusion ApoE gene polymorphism and Hcy are closely related to the severity and clinical significance of cognitive impairment in patients with vascular dementia.In the future,the severity of cognitive impairment and the risk of ineffective treatment can be evaluated by detecting the ApoE gene polymorphism and Hcy level of patients.Targeted interventions can be taken to improve the clinical efficacy of patients with serious conditions and high risk of ineffective treatment.