早期应用多奈哌齐对老年患者卒中后认知障碍恢复及血清Hcy、IL-18的影响

Effect of Early Application of Donepezil on Recovery from Elderly Patients with Post-stroke Cognitive Dysfunction and Serum Hcy and IL-18

目的 探讨老年卒中后认知功能障碍患者早期应用中枢胆碱酯酶抑制剂多奈哌齐的临床效果及患者血清同型半胱氨酸(Hcy)、白介素-18 (IL-18)的表达。方法 选取南京医科大学附属泰州人民医院2020年3月~2023年4月住院的老年卒中后认知障碍患者100例,采取随机分组方法分为早期治疗组及延迟治疗组。早期治疗组起病初期(3~5日内)加用盐酸多奈哌齐,延迟治疗组病程3个月左右加用盐酸多奈哌齐。运用简易智能精神状态量表(MMSE)联合蒙特利尔认知评估量表(MoCA)对患者认知功能改变进行评价。选取同期入院的卒中后无认知功能障碍老年患者50例及同期门诊健康老年人50例作为对照组。对所有研究对象的血清Hcy和IL-18浓度进行测定,分析血清Hcy、IL-18浓度与卒中后认知障碍的关系。结果 病程6个月后早期治疗组MMSE分值、MoCA分值与延迟治疗组相比显著升高(P<0.05),卒中后认知障碍患者血清Hcy及IL-18水平高于卒中后无认知功能障碍者及健康体检者(P<0.05);且卒中后认知障碍患者MMSE分值、MoCA分值与血清Hcy浓度呈负相关(P<0.05)。结论 多奈哌齐可有效改善卒中后认知功能障碍,促进认知功能恢复,早期治疗效果优于延迟治疗。老年卒中后认知功能障碍患者血清Hcy和IL-18水平高于无认知功能障碍患者,提示可作为卒中后发生认知障碍的生物学标志物之一;血清Hcy浓度可反映患者卒中后认知功能障碍的严重程度。

Objective To explore the clinical effect of early application of central cholinesterase inhibitor donepezil in elderly patients with post-stroke cognitive dysfunction and the expression of serum homocysteine(Hcy)and interleukin-18(IL-18)in patients.Methods 100 elderly patients with post-stroke cognitive impairment who were hospitalized in Taizhou People's Hospital affiliated with Nanjing Medical University from March 2020 to April 2023 were selected and randomly grouped into early treatment group and delayed treatment group.Done⁃pezil hydrochloride was added to the early treatment group at the beginning of the disease(within 3-5 days),and donepezil hydrochloride was added to the delayed treatment group at about 3 months of the disease duration.The patients'cognitive function changes were evaluated using the Mini-Mental State Examination(MMSE)combined with the Montreal Cognitive Assessment(MoCA).Fifty elderly patients without cognitive dysfunction after stroke admitted to the hospital during the same period and 50 healthy elderly patients in the outpatient clin⁃ic during the same period were selected as the control group.Serum Hcy and IL-18 concentrations were mea⁃sured in all study subjects to analyze the relationship between serum Hcy and IL-18 concentrations and poststroke cognitive impairment.Results MMSE score and MoCA score were significantly higher in the early treat⁃ment group compared with the delayed treatment group after 6 months of disease duration(P<0.05),and serum Hcy and IL-18 levels were higher in patients with post-stroke cognitive impairment than in those without poststroke cognitive impairment and those with healthy physical examination(P<0.05);and there was a negative correlation between the post-stroke MMSE score and MoCA score and serum Hcy concentration(P<0.01).Conclusion Donepezil can effectively improve post-stroke cognitive dysfunction and promote cognitive recov⁃ery,and early treatment is better than delayed treatment.Serum Hcy and IL-18 levels were higher in elderly pa⁃tients with post-stroke cognitive dysfunction than in patients without cognitive dysfunction,suggesting that it can be used as one of the biomarkers of cognitive dysfunction after stroke,and that serum Hcy concentration can reflect the severity of post-stroke cognitive dysfunction in patients.