摘要
卒中是世界范围内致死和致残的重要病因之一。有研究表明apoE基因型与缺血性卒中风险及卒中严重程度相关,但结论不一。目的:研究apoE基因型对卒中后认知及神经功能缺损的影响。方法:入组95例首次急性缺血性卒中患者(起病<7天),以及年龄相匹配的健康对照组82人。所有卒中病人均于发病第7天NIHSS评分评估卒中后神经功能缺损、mRS和BI评估卒中后功能障碍程度、MMSE和MoCA评估卒中后认知功能状态。基因测序方法分析apoE基因型。Stata10软件进行统计分析,双侧P<0.05认为差异具有统计学意义。结果:1.与对照组相比,大动脉粥样硬化性卒中组中apoEε3/ε4基因型(P=0.004)和等位基因apoEε4比例(P=0.002)显著较高;而apoEε3/ε3(P=0.011)和apoEε3(P=0.006)比例则显著低于对照组。Logistic逐步回归矫正诸多混杂因素影响后,apoEε4与大动脉粥样硬化性卒中仍显著相关(P=0.005,OR=4.71,95%CI=1.60-13.92);2.apoEε4与卒中后中重度神经功能缺损(NIHSS≥4,P=0.044)、严重残疾(BI<60, P=0.027;mRS>3, P=0.036)以及卒中后痴呆(PSD)呈正相关(P=0.022);结论:apoEε4是大动脉粥样硬化性卒中重要的危险因素,而且可能预示卒中后认知功能障碍、神经功能损害较严重。
Stroke is one of leading causes of death or disability worldwide. Currently, a great number of researches have revealed that apoE genotype is related to the risk and severity of ischemic stroke, but the conclusions are different. Objective To explore the relavance between apoE genotypes and post-stroke cognitive and neurological impairment. Methods 95 patients of first acute ischemic stroke(≤7 days) and82 age-matched controls were recruited in the study. Then we evaluated the neurological and cognitive status of patients using National Institutes of Health Stroke Scale(NIHSS), Barthel Index(BI), Modified Rankin Scale(MRS), Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment Scale(MoCA) at the seventh day after stroke. Gene sequencing was performed to analyze apoE genotypes. Stata 10 software package was used for statistical analysis. Two-sided P < 0.05 was considered to be statistically significant. Results 1. Compared with the control group, the proportion of genotype apoEε3/ε4(P=0.004) and allete apoEε4(P=0.002) were significantly higher in the large artery atherosclerosis(LAA) group, while genotype ε3/ε3(P=0.011)and allete ε3(P=0.006) was found in a statistically lower frequency in the LAA group compared with the control group;In a stepwise logistic regression analysis after adjustment for numerous confounding factors, the associations between apoEε4 and acute inchemic stroke remained significant(P=0.005, OR=4.71, 95%CI=1.60-13.92);2. apoEε4 was positively related to moderate-severe neurologycal impairment(NIHSS≥4,P=0.044), severe disability after stroke(BI<60,P=0.027;mR S>3,P=0.036) and post-stroke dementia(PSD)(P=0.022). Conclusion apoEε4 is an important risk factor in the large artery atherosclerosis stroke and may indicate more serious cognitive and neurological impairment after stroke.
作者
田冰洁
魏文石
Tian Bing-jie;Wei Wen-shi(Department of Neurology, Huadong Hospital Affilitated to Fudan University)
出处
《阿尔茨海默病及相关病杂志》
2018年第1期42-47,共6页
Chinese Journal of Alzheimer's Disease and Related Disorders
