血浆中p-tau(181p)蛋白对老年性痴呆的诊断意义

目的研究血浆中p-tau(181P)蛋白对老年性痴呆(Alzheimer Disease,AD)临床诊断的作用.方法对临床AD患者进行分层研究,并改进了实验室检测方法.选择了早期AD组患者23例[19≤简易精神智能状态检测量表(MMSE)≤26,临床痴呆程度量表(CDR)=1],中后期AD组患者35例(MMSE＜19,CDR≥2及年龄性别相匹配的健康对照组30例.所采集血标本置EDTA抗凝管中,低温离心取上清、加酸置低温冰箱保存.应用ELISA方法检测血清p-tau(181P)蛋白.结果早期AD患者血浆中p-tau(181P)蛋白浓度(8.5±14.9)ng/L与健康对照组(5.7±4.3)ng/L差异统计学意义(P＞0.05);但中后期AD患者p-tau(181P)蛋白血浆浓度(18.3士20.3)ng/L较健康对照组显著升高(P＜0.01). 结论改进实验室研究手段并对AD患者分层检测血中p-tau(181P)蛋白的浓度很有可能成为辅助AD临床诊断的生物指标.     

血浆非对称二甲基精氨酸浓度与急性冠状动脉综合征的关系

目的:探讨血浆非对称二甲基精氨酸(ADMA)浓度与急性冠状动脉综合征(ACS)及其不同亚组之间的相关性.方法:根据临床病情,并结合冠状动脉造影结果,将ACS组(88例)患者分为不稳定型心绞痛(UAP)亚组(56例)和急性心肌梗死(AMI)亚组(32例);对照组(42例)为冠状动脉正常患者.通过高效液相色谱联合质谱法(HPLC)测定血浆ADMA、L-精氨酸(L-Arg)含量.比色法测定HDL-C、TC、TG和尿酸(UA).结果:ACS组血浆ADMA浓度显著高于对照组[(5.18±1.32):(3.70±1.32)μg/L,P＜0.01],血浆L-Arg/ADMA浓度比低于对照组(1.64±0.60:2.49±1.79,P＜0.01).血浆L-Arg浓度在2组间差异无统计学意义.亚组间分析:AMI亚组血浆ADMA浓度显著高于对照组[(5.60±1.46):(3.70±1.32)μg/L,p＜0.01]和UAP亚组[(5.60±1.46):(4.93±1.22)μg/L,P＜0.05],血浆L-Arg/ADMA浓度比值低于对照组[(1.57±0.79):(2.49±1.79),P＜0.01];UAP亚组血浆ADMA浓度高于对照组[(4.93±1.22):(3.70±1.32)μg/L,P＜0.01],L-Arg/ADMA浓度比值低于对照组[(1.67±0.45):(2.49±1.79),P＜0.01];血浆L-Arg浓度在3组间差异无统计学意义.血浆ADMA与HDL-C、TC、TG、UA浓度无相关性.结论:ACS患者血浆ADMA浓度显著升高,血浆L-Arg/ADMA浓度比值显著降低,ADMA浓度升高是ACS的危险因素,且独立于冠心病传统危险因子.     

阿尔茨海默病患者尿液中相关的神经丝蛋白的诊断价值

目的 研究尿中阿尔茨海默病(AD)相关的神经丝蛋白(AD7c-NTP)对AD的诊断意义.方法 采用ELISA检测50例AD,60例轻度认知障碍(MCI)和82例智能正常老年人尿中AD7c-NTP的含量.结果 AD组、MCI组和正常对照组尿中AD7c-NTP的含量分别为(2.20±0.34)、(1.53±0.43)、(1.38±0.38) ng/ml,AD组尿液中AD7c-NTP的含量明显高于其他两组(P ＜0.01);MCI组与正常对照组无差异(P＞0.05);中重度AD组尿液中AD7c-NTP的含量明显高于轻度AD组(P＜0.01).90.0％ AD和43.3％ MCI患者尿AD7c-NTP含量异常(＞1.90 ng/ml),而87.8％智能正常老年人该指标正常(≤1.90 ng/ml).结论 尿液中AD7c-NTP的含量对AD诊断和病情评估有重要的参考价值.     

微型营养评价量表在老年阿尔茨海默病患者中的应用

目的 观察老年阿尔茨海默病（Alzheimer＇s disease,AD）患者营养状况及血叶酸、VitB12水平,并分析认知功能对老年患者营养状况影响.方法共纳入AD患者101例.以微型营养评价量表（MNA）和痴呆评定量表（CDR）为工具检查所有研究对象的营养状态和认知功能,分为轻度AD组（51例,CDR 1分）和中重度AD组（50例,CDR 2 ～3分）,根据患者量表得分及生化检测指标进行数据分析.结果与轻度AD组相比,中重度AD组患者MNA总得分（23.74±4.46） vs （26.86±3.13）、整体评估得分（6.32±0.67）vs（7.46±0.44）、膳食评估得分（6.68 ±0.17）vs （7.58±0.38）等降低（P＜0.05）,BMI降低[（21.33±4.08） kg/m2 vs （24.67±4.36） kg/m2,P＜0.01].多元回归逐步方程：MNA评分=30.860-0.215年龄-0.049CDR评分＋0.269血叶酸水平.结论MNA得分随CDR得分升高而降低.年龄、CDR评分与MNA评分呈负相关,血叶酸水平与MNA评分呈正相关.     

多梗死性痴呆CD54和CD106的表达及相关研究

目的 探讨多梗死性痴呆(MID)患者血清CD54、CD106水平与血中氧自由基(OFR)浓度的关系.方法 采用酶联免疫法和电子自旋共振技术测定82例MID患者和23例对照组血清CD54、CD106水平和OFR浓度.结果 MID组血清CD54、CD106水平、OFR浓度分别为[(469±76.33)ng/ml,(1 103.3±98.96)ng/ml,(4.018±1.656)g/g]较对照组[CD54:(196±45.91)ng/ml,CD106:(601.00±76.30)ng/ml,OFR:(1.295±0.718)g/g]高(P＜0.01).血清CD54、CD1061及OFR浓度与痴呆程度呈正相关(r=0.659 4,P＜0.05;r=0.697 5,P＜0.05;r=0.649 4,P＜0.05).血清CD54、CD1061与OFR浓度呈正相关(r=0.714 7,P＜0.01;r=0.732 4,P＜0.01).结论 CD54、CD106、OFR参与了MID病理生理发展过程,并与痴呆程度密切相关.血清 CD54、CD106水平在一定程度上反映了MID神经功能缺损的程度.     

阿尔茨海默病患者尿液中相关神经丝蛋白含量的诊断价值

目的 探讨阿尔茨海默病(AD)患者尿液中Alzheimer相关的神经丝蛋白(AD7c-NTP)的含量在AD诊断中的价值. 方法 收集就诊于我院门诊AD患者及健康体检者的尿液标本450例,其中AD组共257例,轻度131例、中重度126例,健康对照组193例,应用双抗体夹心酶联免疫吸附法测定尿样标本中AD7c-NTP水平. 结果 轻度、中重度AD组尿样标本中AD7c-NTP含量为(1.94±0.74)μg/L和(3.92±0.86)μg/L,健康对照组为(0.65±0.80)μg/L,轻度和中重度AD组比较,差异均有统计学意义(t=1.727,P＜0.001),三组比较差异有统计学意义(F=-13.520,P＜0.001).轻度AD组尿样标本中AD7c-NTP含量与MMSE呈负相关(r=-0.23,P=0.006),而中重度AD组尿样标本中AD7c-NTP含量与MMSE无明显的相关性(r=0.59,P=0.113).根据ROC曲线,确定1.50 μg/L为尿AD7c-NTP诊断AD的切点,对应的灵敏度和特异度分别为90.6％和91.8％,ROC曲线下面积为0.94,95％可信区间为0.91～0.97. 结论 尿AD7c-NTP含量检测可作为AD辅助诊断的方法之一.     

阿尔茨海默病和轻度认知障碍患者血清皮质醇水平变化及意义

目的探讨阿尔茨海默病(AD)和轻度认知障碍(MCI)患者血清皮质醇水平的变化及意义。方法采集46例AD、42例MCI及44例正常对照者的外周静脉血进行血清皮质醇水平检测,所有受试者均进行简易精神状态量表(MMSE)、Hachinski缺血指数(HIS)及汉密顿抑郁量表(HAMD)评定,AD患者用临床痴呆评定量表(CDR)进行痴呆严重程度分级。结果 AD组血清皮质醇水平为(596.47±58.29)nmol/L,MCI组为(558.64±71.05)nmol/L,正常对照组为(408.65±79.86)nmol/L,AD组和MCI组均显著高于对照组(P0.01);AD组与MCI组比较无显著差异(P0.05)。AD组血清皮质醇水平与MMSE评分存在负相关(P0.05)。结论 AD和MCI患者存在血清皮质醇升高,且与AD严重程度显著相关,皮质醇可能参与了AD和MCI的病理过程。     

联合检测PTH和NT-proBNP对急性心力衰竭患者临床诊断及预后的价值

目的:探讨联合检测外周血中甲状旁腺激素(PTH)和N末端脑钠肽前体(NT-proBNP)对急性心力衰竭(AHF)患者的临床诊断和预后价值。方法:选择我院的AHF患者112例为AHF组,选择同期健康体检者100例为健康对照组;AHF组根据病情分为轻度心衰组(62例)和重度心衰组(50例);根据近期预后情况分为事件组(47例)和非事件组(65例)。分别检测并比较各组间血清PTH和血浆NT-proBNP的水平,及对AHF诊断的灵敏度和特异度。结果:与健康对照组比较,AHF组患者血清PTH[(46.45±10.42)ng/L比(86.24±15.68)ng/L]和血浆NT-proBNP [(420.45±68.73)ng/L比(2678.34±211.06)ng/L]水平显著升高(P均=0.001);与轻度心衰组比较,重度心衰组患者血清PTH[(66.47±10.65)ng/L比(82.06±11.86) ng/L]和血浆NT-proBNP [(2001.45±119.83) ng/L比(2607.34±118.53) ng/L]水平显著升高(P均=0.001);与非事件组比较,事件组患者血清PTH [(68.53±8.75) ng/L比(80.04±12.86) ng/L]和血浆NT-proBNP [(2116.66±119.79) ng/L比(2563.29±145.52) ng/L]水平显著升高(P均=0.001);与单纯PTH或NT-proBNP检测比较,PTH联合NT-proBNP检测对各组的灵敏度和特异度显著提高(P0.05或0.01)。结论:联合检测PTH和NT-proBNP对急性心力衰竭患者的病情和预后评估十分重要。     

血管紧张素转化酶抑制剂对兔腹主动脉球囊损伤后的影响

目的:研究血管紧张素转化酶抑制剂(ACEI)对兔腹主动脉球囊损伤后的影响及作用机制。方法:雄性新西兰大白兔随机分为ACEI组和对照组,每组10只。球囊损伤腹主动脉后,ACEI组给予福辛普利5mg.kg-1.d-1,对照组不给予药物处理。实验4周后,取腹主动脉标本,使用计算机辅助形态分析系统比较2组新生内膜、中膜及管腔面积,测定血清、组织肝细胞生长因子(HGF)浓度以及与新生内膜面积的相关关系。结果:ACEI组新生内膜面积显著低于对照组[(0.048±0.011)mm2∶(0.124±0.021)mm2,P<0.001];管腔面积对照组显著低于ACEI组[(1.920±0.140)mm2∶(2.290±0.260)mm2,P=0.001];血管中膜面积2组差异无统计学意义[(0.890±0.130)mm2∶(0.990±0.120)mm2,P>0.05]。2组血浆HGF浓度差异无统计学意义[(485±84)ng/L∶(507±106)ng/L,P>0.05],组织HGF浓度ACEI组显著高于对照组[(49.9±5.5)ng/g∶(32.7±4.5)ng/g,P<0.001];单因素相关分析发现新生内膜面积与组织HGF浓度呈负相关(r=-0.943,P<0.001)。结论:ACEI可以减轻兔腹主动脉球囊损伤后新生内膜的形成,增加管腔面积,升高组织HGF浓度而对血浆HGF浓度无影响。ACEI减轻血管球囊损伤后的新生内膜形成部分通过升高组织HGF发挥作用。     

军事训练中运动性猝死高危人群筛查方法的研究

目的 探索军事训练中运动性猝死高危人群的筛查方法.方法 通过问卷调查、物理查体、12导联心电图分析筛查,在960名士兵中筛选出高危人群作为高危组(120例),从剩余士兵中随机匹配正常对照组(120例).比较两组士兵5000米跑步前、后(跑步前30 min,跑步后30 min)血浆中肾上腺素(EPI)、一氧化氮(NO)、高敏C反应蛋白(CRP)浓度的变化(ELISA法检测).结果 两组士兵运动后血浆EPI、CRP水平较运动前显著增高,血浆NO水平较运动前显著降低(P＜0.05).运动后高危组血浆EPI和CRP较对照组明显升高[(111.1±10.3)ng/L比(101.9±12.5)ng/L,(33.9±5.8)ng/L比(28.1±4.1)ng/L],高危组NO较对照组显著降低[(102.3±12.3)μmol/L比(108.3±9.7)μmol/L] (P＜0.05).结论 本方法有助于对运动性猝死高危人群的筛选,对预防运动性猝死的发生有一定的指导意义.     

Depression as prognostic factor: 6 months follow-up in a geriatric institution

Depression in the elderly and especially in the demented elderly is common, but it is unclear to what extent depression affects the prognosis of dementia. We performed a 6 months follow-up on the elderly to evaluate the effect of depression on the prognosis of dementia. Among the residents in a Korean geriatric institution, a total of 141 elderly residents were included in this study. Those residents who had geriatric depression scale (GDS) scores over 20 were considered as having depression. The subjects were assessed at baseline and at 6 months later with the Korean Mini-Mental State Examination (K-MMSE), Clinical Dementia Rating (CDR) and Barthel index (BI). For all the 141 subjects, the changes of the K-MMSE, CDR and BI scores were first compared between the depressed and non-depressed groups. Then, for the 58 depressed subjects subdivided into three groups (36 subjects in the non-demented group, 14 subjects in the Alzheimer disease (AD) group and 8 subjects in the vascular dementia (VaD) group), the changes of the scores among the three groups were compared. For all subjects, the changes of the K-MMSE and CDR scores were more severe in the depressed group than in the non-depressed group. For the 58 depressed subjects, the changes were significantly different among the three groups (p=0.02 for the K-MMSE, p<0.001 for the CDR), and the changes were the most severe in the VaD group. For the elderly, depression has a significant influence on the cognitive deterioration. Moreover, the effect of depression on the cognitive dysfunction and on the prognosis of dementia is more severe in the demented elderly, and especially for the VaD patients.     

阿尔茨海默病不同严重程度时的神经心理学研究

目的 研究阿尔茨海默病（ＡＤ）不同痴呆严重程度时的神经心理模式特点。方法 使用多种神经心理测验测试了符合国际公认的痴呆诊断标准（ＮＩＮＣＤＳ－ＡＤＲＤＡ）“很可能为ＡＤ”的患者,使用临床痴呆评定（ＣＤＲ）确定痴呆严重程度。结果 ＡＤ早期即出现视空间功能障碍,中、重度阶段均明显衰退。认知功能障碍也始于ＡＤ早期,中、重度阶段呈持续性显著衰退趋势,记忆功能在ＡＤ早期即出现大幅度衰退,,中期衰退幅度不大,     

高血浆高半胱氨酸和脂蛋白相关磷脂酶A2水平与痴呆的相关性

目的 探讨血浆高半胱氨酸(homocysteine, Hcy)和脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2, Lp-PLA2)水平与痴呆的相关性.方法 回顾性纳入住院的痴呆患者,根据Hachinski缺血量表分为血管性痴呆(vascular dementia, VaD)组、混合性痴呆(mixed dementia, MD)组和阿尔茨海默病(Alzheimer''s disease, AD)组,同时根据简易精神状态检查量表将痴呆严重程度分为轻度、中度和重度.另选同时期住院的非痴呆患者作为对照组.比较各组人口统计学、血管危险因素以及血浆Hcy和Lp-PLA2水平.应用logistic回归分析确定血浆Hcy和Lp-PLA2水平与痴呆风险和严重程度的独立相关性.结果 共纳入125例痴呆患者,VaD组52例(41.6%),MD组21例(16.8%),AD组52例(41.6%);轻度组49例(39.2%),中度组51例(40.8%),重度组25例(20%).40例非痴呆患者被纳入作为对照组.VaD组、MD组和AD组血浆Hcy及Lp-PLA2水平均显著高于对照组(P均<0.001).多变量logistic回归分析显示,高龄[优势比(odds ratio, OR)1.12,95%可信区间(confidence interval, CI)1.03~1.21;P=0.010]、高血浆Hcy水平(OR 1.44,95% CI 1.21~1.71;P<0.001)、高Lp-PLA2水平(OR 1.01,95% CI 1.00~1.02;P=0.006)和既往卒中史(OR 4.29,95% CI 1.50~12.36;P=0.007)是痴呆的独立危险因素;高Hcy水平(OR 1.48,95% CI 1.21~1.82;P<0.001)、高Lp-PLA2水平(OR 1.01,95% CI 1.00~1.03;P=0.002)和既往卒中史(OR 152.78,95% CI 20.41~999.97;P<0.001)是VaD的独立危险因素;高龄(OR 1.10,95% CI 1.02~1.17;P=0.008)和高Hcy水平(OR 1.41,95% CI 1.25~1.58;P<0.001)是重度痴呆的独立危险因素.结论 血浆Hcy和Lp-PLA2水平升高与痴呆相关,降低血浆Hcy和Lp-PLA2水平可能对治疗和预防痴呆有益.     

中老年男性肥胖者阻塞性睡眠呼吸暂停低通气综合征与代谢综合征相关性研究

目的 探讨中老年男性肥胖者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与代谢综合征(metabolic syndrome,MS)及其组分之间的关系.方法 选择中老年男性肥胖患者154例,根据多导睡眠呼吸监测仪监测结果诊断OSAHS及病情严重程度,测定MS相关指标,应用统计学方法对OSAHS各组相关指标及OSAHS与MS之间的关系进行比较分析.结果 与对照组比较,重度OSAHS组高密度脂蛋白胆固醇明显降低[(1.03±0.29)mmol/L对(1.31±0.38)mmol/L,P＜0.05],血糖[(6.61±1.76)mmol/L对(5.47±0.64)mmol/L]、收缩压[(133±13)mm Hg对(125±12)mm Hg]及舒张压[(99±10)mm Hg对(80±5)mm Hg]明显升高(均P＜0.05);MS患病率轻度OSAHS组25.7%,中度OSAHS组46.5%,重度OSAHS组84.4%,均明显高于对照组16.1%(均P＜0.01);在OSAHS患者中,MS患病率是对照组的6.16倍.结论 中老年男性肥胖患者OSAHS是MS发病的独立危险因素.

Abstract：

Objective To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and metabolic syndrome (MS) in obese middle-aged and older men. Methods We selectively recruited 154 obese middle-aged and older men matched for body mass index (BMI) and age. The polysomnography was performed for diagnosing OSAHS and for discriminating disease severity. The BMI, waist circumference, blood pressure, plasma glucose and lipid profiles were measured and analyzed in all subjects. Appropriate statistical methods were used to compare the components of MS in each group. Logistic regression was taken to elucidate the relationship between OSAHS and MS. Results Compared to control group, severe OSAHS group had significantly lower high density lipoprotein cholesterol level [( 1.03 ± 0.29 ) mmol/L vs. ( 1.31 ± 0. 38) mmol/L,P＜0. 05] and higher fasting glucose [(6.61±1.76) mmol/L vs. (5.47±0.64) mmol/L, P＜0. 05]as well as higher systolic blood pressure [( 133 ± 13) mm Hg vs. ( 125 ± 12) mm Hg, P＜0. 05] and diastolic blood pressure [(99±10) mm Hg vs. (80±5) mm Hg, P＜0. 05]. The prevalence of MS was significantly higher in OSAHS group than in control group (mild OSAHS group: 25.7%,moderate OSAHS group: 46. 5%, severe OSAHS group: 84.4%, control group: 16. 1 %, all P＜0. 01). OSAHS was independently associated with an increased prevalence of MS Odds ratio, 6.16).Conclusions OSAHS is independently associated with MS in obese middle-aged and older men.     

慢性重度心力衰竭患者血B型利钠肽浓度正常的临床意义探讨

目的 探讨慢性重度心力衰竭(心衰)患者出现血B型利钠肽(B-type natriuretic peptide,BNP)浓度正常的临床意义.方法 采用前瞻性对照研究的方法观察心功能Ⅲ～Ⅳ级的慢性重度心衰患者57例.血BNP浓度正常的13例患者为研究组(A组),血BNP浓度明显升高的44例为对照组(B组),分析两组患者的临床特点,判定血BNP浓度正常对于慢性重度心衰患者的意义.结果 两组患者的基线情况差异无统计学意义.A组的左室舒张末期内径大于B组[(70.56±4.33)mm与(63.73±3.75)mm,P＜0.05];A组的左室射血分数小于B组[(24.16±2.50)%与(28.49±2.63)%,P＜0.05].A组中能耐受美托洛尔的人数比例少于B组[(7/13)与(39/44),P＜0.05],耐受剂量低于B组[(12.5±6.25)mg/d与(24.20±11.22)mg/d,P＜0.05].两组血BNP浓度在稳定期各时间段无明显改变,但在慢性心衰急性发作与缓解后,A组无显著性改变[(74.03±11.18)ng/L与(71.38±11.68)ng/L,P＞0.05],而B组改变明显[(962.73±165.00)ng/L与(876.24±167.70)ng/L,P＜0.05].随访中,A组病死率高于B组(11/13与6/44,P＜0.05).Logistic多因素回归分析显示:血BNP降低为预测重度慢性心衰患者心原性死亡的独立危险因素(OR值45.488,95%可信区间5.322～388.791),P＜0.05.结论 慢性重度心衰患者出现血BNP浓度正常提示BNP分泌机制的耗竭和心脏功能的进一步恶化.     

Different MRI findings for normal elderly and very mild Alzheimer's disease in a community: implications for clinical practice the Tajiri Project

To investigate magnetic resonance imaging (MRI) findings of very mild dementia, 485 participants were randomly selected in a community. Three hundred and forty participants were of Clinical Dementia Rating (CDR) 0 (healthy), 113 were of CDR 0.5 (questionable dementia), and 32 were of CDR 1 and 2 (including 20 Alzheimer's disease, AD). Cortical atrophy, white matter lesion, etc., were visually assessed. We found that each part of the brain showed atrophy in older adults for CDR 0. For CDR 0.5, the relationships between MRI findings and age were weaker, and for AD, there were no such relationship. Atrophy related with dementia severity was found to be limited to the lateral and medial temporal lobes. For CDR 0.5, amygdala atrophy was the only finding indicating CDR effect but no age effect. The amygdala or anterior entorhinal atrophy is important for discriminating very mild dementia from normal elderly.     

Relationship between serum insulin-like growth factor-1 levels and Alzheimer's disease and vascular dementia

OBJECTIVES: To determine whether decreased serum insulin-like growth factor-1 (IGF-1) levels could be a risk factor for dementia in older people. DESIGN: Case control study. SETTING: Showa University Karasuyama Hospital, Tokyo, Japan. PARTICIPANTS: A total of 436 Japanese elderly subjects: 106 patients with Alzheimer's disease (AD), 103 patients with vascular dementia (VaD), and 227 age-matched controls without dementia. MEASUREMENTS: Serum concentrations of IGF-1 and atherogenic lipoproteins, carotid artery intima-media thickness (IMT), and plaques were determined. RESULTS: Mini-Mental State Examination (MMSE) scores were positively correlated with serum IGF-1 concentrations as well as mean blood pressure or body mass index and were negatively correlated with age, serum low-density lipoprotein cholesterol and lipoprotein(a) concentrations, and carotid IMT. Serum IGF-1 concentrations had a significant inverse correlation with carotid IMT. Analysis across the IGF-1 quartiles revealed a threshold effect of low IGF-1 on MMSE score in subjects with the IGF-1 levels of 140 ng/mL or less (50% percentile) versus those with IGF-1 levels greater than 140 ng/mL. Multiple logistic regression concerning AD and VaD retained serum IGF-1 concentrations of 140 ng/mL or less and carotid IMT of 0.9 mm or more. Patients with AD and VaD had significantly lower IGF-1 concentrations and greater mean IMT than nondemented controls. CONCLUSION: These results suggest that decreased serum IGF-1 level and the progression of carotid atherosclerosis could play a role as independent risk factors for dementia.     

盐酸美金刚对血管性痴呆大鼠CREB和细胞色素c表达的影响

目的 探讨盐酸美金刚对血管性痴呆(vascular dementia,VaD)大鼠学习记忆功能的影响和可能机制.方法 采用双侧颈总动脉永久结扎法建市大鼠VaD模型.36只SD大鼠分为假手术组、VaD组和美金刚组(灌胃给予盐酸美金刚,1次/d,连续8周),每组12只.用Y型迷官试验观察其行为学改变,用免疫组化技术检测大鼠海马CA1区和皮质神经元环磷酸腺苷反应元件结合蛋白(cAMP responsive element binding protein,CREB)和细胞色素c(cytochrome c,CytC)表达变化.TUNEL染色检测神经元凋亡情况.结果 美金刚组学习和记忆成绩分别为(50.17±5.56)次和(7.08±0.90)次,显著优于VaD组的(66.36±5.41)次和(4.64±1.03)次(P均＜0.01);海马CA1区和皮质CREB平均吸光度分别为147.51±7.11和155.37±4.52,显著高于VaD组的135.11±8.52和142.39±5.24(P均＜0.01);海马CA1区和皮质CytC平均吸光度分别为116.53±4.91和113.51±6.05,显著低于VaD组的136.65±7.43和138.09±4.88(P均＜0.01);美金刚组细胞凋亡程度也较VaD组明显改善.结论 盐酸美金刚可能通过上调CREB表达、抑制CytC释放和神经元凋亡来改善VaD大鼠的学习记忆功能.