载脂蛋白E基因多态性与卒中后认知功能变化的相关性研究OA

Objective To investigate the differences in clinical characteristics among various apolipoprotein E(APOE)genotypes in patients with acute ischemic stroke,and to explore the association between APOE gene polymorphism and changes in cognitive function after stroke. Methods This study was based on a multicenter,prospective study(predictive,preventive and personalized project of vascular cognitive impairment in China).Patients with acute ischemic stroke admitted to six medical institutions in China from September 1,2022 to August 31,2023 were enrolled.Baseline data collected at enrollment included age,sex,years of education,BMI,medical history(hypertension,diabetes mellitus,heart disease,hyperlipidemia,stroke or TIA),smoking history,drinking history,medication history,NIHSS score,MoCA score,Hamilton depression scale(HAMD)score,Hamilton anxiety scale(HAMA)score,imaging data(whether critical site infarction,infarct size grade),TOAST classification,and APOE genotype.Patients were categorized into three groups based on their APOE genotypes:APOE ε3 homozygotes(ε3/ε3),APOE ε2 carriers(ε2/ε3,ε2/ε2),and APOE ε4 carriers(ε3/ε4,ε4/ε4).The patients were followed up 6 to 12 months after stroke onset.One-factor analysis of variance was performed to compare the above baseline clinical data among the three groups.Additionally,generalized linear mixed models were utilized to analyze the correlation between APOE genotypes and the longitudinal changes in MoCA scores after stroke. Results A total of 202 patients with acute ischemic stroke were included at baseline,including 155 males and 47 females,with a mean age of(58.5±10.4)years.There were no statistically significant differences in baseline age,sex,years of education,BMI,medical history,smoking history,drinking history,medication history,NIHSS score,MoCA score,HAMD score,HAMA score,proportion of critical site infarction,infarct size grade,or TOAST classification among the three groups of patients with different APOE genotypes(all P＞0.05).A total of 151 patients completed the follow-up,and the median follow-up period was 8.0(7.0-10.0)months.After adjusting for sex,age,years of education,and center effect,it was found that compared with the APOE ε3 homozygotes,the APOE ε4 carriers showed a significant negative correlation with MoCA score at baseline(β=-1.682,P=0.029),and the interaction between follow-up period and APOE ε4 carrier status was also significantly negatively correlated with MoCA score(β=-0.322,P＜0.001). Conclusions The polymorphism of the APOE gene is related to the changes in cognitive function scores after stroke.Compared with the APOE ε3 homozygotes,APOE ε4 carriers exhibit lower cognitive function scores at stroke onset,and show a more rapid decline in cognitive function scores after stroke.