CAJ | 학술논문

目的探讨替米沙坦对高血压合并阿尔茨海默病患者β淀粉样蛋白(Aβ)、白细胞介素-1(IL-1β)、肿瘤坏死因子α(TNF-α)的表达水平影响和认知功能障碍程度改善的临床疗效.方法选取2008年3月至2011年10月间河南省人民医院门诊确诊的48例高血压病合并阿尔茨海默病患者,按时间顺序依次分为治疗组24例和对照组24例.治疗组采用阿尔茨海默病基本药物治疗加替米沙坦40 ～ 80 mg/d治疗；对照组采用阿尔茨海默病基本药物加氨氯地平5～10 mg治疗.在治疗前和治疗后24周后分别对两组患者进行疗效评估.主要评估指标包括简易精神状态量表(MMSE)、阿尔茨海默病评价量表-认知分量表(ADAS-cog)和测定血压水平；同时对Aβ、IL-1 β和TNF-α的表达水平进行测定.结果在24周后,治疗组和对照组两组的血压水平均较治疗前有明显下降(P＜0.05),但两组间差异无统计学意义；治疗组患者的测量值Aβ1-42(598±379) pg/ml明显高于对照组(489±356) pg/ml.治疗组患者的测量值IL-1β[(8±4) pg/ml]和TNF-α[(35±11) pg/ml]水平较治疗前IL-1β[(12±5)pg/ml]和TNF-α[(49±10) pg/ml]和对照组IL-1β[(14±6)pg/ml]和TNF-α[(48±11) pg/ml]均有明显降低(P＜0.05).治疗组患者量表评分MMSE[(22.0±3.4)分]和ADAS-cog[(15±5)分]较对照组MMSE[(19.5±2.8)分]和ADAS-cog[(18±5)分]均有明显改善(P＜0.05),且治疗组上述评分显著优于对照组(P＜0.05).结论替米沙坦可延缓AD患者脑脊液中Aβ1-42的下降,降低脑脊液中IL-1β和TNF-α的水平,从而改善AD患者的认知功能,其疗效优于常规抗高血压药物治疗,且用药安全,耐受性好.
목적 탐토체미사탄대고혈압합병아이자해묵병환자β정분양단백(Aβ)、백세포개소-1(IL-1β)、종류배사인자α(TNF-α)적표체수평영향화인지공능장애정도개선적림상료효.방법 선취2008년3월지2011년10월간하남성인민의원문진학진적48례고혈압병합병아이자해묵병환자,안시간순서의차분위치료조24례화대조조24례.치료조채용아이자해묵병기본약물치료가체미사탄40 ～ 80 mg/d치료；대조조채용아이자해묵병기본약물가안록지평5～10 mg치료.재치료전화치료후24주후분별대량조환자진행료효평고.주요평고지표포괄간역정신상태량표(MMSE)、아이자해묵병평개량표-인지분량표(ADAS-cog)화측정혈압수평；동시대Aβ、IL-1 β화TNF-α적표체수평진행측정.결과 재24주후,치료조화대조조량조적혈압수평균교치료전유명현하강(P＜0.05),단량조간차이무통계학의의；치료조환자적측량치Aβ1-42(598±379) pg/ml명현고우대조조(489±356) pg/ml.치료조환자적측량치IL-1β[(8±4) pg/ml]화TNF-α[(35±11) pg/ml]수평교치료전IL-1β[(12±5)pg/ml]화TNF-α[(49±10) pg/ml]화대조조IL-1β[(14±6)pg/ml]화TNF-α[(48±11) pg/ml]균유명현강저(P＜0.05).치료조환자량표평분MMSE[(22.0±3.4)분]화ADAS-cog[(15±5)분]교대조조MMSE[(19.5±2.8)분]화ADAS-cog[(18±5)분]균유명현개선(P＜0.05),차치료조상술평분현저우우대조조(P＜0.05).결론 체미사탄가연완AD환자뇌척액중Aβ1-42적하강,강저뇌척액중IL-1β화TNF-α적수평,종이개선AD환자적인지공능,기료효우우상규항고혈압약물치료,차용약안전,내수성호.
Objective To explore the effects of telmisartan,an angiotensin Ⅱ type 1 receptor blocker with peroxisome proliferator-activated receptor γ-stimulating activity,on the levels of Aβ1-42,interleukin-1 β (IL-1β),tumor necrosis factor-alpha (TNF-α) and cognition in elderly hypertensive patients with Alzheimer' s disease (AD).Methods A total of 48 patients with probable AD and essential hypertension were randomly assigned into telmisartan group (n =24,40-80 mg qd) or amlodipine group (n =24,5-10 mg qd) for 6 months at Henan Provincial People's Hospital during 2008-2011.Cognitive evaluations were assessed at pre-treatment and 24 weeks post-treatment by clinical assessment,rating scales and neuropsychological tests while the cerebrospinal fluid (CSF) levels of Aβ1-42,IL-1β and TNF-α by enzyme-linked immunosorbent assay (ELISA).Results After 6 months,mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly decreased compared with baseline values to a similar extent in both groups.No significant differences existed between two groups in SBP or DBP.The patients displayed significantly higher Aβ1-42 and greatly lower levels of IL-1 β and TNF-α in the telmisartan group versus the amlodipine group (P ＜ 0.05).At 24 weeks,the patients in the telmisartan group had better mini-mental state examination (MMSE) (22.0 ± 3.4) and Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) (15 ± 5) scales scores than those taking amlodipine (MMSE (19.5 ± 2.8) and ADAS-cog (18 ± 5).Patients treated with telmisartan had better improvement on the MMSE (P ＜ 0.05) and ADAS-cog (P ＜ 0.05) scales compared with the amlodipine group by the end of study week 24.Conclusion Telmisartan may delay the decreased level of Aβ1-42 and reduce the levels IL-1 β and TNF-α in CSF so as to improve the cognitive function of elderly hypertensive patients with AD.With additional benefits in comparison with common antihypertensive drugs,it may offer a novel therapeutic strategy of AD.