Mu N, Xu S C, Chang Q, Rao D P, Chen J P, Ma C
Division of Geriatric Psychiatry, Guangzhou Brain Hospital, Guangzhou, PR China; The First Clinical Medical School, Jinan University, Guangzhou, PR China.
East Asian Arch Psychiatry. 2013 Sep;23(3):114-9.
To investigate the characteristics of blood lipids, insulin metabolism, and paraoxonase-2-311 (PON2-311) polymorphism among patients with Alzheimer's disease with different types of dementia.
A total of 84 patients with Alzheimer's disease, according to the National Institute of Neurological and Communicative Disorders and Stroke, and the Alzheimer's disease and Related Disorders Association clinical criteria for 'possible Alzheimer's disease', and with no family history of the condition, were enrolled. They were then categorised into 3 groups (senile dementia, presenile dementia, and mixed dementia) according to the diagnostic criteria of the Chinese Classification of Mental Disorders, third edition. Polymerase chain reaction-restriction fragment length polymorphism analysis was used to determine the presence of PON2-311 polymorphism. Serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and fasting blood sugar were measured. Fasting plasma insulin was measured using chemiluminescence. The basal-state method was used to assess insulin resistance expressed as insulin sensitivity index. The cognitive rating scale of the Mini-Mental State Examination, Activities of Daily Living scale, and Hachinski Ischemic Scale were used to establish the clinical features and severity of cognitive impairment. Differences in PON2-311C/S polymorphism, serum insulin, blood glucose, blood lipids, and neuropsychological score were analysed.
The serum triglyceride and cholesterol levels of the presenile dementia group were significantly higher than those of the senile and mixed dementia groups (p < 0.01). The high-density lipoprotein level of the senile dementia group was significantly higher than that of the mixed dementia group (p < 0.05). The serum insulin level of the presenile dementia group was significantly higher than that of the senile (p < 0.05) and mixed dementia groups (p < 0.01). There were no significant differences in distribution of the PON2-311 genotypes C/C, C/S, and S/S between the senile and mixed dementia groups, and no significant differences in C-allele and S-allele frequency between the 2 groups.
The differences in serum triglycerides, cholesterol, high-density lipoprotein, and insulin levels between Alzheimer patients with senile, presenile, and mixed dementia found in this study suggest that patients with presenile dementia should monitor their lipid and insulin metabolism. No significant differences were found for PON2-311 genotypes or allele frequencies in patients with dementia due to Alzheimer's disease.
研究不同类型痴呆的阿尔茨海默病患者的血脂、胰岛素代谢及对氧磷酶-2-311（PON2-311）基因多态性特征。
根据美国国立神经疾病与中风研究所及阿尔茨海默病及相关疾病协会的“可能阿尔茨海默病”临床标准，纳入84例无家族病史的阿尔茨海默病患者。然后根据《中国精神障碍分类与诊断标准》第三版的诊断标准将他们分为3组（老年痴呆、早老性痴呆和混合性痴呆）。采用聚合酶链反应-限制性片段长度多态性分析来确定PON2-311基因多态性的存在。检测血清胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白和空腹血糖。采用化学发光法检测空腹血浆胰岛素。采用基础状态法评估胰岛素抵抗，以胰岛素敏感指数表示。使用简易精神状态检查表认知评定量表、日常生活活动量表和哈金斯基缺血量表来确定认知障碍的临床特征和严重程度。分析PON2-311C/S基因多态性、血清胰岛素、血糖、血脂和神经心理学评分的差异。
早老性痴呆组的血清甘油三酯和胆固醇水平显著高于老年痴呆组和混合性痴呆组（p<0.01）。老年痴呆组的高密度脂蛋白水平显著高于混合性痴呆组（p<0.05）。早老性痴呆组的血清胰岛素水平显著高于老年痴呆组（p<0.05）和混合性痴呆组（p<0.01）。老年痴呆组和混合性痴呆组之间PON2-311基因型C/C、C/S和S/S的分布无显著差异，两组之间C等位基因和S等位基因频率也无显著差异。
本研究发现，老年、早老性和混合性痴呆的阿尔茨海默病患者在血清甘油三酯、胆固醇、高密度脂蛋白和胰岛素水平上存在差异，提示早老性痴呆患者应监测其脂质和胰岛素代谢。阿尔茨海默病所致痴呆患者的PON-311基因型或等位基因频率无显著差异。
