氟西汀可能增强非痴呆型血管性认知障碍患者的血管内皮生长因子、脑源性神经营养因子及认知功能：一项开放标签随机临床研究。
Fluoxetine May Enhance VEGF, BDNF and Cognition in Patients with Vascular Cognitive Impairment No Dementia: An Open-Label Randomized Clinical Study.
作者信息
Zhang Lei, Liu Xuan, Li Tong, Xu Bing, Fu Binfang
机构信息
Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, People's Republic of China.
出版信息
Neuropsychiatr Dis Treat. 2021 Dec 29;17:3819-3825. doi: 10.2147/NDT.S334647. eCollection 2021.
PURPOSE
Selective serotonin reuptake inhibitors (SSRIs) enhance angiogenesis and neurogenesis. Brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) play an important role in neurogenesis and angiogenesis. However, the effect of SSRIs on cognition and serum BDNF and VEGF in patients with vascular cognitive impairment no dementia (VCIND) is largely unknown.
PATIENTS AND METHODS
It was an open label study. Fifty VCIND patients were randomly allocated to receive fluoxetine (20 mg/d; n = 25) or no fluoxetine (control group; n = 25) for 12 weeks. VCIND patients received fluoxetine 20 mg/d and secondary prevention of stroke for 12 weeks in the fluoxetine group, whereas the control group received only secondary prevention of stroke for 12 weeks. The primary outcome and secondary outcome were of assessment of Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) score, Ten Point Clock drawing test score (TPC), Verbal Fluency Test (VFT), Trail Making Test form a (TMTa), Trail Making Test form b (TMTb) and Digit Span Test score at baseline and week 12 in the both groups. And serum concentration of BDNF and VEGF was also tested at baseline and week 12 in both groups.
RESULTS
After 12 weeks, TPC scores increased more significantly in the fluoxetine group than in the control group, while TMTa score and TMTb score were decreased more significantly in the fluoxetine group than in the control group. We also found that the serum concentration of BDNF and VEGF in the fluoxetine group increased more significantly than in the control group. However, we found no significant differences in mean change from baseline between fluoxetine and control group in ADAS-Cog score, Digit Span Test score and VFT score.
CONCLUSION
Fluoxetine may enhance cognition in certain cognitive domains and serum concentration of BDNF and VEGF in patients with VCIND.
目的
选择性5-羟色胺再摄取抑制剂（SSRIs）可促进血管生成和神经生成。脑源性神经营养因子（BDNF）和血管内皮生长因子（VEGF）在神经生成和血管生成中发挥重要作用。然而，SSRIs对非痴呆性血管性认知障碍（VCIND）患者认知功能以及血清BDNF和VEGF的影响在很大程度上尚不清楚。
患者与方法
这是一项开放标签研究。50例VCIND患者被随机分为两组，分别接受氟西汀治疗（20mg/d；n = 25）或不接受氟西汀治疗（对照组；n = 25），为期12周。氟西汀组的VCIND患者接受20mg/d氟西汀治疗并进行为期12周的卒中二级预防，而对照组仅进行为期12周的卒中二级预防。主要结局指标和次要结局指标为两组在基线及第12周时阿尔茨海默病评估量表认知分量表（ADAS-cog）评分、十点画钟试验评分（TPC）、语言流畅性测验（VFT）、连线测验A（TMTa）、连线测验B（TMTb）和数字广度测验评分。同时，两组在基线及第12周时也检测了血清BDNF和VEGF浓度。
结果
12周后，氟西汀组的TPC评分较对照组升高更为显著，而氟西汀组的TMTa评分和TMTb评分较对照组降低更为显著。我们还发现，氟西汀组血清BDNF和VEGF浓度较对照组升高更为显著。然而，我们发现氟西汀组与对照组在ADAS-Cog评分、数字广度测验评分和VFT评分方面，与基线相比的平均变化无显著差异。
结论
氟西汀可能改善VCIND患者某些认知领域的认知功能，并提高血清BDNF和VEGF浓度。
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