Samartsev I N, Zhivolupov S A, Gorbatenkova O V, Ponomarev V V, Butakova J S
Kirov Military medical academy, St. Petersburg, Russia.
Belarusian State Medical University, Minsk, Belarus.
Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(12):50-58. doi: 10.17116/jnevro202312312150.
To evaluate the effect of vinpocetine therapy on clinical manifestations of chronic cerebral ischemia (CCI) and the blood concentrations of neuroinflammation markers (S100B, IL-1β).
The study included 30 patients (mean age 61.6 [56.9; 67.9] years) with CCI that received vinpocetine (30 mg/day) for 3 months. Brain changes according to magnetic resonance imaging data were assessed using the STRIVE protocol. We analyzed the dynamics of changes in the clinical questionnaires: Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Asthenic State Scale (ASS), Epworth Sleepiness Scale (ESS), general impressions of treatment (Global Rating of Change Scale, GRC).
In 3 months after vinpocetine therapy there was a significant improvement in cognitive status (MoCA: 25.1±2.1 vs 26.6±1.4 <0.05), emotional state (HADS: 8.4±1.4 vs 7.1±1.8 (<0.05)), daytime sleep parameters (ESS 8.4±2.1 vs 6.2±2.3 <0.05) and reduction in asthenia (ASS: 72.2±18.1 vs 52.3±9.3, <0.05). A significantly larger proportion of patients assessed the improvement from therapy as «moderate» and «pronounced» (GRC, =22, 73.3%). Concentrations of S100B and IL-1β decreased significantly by the time therapy was completed. The overall severity of cerebrovascular changes according to MRI was significantly associated with blood levels of S100β, but not IL-1β: β=0.504, =0.026, 95% CI 0.149-0.901, mainly due to periventricular changes in white matter (β=0.562, =0.035, 95% CI (-0.024-0.820). Blood levels of S100β correlated with MoCA test results (=0.6795), and IL-1β correlated with ESS scores (=0. 6657).
The use of vinpocetine can significantly reduce the severity of cognitive and affective disorders, asthenia, normalize the circadian rhythm of sleep, suppress the expression S100β and IL-1β in patients with CCI. One of the vinpocetine's mechanisms of action may be the inhibition of neuroinflammation.
评估长春西汀治疗对慢性脑缺血（CCI）临床表现及神经炎症标志物（S100B、IL-1β）血药浓度的影响。
本研究纳入30例CCI患者（平均年龄61.6[56.9；67.9]岁），接受长春西汀（30mg/天）治疗3个月。根据磁共振成像数据评估脑变化，采用STRIVE方案。我们分析了临床问卷变化动态：蒙特利尔认知评估量表（MoCA）、医院焦虑抑郁量表（HADS）、虚弱状态量表（ASS）、爱泼华嗜睡量表（ESS）、治疗总体印象（总体变化量表，GRC）。
长春西汀治疗3个月后，认知状态（MoCA：25.1±2.1 vs 26.6±1.4 <0.05）、情绪状态（HADS：8.4±1.4 vs 7.1±1.8（<0.05））、白天睡眠参数（ESS 8.4±2.1 vs 6.2±2.3 <0.05）有显著改善，虚弱症状减轻（ASS：72.2±18.1 vs 52.3±9.3，<0.05）。评估治疗改善为“中度”和“显著”的患者比例显著更高（GRC，=22，73.3%）。治疗结束时，S100B和IL-1β浓度显著降低。根据MRI评估的脑血管变化总体严重程度与S100β血药水平显著相关，但与IL-1β无关：β=0.504，=0.026，95%CI 0.149 - 0.901，主要是由于脑室周围白质变化（β=0.562，=0.035，95%CI（-0.024 - 0.820））。S100β血药水平与MoCA测试结果相关（=0.6795），IL-1β与ESS评分相关（=0. 6657）。
使用长春西汀可显著降低CCI患者认知和情感障碍、虚弱的严重程度，使睡眠昼夜节律正常化，抑制S100β和IL-1β的表达。长春西汀的作用机制之一可能是抑制神经炎症。
