重症肌无力患者认知功能特征

目的探讨重症肌无力(myasthenia gravis,MG)患者的认知功能特征。方法纳入83例MG患者和39例健康对照者,应用简易智能状态检查量表(mini-mental status examination,MMSE)、加利福尼亚语言学习测验(California verbal learning test,CVLT)、简易视觉空间记忆测验(brief visuospatial memory test-revised,BVMT-R)、符号数字模式测验(symbol digit modalities test,SDMT)、Benton线方向判断测验(benton judgment of line orientation test,BJLOT)、定步调听觉连续加法测验(paced auditory serial addition test,PASAT)、言语流畅性测验(verbal fluency test,VFT)进行认知功能评估,应用贝克抑郁测验(Beck depression inventory,BDI)评估抑郁状态,对两组资料进行对比分析,并进一步评估疾病分型、合并症情况、病程、疾病严重程度、药物治疗情况等临床特征对MG组认知损害的影响。结果MG组MMSE28(26,29)分,29(28,30)分]、CVLT、BVMT-R、SDMT(37.06±12.18)分,(47.54±14.91)分]、PASAT(32.86±10.23)分,(37.00±8.82)分]评分低于对照组,差异具有统计学意义(P<0.05),两组间BJLOT、VFT、BDI评分差异无统计学意义(均P>0.05)。Spearman相关分析显示重症肌无力患者疾病严重程度定量评分(quantitative MG score,QMG)与SDMT得分存在负相关(r=-0.234,P<0.05);MG日常生活质量量表(MG-activities of daily living profile,MG-ADL)评分与BVMT-R 3试总和得分存在负相关(r=-0.283,P<0.05)。结论重症肌无力存在认知功能损害,主要表现在记忆力、注意力、信息处理速度、视觉记忆,提示重症肌无力可能存在中枢神经系统受累。部分认知领域的损害可能与疾病严重程度相关。临床医生在工作中应加强对MG患者认知障碍的认识,早期评估,密切随访,适当干预。

Cognitive function characteristics in patients with myasthenia gravis

Objective To evaluate the cognitive function characteristics in patients with myasthenia gravis(MG).Methods The cognitive function of 83 MG patients and 39 healthy controls(HC)were evaluated by MMSE,California verbal learning test(CVLT),brief visuospatial memory test revised(BVMT-R),symbol digit modalities test(SDMT),benton judgment of line orientation test(BJLOT),paced auditory serial addition Test(PASAT)and verbal fluency test(VFT).The depression state was assessed by beck depression inventory(BDI).The results were compared between MG and HC groups.The effect of clinical characteristics such as disease type,comorbidities,course of disease,disease severity,and drug treatment on cognitive impairment in MG group was further analysed.Results The scale scores of MMSE(28(26,29),29(28,30)),CVLT,BVMT-R,SDMT((37.06±12.18),(47.54±14.91))and PASAT((32.86±10.23),(37.00±8.82))in MG were significantly lower than those in control group(P<0.05).There were no statistical difference regarding the scores of BJLOT,VFT and BDI in the two groups(P>0.05).Spearman correlation analysis showed that QMG scores were negatively correlated with SDMT scores(r=-0.234,P<0.05).MG-ADL scores were inversely correlated with total BVMT-R scores of three trials(r=-0.283,P<0.05).Conclusion Patients with MG suffered from cognitive impairment,mainly in memory,attention,processing speed and visual memory,which supported the hypothesis of CNS involvement in MG.Dysfunction in some cognitive domains may be related to the disease severity.Clinicians need take morce attention to early assessment,developing long-term follow-ups and appropriate intervention.