慢性阻塞性肺疾病病患的认知功能探讨

目的评估慢性阻塞性肺疾病(慢阻肺)病患的认知功能状态,以及与临床资料的相关性。方法从2014年10月-2018年12月,160例符合标准的受试者入组;认知评估使用蒙特利尔(MoCA)量表,获取临床资料并完成相关性分析。结果约46%的慢阻肺病患存在认知功能障碍。四组受试者的MOCA总分为:健康对照组26.47±1.31、慢阻肺病患轻度组24.77±2.61、中度组22.39±3.64、重度组21.92±2.65;相比对照组,慢阻肺受试者的认知得分降低(p<0.05),表现在注意、定向、抽象思维、延迟记忆、视空间与执行功能。组间比较亦有统计学差异;同时慢阻肺受试者的MoCA总分和肺功能中FEV 1有正相关(r=0.377,P<0.001),与血气分析中PaO 2有正相关性(r=0.295,P<0.05),与PaCO 2无相关性(r=0.059,P>0.05)。结论慢阻肺病患存在特定的认知障碍。低氧血症、肺功能中的FEV 1降低可能是造成慢阻肺认知障碍的病理生理学机制。

Investigation on cognitive function in patients with chronic obstructive pulmonary disease

Objective To assess the cognitive function and the possible correlation with clinical characteristics in patients with chronic obstructive pulmonary disease(COPD).Methods From October 2014 to December 2018,120 eligible COPD patients were divided into the mild group(GOLD1 level1),the medium group(GOLD2 level2),and the severe group(GOLD3 level3).At the same time.40 healthy subjects were taken as the control group.The cognitive assessment was measured by Montreal Cognitive Assessment(MoCA)scale.All subjects completed the pulmonary function test and arterial blood gas analysis test.Pearson s correlation analysis was used to analysis the correlation between the clinical characteristics and the cognitive function.Results There was 55 COPD patients(46%)with cognitive impairment.The total MOCA scores of the four groups were 26.47±1.31 for the healthy control group,24.77±2.61 for the mild COPD group,22.39±3.64 for the moderate COPD group,and 21.92±2.65 for the severe COPD group.Compared with the control group,the cognitive scores of the COPD patients were significantly decreased(P<0.05),including attention,orientation,abstract thinking,delayed memory,visuospatial and executive function.In the inter-group comparison,there were also statistical differences among the four groups.Meanwhile,the total MoCA score of COPD subjects was positively correlated with FEV 1 in lung function(r=0.373,P<0.001),positively correlated with PaO 2 in blood gas analysis(r=0.295,P<0.05),and was not correlated with PaCO 2(r=0.059,P>0.05).Conclusion Cognitive dysfunction exists in COPD patients,which is related with the severity of the disease.Hypoxemia and impaired pulmonary function(FEV 1)may be the pathophysiology mechanism that causes cognitive impairment in COPD patients.