巨幼细胞性贫血老年患者的认知功能损害特征

Characteristics of cognitive impairment in elderly patients with megaloblastic anemia

目的:分析不同贫血程度和营养成分(叶酸/维生素B12)缺乏及病程时间对巨幼细胞性贫血老年患者认知功能损害的影响,并以中国韦氏成人智力量表为标准,比较与国内相应年龄组正常常模数据的差异。方法:①选择1999-03/2004-03在中国医科大学第一临床医院血液内科住院的巨幼细胞性贫血老年患者156例;年龄均在60周岁以上,且自愿参加。②按贫血程度将患者分为设为重度贫血组62例(血红蛋白<60g/L)和轻度贫血组94例(血红蛋白≥60g/L)。按缺乏的营养成分将患者分为叶酸缺乏组61例和维生素B12缺乏组133例(其中维生素B12和叶酸同时缺乏38例)。按病程分为病程长组65例(病程≥2年),病程短组91例(病程<2年)。③评估巨幼细胞性贫血老年患者认知功能采用中国韦氏成人智力量表犤分语言量表测验(包括6个分量表,为知识、领悟、算术、相似性、数字广度、词汇,有的项目通过时记1分,未通过时记0分;另一些项目按回答质量记0,1或2分),操作量度测验(包括5个分量表,为数字符号、图画填充、木块图案、图片排列、图形拼凑,每种操作结果都按质记分)。有时间限制的项目,超过规定时间即使通过也记0分;提前完成的按提前时间的长短记奖励分。一个分测验中的各项目的得分相加,称该分测验的粗分(或称原分)。粗分按手册上相应用表换算成量表分犦。将测得认知水平与正常人常模比较,同时比较不同贫血程度和叶酸/维生素B12缺乏及病程巨幼细胞性贫血老年患者认知功能。④组间计量资料差异测定采用t检验。结果:巨幼细胞性贫血老年患者156例均进入结果分析。①巨幼细胞性贫血老年患者中国韦氏成人智力量表测验结果与国内常模数据比较结果:巨幼细胞性贫血老年患者知识、算术、相似性、词汇、图形排列分量表评分均明显低于国内常模(t=2.237～3.196,P<0.05～0.01)。②不同贫血程度巨幼细胞性贫血老年患者中国韦氏成人智力量表测验结果:重度贫血组知识、算术、数字广度、词汇、图形排列分量表评分均明显低于轻度贫血组(t=2.132～2.356,P<0.05)。③缺乏叶酸/维生素B12巨幼细胞性贫血老年患者中国韦氏成人智力量表测验结果:叶酸缺乏组知识、算术、相似性、数字广度、数字符号、木块图、图形排列分量表评分均高于维生素B12缺乏组(t=2.135～2.413,P<0.05);词汇分量表评分低于维生素B12缺乏组(t=3.178,P<0.01)。④不同病程巨幼细胞性贫血老年患者中国韦氏成人智力量表测验结果:病程长组知识、领悟、算术、词汇、数字符号、填图、木块图、图形排列分量表评分明显高于病程短组(t=2.138～3.246,P<0.05～0.01)。结论:老年巨幼细胞性贫血的认知功能特征为不仅有记忆力和注意力的减退,非语言能力和动手操作部分也受到一些影响。贫血程度的越重,病程越长,认知功能损害越重。维生素B12缺乏的老年巨幼细胞性贫血患者比单纯叶酸缺乏性有更加严重的认识功能障碍。

AIM： To analyze the influence of different severity of anemia, deficiency of nutritional component （folic acid/vitamin B12） and duration of disease course on the cognitive impairment in elderly patients with megaloblastic anemia, and compare the difference with the data of national norms of the correspondent age taken Wechsler Adult Intelligence Scale-Chinese Version as the standard. METHODS： ①Totally 156 elderly inpatients （87 males and 69 females） with megaloblastic anemia in the Department of Hematolgy, the First Clinical Hospital of China Medical University from March 1999 to March 2004 took part in the study voluntarily. Their average age was above 60 years old. ②According to the severity of anemia, the patients were divided into severe anemia group （n=62, hemoglobin 〈 60 g/L） and mild anemia group （n =94, hemoglobin ≥ 60 g/L）. According to the deficient nutritional component, the patients were divided into folic acid deficiency group （n=61） and vitamin Bt2 deficiency group （n=133）, and 38 cases had deficiencies of both folio acid and vitamin B12. According to their disease course, the patients were divided into long course group （n=65, disease course≥ 2 years） and short course group （n=91, disease course 〈 2 years）. ③ The cognitive function of the elderly patients with megaloblastic anemia was assessed with Wechsler Adult Intelligence Scale-Chinese Revision, consisted of language scale （including 6 subscales of knowledge, comprehension, arithmetics, similarity, digital span and vocabulary, some of the items were marked as 1 point in passed and 0 point if failed, and others were marked as 0, 1 or 2 points according to the quality of the answer） and operation scale （including 5 subscales of digital symbol, picture completion, block pattern, picture arrangement and figure put- together, the result of each operation was scored according to the quality）. For the items with time limitation, 0 point was given if it was completed out of the time limitation although it passed, reward scores were given if it was completed before the time limitation according to the length ahead of time. The add-up of the scores of the items in a subtest was taken as its crude score （or original score）, and then the crude scores were transformed into scores of scale according to the corresponding table in manual. The measured cognitive levels were compared with those of national norms, and those were also compared among the elderly patients with megaloblastic anemia having different severity of anemia, deficiency of folio acid, vitamin Bn and disease course. ④ The intergroup difference of the measured data was analyzed with the t test. RESULTS： All the 156 elderly patients with megaloblastic anemia were involved in the analysis of results. ①Comparison of the scores of Wechsler Adult Intelligence Scale-Chinese Revision between the elderly patients with megaloblastic anemia and national norms： The scores of the subscales of knowledge, arithmetics, similarity, vocabulary and picture arrangement were obviously lower in the elderly patients with megaloblastic anemia than in national norms （t=2.237 to 3.196, P 〈 0.05 to 0.01）. ② Comparison of the scores of Wechsler Adult Intelligence Scale-Chinese Revision between the elderly patients with megaloblastic anemia of different severity of anemia： The scores of the knowledge arithmetics, digital span, vocabulary and picture arrangement were obviously lower in the severe anemia group than in the mild anemia group （t=2.132 to 2.356, P 〈 0.05）. ③Comparisen of the scores of Wechsler Adult Intelligence Scale-Chinese Revision between the elderly patients with megaloblastic anemia having deficiency of folic acid and vitamin Bu： The scores of subscales of knowledge, arithmetics, similarity, digital span, digital symbol, block pattern and picture arrangement were all higher in the folic acid deficiency group than in the vitamin B12 deficiency group （t=2.135 to 2.413, P 〈 0.05）, and the score of vocabulary subscale was lower in the folic acid deficiency group than in the vitamin Bu deficiency group （t=3.178, P 〈 0.01）. ④Comparison of the scores of Wechsler Adult Intelligence Scale-Chinese Revision between the elderly patients with megaloblastic anemia having different disease courses： The scores of knowledge, comprehension, arithmetics, vocabulary, digital symbol, picture completion, block pattern and picture arrangement were obviously higher in the long course group than in the short course group （t=2.138 to 3.246, P 〈 0.05 to 0.01）. CONCLUSION： The elderly patients with megaloblastic anemia have the cognitive characteristics of the declines of memory and attention, their non- language ability and operation are also affected. The severer the anemia and the longer the disease course, the severer the cognitive impairment. The cognitive impairments are much severer in the patients with megaloblastic anemia having folic acid deficiency than in those having vitamin B12 deficiency.