轻度认知障碍老年人中医证型与记忆损伤及CT变化的相关性

Correlation of syndromes of traditional Chinese medicine with memory impairment and CT changes in aged people with mild cognitive impairment

目的:了解轻度认知障碍老年人的症状特点,探讨轻度认知障碍的中医证型与记忆损伤及CT变化的关系。方法:①于2001-12/2002-12从北京市10个国家机关的家属宿舍区近600名50～80岁的老年人中筛查出轻度认知障碍患者44例为患者组,男15例,女29例。选择同期上述家属宿舍区,记忆、认知检查等均正常的健康者20人为健康对照组,男11人,女9人。均自愿配合检查和量表评估。②根据《中药新药临床研究指导原则》中提出的老年期痴呆中医诊断标准中医辨证,确定虚证、虚实夹杂证的证型。③中医症状积分方法:重度(6分)为症状由患者主动说出或显著、持续;中度(4分)为症状时轻时重;轻度(2分)为症状轻微或偶尔出现。④应用中国医学科学院心理研究所许淑莲主编的临床记忆量表(指向记忆、联想学习、图像自由回忆、无意义图形再认、人像特点联想回忆五大内容)。检查的原始分换算成等值量表分及记忆商。⑤用CT检测海马回钩间距、大脑横径及颞角宽度,计算海马指数(海马回钩间距/大脑横径)。⑥数据间差异比较采用SNK检验。结果:轻度认知障碍患者44例和健康者20人均进入结果分析,其中进行CT检查的健康者10人。①虚实夹杂证者中医辨证积分明显高于虚证者犤(29.76±10.34),(23.11±7.13)分,P<0.05犦。②患者组临床记忆等值量表评分结果及记忆商均明显低于健康对照组(P<0.01)。虚实夹杂证轻度认知障碍患者记忆商、人像特点联系回忆的分值明显低于虚证患者(P<0.01)。③脑CT的结果显示,患者组海马指数和颞角宽度明显高于健康对照组(P<0.05～0.01)。虚证与虚实夹杂证轻度认知障碍患者海马指数和颞角宽度差异不明显(P>0.05)。结论:轻度认知障碍的虚证、虚实夹杂证患者存在不同程度记忆损伤,轻度认知障碍的中医证型与CT变化关系不大。

AIM： To comprehend the symptoms characteristics of aged people with mild cognitive impairment （MCI） and probe into correlation among syndromes of traditional Chinese medicine （TCM）, memory impairment and CT changes of patients with MCI. METHODS： （1）Forty-four patients with MCI, including 15 males and 29 females, who were selected from 600 people aged 50-80 living in the family dorms of 10 national institutions in Beijing from December 2001 to December 2002 were selected as patient group, and 20 healthy people of the same time living in the family dorms, who were healthy in the examination of memory and cognitive, were selected as normal control group, including 11 males and 9 females. All subjects took part in the examination and scale evaluation voluntarily. （2）According to the principle of clinical research for new traditional herbs, there were 3 patterns of syndrome, such as differentiation of TCM, definition of asthenia syndrome and inclusion of asthenia and sthenia in senileaphrenia diagnostic criteria. （3） TCM symptom integrating method： Severe （6 points） as patients told symptoms initiatively, which were lasting and prominent; Moderate （2 points） as light symptoms, which seldomly existed.（4）Using the clinical memory scale edited mainly by Xu Shu-lian from the Psychological Institute, Chinese Academy of Medical Sciences （including five parts, namely directed memory, associational study, pictures freely memory, meaningless figures recollection, associational memory of portraits＇ characteristic）. The primitive score of examination were converted to equivalent scale score and memory quotient. （5）CT examination was used to measure the width of hippocampus, the diameter of cerebra and the width of temporal horn. The index of hippooampus was caculated （the width of hippocampus and the diameter of cerebra）. （6） Differences among data were compared with SNK test. RESULTS： Forty-four patients with MCI and 20 healthy people were involved in the analysis of resuhs,10 of which received CT text. （1）Score of TCM differentiation in patients with inclusion of asthenia and sthenia was significantly higher than that in patients with asthenia syndrome [（29.76±10.34）,（23.11±7.13） points,P〈0.05].（2）Score of clinical memory equivalent scale and memory quotient in the patient group were significantly lower than those in the normal control group （P 〈 0.01）. Memory quotient and. score of associational memory of portaits＇ characteristic in patients with inclusion of asthenia and sthenia of MCI were obviously lower than those in patients with asthenia syndrome （P 〈 0.01）. （3）Result of cerebral CT： Hippoeampus index and width of temporal horn in the patient group were obviously higher than those in the normal group （P〈0.05-0.01）. Differences of hippoeampus index and width of temporal horn among patients with aathenia syndrome and inclusion of asthenia and sthenia of MCI were not significant （P〈0.05）. CONCLUSION： Patients with asthenia syndrome and inclusion of asthenia and sthenia of MCI have memory impairments to different extent, but there are no significant relationship between TCM syndrome types of MCI and patients＇ CT changes.