重症肌无力患者的认知功能

Cognitive function of patients with myasthenia gravis

目的:重症肌无力是周围神经肌肉疾病。有研究表明重症肌无力还累及中枢神经系统,存在认知功能、情感、睡眠、精神等方面的障碍;亦有持不同观点者。重症肌无力是否存在中枢受累仍有争议。资料来源:应用计算机检索Medline1985-01/2004-12期间的关于重症肌无力中枢神经系统受累、神经心理及认知功能的文章,检索词包括“myastheniagravis、Neuropsychologicaltest、Memory、central、Brain、Cogni-tivedysfunction”等,限定语言种类为英文。同时检索中国期刊全文数据库1995-10/2005-12期间的关于重症肌无力的神经心理及认知功能的文章,检索词包括“重症肌无力,神经心理,认知功能”,限定语言种类为中文。资料选择:对资料进行初审,选择与重症肌无力中枢神经系统受累、神经心理及认知功能、中枢胆碱能相关的文章,然后筛除与以上要求无明显联系的文章。纳入标准:详细阐述重症肌无力的神经心理及认知功能的文献。排除重复性研究。资料提炼:共收集到相关的89篇外文文献和34篇中文文献,涉及重症肌无力中枢神经系统受累39篇,中枢胆碱能及胆碱能受体27篇,与本文密切相关的神经心理及认知功能的文献57篇,符合纳入标准57篇,排除66篇。选择其中15篇进行综述。资料综合:重症肌无力是周围神经肌肉接头处乙酰胆碱传递阻滞导致肌肉病态疲劳的一种自身免疫疾病,国内外对重症肌无力的认知功能的研究,采用了简易智能精神状态量表、韦氏记忆量表、韦氏成人智力量表、波士顿命名测验及Rey听觉词语学习测验等,检测重症肌无力患者的记忆、注意力、反应流畅性、信息处理速度等。结论:重症肌无力患者存在记忆、智力、注意力、反应流畅性、信息处理速度等认知功能损害,但有一些研究未能证实有意义的明确的重症肌无力认知功能损害。重症肌无力是否存在认知功能受损还有争议,期待以后的更完善的研究进一步探讨。

OBJECTIVE： Myasthenia gravis （MyG） is considered as a peripheral neuromuscular disorder. Research shows that MyG affected the central nervous system （CNS）, and there are disorders in cognitive functions, passion, sleep and mental status of patients with MyG. However, there are also some anti-standpoints. Whether MyG exists in the CNS is still in debating. DATA SOURCES： A computer-based search was conducted in Medline for English articles about MyG in CNS, neuropsychology and cognitive function published between January 1985 and December 2004 with the key words of ＂myasthenia gravis, neuropsychological test, memory, central, brain, cognitive dysfunction＂ Meanwhile, relevant Chinese articles were searched in CNKI with the key words of ＂myasthenia gravis, neuropsychology, cognitive dysfunction＂. STUDY SELECTION： Data were checked in the first trial, and articles about the influence of MyG in CNS, neuropsychology, cognitive function and central cholinergic were selected, while obvious unrelated literatures were excluded. Inclusion criteria： literatures explaining the neuropsychology and cognitive function of MyG. Repetitive studies were excluded. DATA EXTRACTION： A total of 89 related English aiticles and 34 Chinese articles were collected, including 39 studies about the influence of MyG on CNS, 27 researches on central cholinergic and cholinergic receptor. 57 articles about the neuropsychology and cognitive function were in close relation with this articles, and 57 literatures were in accordance with the inclusion criteria. Sixty-six articles were excluded, 15 out which were reviewed. DATA SYNTHESIS： MyG is a kind of autoimmune disease of muscular ill fatigue induced by occlusive transmit of acetylcholine at the peripheral myoneural junction. The mini-mental state examination （MMSE）, Wechsler memory scale, Wechsler adult intelligence scale （WAIS）, BNT as well as Rey auditory verb and learning test etc. were adopted in researches on MyG at home and abroad to detect the memory, attention, fluency of reaction as well as information-processing velocity etc. CONCLUSION： There are lesions in memory, intelligence, attention, reaction fluency as well as information procession speed in patients with MyG. However, there are some anti-standpoints on lesion in cognitive function caused by MyG, and more work must be done for further exploration.