血管性认知损害的中医证候与认知功能的关系

Correlation between cognitive functions and syndromes of traditional Chinese medicine in vascular cognitive impairment

目的：探讨血管性认知损害（vascular cognitive i mpairment,VCI）患者的认知功能与中医证候的相关性,为VCI的中医辨证治疗提供依据。方法：2006年12月~2010年3月从北京东直门医院老年病科和社区居民中招募774名患者,筛选出认知正常组251例,VCI组107例。采用海金斯基缺血量表（Hachinski ischemic scale,HIS）、汉密尔顿抑郁评定量表（Hamilton depression scale,HAMD）、简易精神状态检查（mini-mental state examination,MMSE）中文版、临床痴呆评定量表（clinical dementia ratingscale,CDR）、画钟试验（clock drawing test,CDT）及日常生活能力量表（ability of dailyliving,ADL）评价患者认知功能、日常生活能力和痴呆的严重程度等,采用偏相关分析法分析VCI患者认知功能与中医证候的相关性。结果：VCI组中医证候与量表成绩的相关性分析显示,MMSE总分、CDT得分均与痰浊蒙窍证呈负相关（r=-0.525,r=-0.321;P=0.000,P=0.001）,ADL与痰浊蒙窍证呈正相关（r=0.424,P=0.000）,与肾精亏虚证呈正相关（r=0.216,P=0.028）。VCI组的认知功能与中医证候的偏相关分析显示,MMSE中总定向力以及时间和空间定向力得分均与痰浊蒙窍证呈负相关（r=-0.451,r=-0.448,r=-0.392;P=0.001,P=0.000,P=0.004）,单词即刻记忆和单词延迟回忆得分与痰浊蒙窍证呈负相关（r=-0.355,r=-0.225;P=0.000,P=0.021）,计算力/注意力、语言功能及执行功能得分均与痰浊蒙窍证呈负相关（r=-0.379,r=-0.448,r=-0.321;P=0.000,P=0.000,P=0.013）。痰浊蒙窍证患者的MMSE中总定向力、时间定向力、空间定向力、注意力/计算力均显著低于无痰浊蒙窍证患者（P〈0.01）,痰浊蒙窍证患者语言功能及单词延迟回忆得分均显著低于无痰浊蒙窍证患者（P〈0.05）。结论：VCI的主要中医证候为肾精亏虚、痰浊蒙窍和瘀阻脑络,其中痰浊与患者定向力、记忆力、注意力/计算力、语言功能关系密切,故化痰开窍法可用于防治血管性认知损害。

Objective：To investigate the correlation between cognitive function and the Chinese medicine syndrome characteristics of vascular cognitive impairment（VCI）.Methods：A total of 774 subjects（age from 41 to 87 years old）from Beijing of China accepted neuropsychological assessments and differentiation of Chinese medicine syndromes.The mini-mental state examination（MMSE）and clinic dementia rating（CDR）were used to access the global cognitive function;the Hachinski ischemia scale（HIS）and the Hamilton depression scale（HAMD）were used for differential diagnosis;the ability of daily living（ADL）scale was used to assess the ability of daily living;the clock drawing test was used to access the executive function;the investigation of syndrome manifestations and the syndrome differentiation scale of vascular dementia（SDSVD）were used for diagnosis of syndrome manifestations.According to the diagnostic criteria of vascular cognitive impairment,subjects were subgrouped as normal cognition（NC）group and VCI group,and then the correlation between the cognitive functions and Chinese medicine syndromes was analyzed.Results：The correlation between cognitive scales and Chinese medical syndrome：in the VCI group,the syndrome of phlegm turbid blocking upper orifices showed negative correlation with the scores of MMSE and CDT（r=-0.525,r=-0.321,P=0.000,P=0.001）,and the ADL demonstrated positive correlation to the syndrome（r=0.424,P=0.000）.The correlation between cognitive function and Chinese medical syndrome：the phlegm turbid blocking upper orifices was closely correlated with the total orientation,time orientation and place orientation（r=-0.451,r=-0.448,r=-0.392,P=0.001,P=0.000,P=0.004）;instant word recall and delayed word recall were closely correlated with the syndrome of phlegm turbid blocking upper orifices（r=-0.355,r=-0.225,P=0.000,P=0.021）;calculation/attention,language function and executive function had negative correlation to the syndrome of phlegm turbid blocking upper orifices（r=-0.379,r=-0.448,r=-0.321,P=0.000,P=0.000,P=0.013）.The scores of orientation,calculation/attention,delayed word recall and language function in the patients with phlegm turbid blocking upper orifices were significantly lower than the patients with non-phlegm turbid blocking upper orifices（P0.05）.Conclusion：The syndrome of phlegm turbid blocking upper orifices is significantly correlated to the scores of MMSE and ADL,indicating that the phlegm turbid blocking upper orifices is related to the cognitive function and ability of daily living in the VCI patients.Treatment of the phlegm is important in the cognitive impairment in VCI patients.