稳定期慢性阻塞性肺疾病患者的认知功能评价及其影响因素

Assessment of cognition and associated factors in patients with stable chronic obstructive pulmonary disease

目的 探讨并分析稳定期慢性阻塞性肺疾病（简称慢阻肺）患者的认知功能及其影响因素.方法 连续选择2012年12月至2013年12月天津市胸科医院门诊就诊的稳定期慢阻肺患者,采用蒙特利尔认知评估（MoCA）方法观察稳定期慢阻肺患者与健康对照人群的认知功能差异,并观察慢阻肺全球创议（GOLD）分级（GOLD Ⅰ级、GOLDⅡ级、GOLDⅢ级、GOLDⅣ级）、PaO2及PaCO2对认知功能的影响.结果 慢阻肺组MoCA评分为20.6±2.3,对照组MoCA评分为25.3±1.7,前者低于后者,差异有统计学意义（P＜0.01）.GOLD Ⅰ级组、GOLDⅡ级组、GOLDⅢ级组及GOLDⅣ级组MoCA评分比较差异有统计学（F=31.69,P＜0.05）,其中GOLD Ⅰ级组MoCA评分（22.4±0.8）高于GOLDⅡ级组（21.7±1.0）,但差异无统计学意义（P＞0.05）;GOLDⅡ级组MoCA评分高于GOLDⅢ级组（20.2±1.2）,差异有统计学意义（P＜0.05）;GOLDⅢ级组MoCA评分高于GOLDⅣ级组（19.1±1.2）,差异有统计学意义（P＜0.05）.PaO2≥60 mmHg（1 mmHg=0.133 kPa）组的MoCA评分（22.2±1.1）高于PaO2＜ 60 mmHg组（19.8±1.1）,差异有统计学意义（P＜0.05）;PaCO2 ≥50 mmHg组的MoCA评分（20.0±1.3）低于PaCO2＜ 50 mmHg组（22.3±1.0）,差异有统计学意义（P＜0.05）.回归分析结果显示,年龄（标准化回归系数为-0.146）、受教育程度（标准化回归系数为0.134）、GOLD分级（标准化回归系数为0.351）、PaO2（标准化回归系数为0.305）及PaCO2（标准化回归系数为-0.145）是影响慢阻肺患者认知功能的主要因素（均P＜0.01）.结论 稳定期慢阻肺患者的MoCA评分低于正常人群;GOLD分级越差,MoCA评分越低;伴有低氧血症的稳定期慢阻肺患者的MoCA评分低于非低氧血症患者;伴有高碳酸血症患者的MoCA评分低于非高碳酸血症患者;慢阻肺患者认知功能的主要影响因素是年龄、受教育程度、GOLD分级、PaO2及PaCO2.

Objective To explore and analyze the cognitive function in patients with stable chronic obstructive pulmonary disease （COPD）.Methods The cognition differences between patients with COPD and healthy subjects were analyzed by Montreal Cognitive Assessment （MoCA）.GOLD grade,PaO2,PaCO2,the education degree and the age were included as associated factors.The correlation between those factors with cognition were analyzed.Results The MoCA in patients with COPD was 20.6 ± 2.3,and that in healthy subjects was 25.3 ± 1.7 ; the difference between the 2 groups being significant （P ＜ 0.01）.The MoCA was 22.4 ± 0.8 in patients with GOLD grade Ⅰ disease,21.7 ± 1.0 in grade Ⅱ,20.2 ± 1.2 in grade Ⅲ,and 19.1 ± 1.20 in grade Ⅳ diseases; the difference among the 4 subgroups being significant （F=31.69,P＜0.05）.The MoCA in GOLD grade Ⅰ was higher than that in GOLD grade Ⅱ,but the difference did not reach significance （P ＞ 0.05）.The MoCA of GOLD grade Ⅱ was higher than that in GOLD grade Ⅲ （P ＜ 0.05）,and the MoCA of GOLD grade Ⅲ was higher than that GOLD grade Ⅳ （P ＜ 0.05）.The MoCA in non-hypoxemia subgroup and hypoxemia subgroup was 22.2 ± 1.1 and 19.8 ± 1.1,respectively（P ＜ 0.05）,while the MoCA in hypercapnia subgroup and non-hypercapnia subgroup was 20.0 ± 1.3 and 22.3 ± 1.0 respectively （P ＜ 0.05）.By regression analysis,the score of MoCA was correlated positively to education degree （Standard B1 =0.134,P ＜ 0.01）,GOLD grade （Standard B2 =0.351,P ＜ 0.01） and PaO2 （Standard B3 =0.305,P ＜ 0.01）,while the score of MoCA was correlated negatively to age（Standard B4 =-0.146,P ＜ 0.01） and PaCO2 （Standard B5 =-0.145,P ＜ 0.01）.Conclusions The MoCA score in patients with COPD was lower than that in healthy people.Lower MoCA score was found in patients with severe COPD.The MoCA scores in both hypoxemia subgroup and hypercapnia subgroup were lower.The cognitive dysfunction in patients with stable COPD was positively correlated with education degree,GOLD grade,and PaO2,but negatively with age and PaCO2.