正常眼压性青光眼患者认知功能损害及相关因素分析

Cognitive Impairment of Patients with Normal Tension Glaucoma and Its Relative Factors

目的探讨正常眼压性青光眼(NTG)患者认知功能损害发生情况及相关影响因素。方法选取2011年6月—2014年1月在北京大学第三医院眼科门诊就诊的NTG患者41例,记录其一般资料,并进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)、蒙特利尔认知评估量表(Mo CA)等检测。结果根据Mo CA量表检测结果,将患者分为伴认知功能损害组(27例)和不伴认知功能损害组(14例)。认知功能损害发生率为65.8%(27/41)。两组患者性别、吸烟、饮酒、文化程度、睡眠障碍史、失眠家族史、打鼾、高脂血症、糖尿病、冠心病、脑血管疾病、胃肠道疾病、焦虑、抑郁发生率比较,差异均无统计学意义(P>0.05);两组患者年龄、BMI、高血压、睡眠障碍发生率比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、BMI及PSQI是NTG伴认知功能损害的危险因素(P<0.05)。NTG伴认知功能损害患者Mo CA总分为(22.5±2.4)分,各项目评分较参考值下降程度比较,差异有统计学意义(F=17.99,P<0.05),其中记忆功能评分较参考值下降程度均高于其他项目评分较参考值下降程度(P<0.05)。将各项目评分较参考值下降程度与年龄、PSQI、BMI进行相关分析,结果显示,各项目评分较参考值下降程度与年龄均无直线相关关系(r=0.219、0.172、0.008、0.046、0.349、-0.137、0.118、0,P>0.05);记忆功能、视空间功能、执行功能、注意力、语言功能、时间定向力、地点定向力与PSQI均无直线相关性(r=0.141、0.171、-0.035、-0.027、-0.093、-0.275、0,P>0.05),计算力、注意力和短期记忆力与PSQI呈正相关(r=0.410,P=0.042);记忆功能、视空间功能、执行功能、注意力、语言功能、时间定向力、地点定向力与BMI均无直线相关性(r=0.042、-0.011、0.192、0.038、0.168、-0.141、0,P>0.05),计算力、注意力和短期记忆力与BMI呈正相关(r=0.432,P=0.031)。结论 NTG伴认知功能损害发生率较高,增龄、睡眠障碍和肥胖可增加NTG患者伴发认知功能损害的风险,并以记忆功能损害更为显著。

Objective To explore the cognitive impairment（ CI） of patients with normal tension glaucoma（ NTG）and its relative factors. Methods Forty-one NTG patients who visited the outpatient eye clinic of Peking University Third Hospital from June 2011 to January 2014 were enrolled in this study. Their general information and had tests of Hamilton Anxiety Scales（ HAMA）,Hamilton Depression Scales（ HAMD）,Pittsburgh Sleep Quality Index（ PSQI）,Montreal Cognitive Assessment（ Mo CA） were recorded. Results The patients were divided,according to Mo CA testing,into groups with-CI（ n =27）,without-CI（ n = 14）. The incidence of CI was 65. 8%（ 27 /41）. There was no significant difference in gender,smoking,drinking,educational level,history of sleep disorders,insomnia family history,incidences of snoring, hyperlipidemia,diabetes,coronary heart disease,cerebrovascular diseases,gastrointestinal disease,anxiety,depression between the 2 groups（ P〈0. 05）,there was difference in age,BMI,incidences of hypertension,sleep disorders（ P〈0. 05）. Logistic regression analysis showed that age,BMI,PSQI were the risk factors of NTG combined with CI（ P〈0. 05）. Mo CA total score was（ 22. 5± 2. 4） in NTG patients with CI,there was difference in normal value declining between each item score（ F = 17. 99,P〈0. 05）,the normal value declining in memory function was higher than other item score（ P〈0. 05）. By correlation analysis,normal value declining of each item score was not correlated linearly with age（ r = 0. 219,0. 172,0. 008,0. 046,0. 349,-0. 137,0. 118,0,P〉0. 05）, memory function, visual-spatial function and executive function, attention, linguistic function,time orientation, place orientation not correlated linearly with PSQI（ r = 0. 141,0. 171,-0. 035,-0. 027,-0. 093,-0. 275,0,P〉0. 05）,calculation power,attention,short-term memory correlated positively with PSQI（ r =0. 410,P = 0. 042）,memory function,visual-spatial function and executive function,attention,linguistic function,time orientation,place orientation not correlated linearly with BMI（ r = 0. 042,-0. 011,0. 192,0. 038,0. 168,-0. 141,0,P〉0. 05）,calculation power,attention,short-term memory correlated positively with BMI（ r = 0. 432,P = 0. 031）. Conclusion The incidence of NTG complicated by CI is high,aging,sleep disorders,obesity can increase the risks of CI,especially those of memory function impairment.