轻度认知障碍中医证候与认知损害特点的相关性

Study on the Correlation between Chinese Medicine Syndrome and Cognitive Impairment Characteristics of Mild Cognitive Impairment

目的探讨轻度认知障碍(MC1)患者中医证候与认知损害特点的关系。方法将120例MCI患者根据认知损害的领域不同分为遗忘型轻度认知功能损害(a MCI)及非遗忘型轻度认知功能损害(na MCI)两个亚型,按照老年期痴呆中医证候分型标准对患者进行辨证分型,并统计各中医证型患者在不同亚型的分布情况;采用蒙特利尔认知评估量表(Mo CA)对不同中医证型患者各认知域包括视空间执行、命名、注意、语言表达、抽象、延迟回忆、定向力进行评分,并对中医证型与认知域损害进行相关性分析。结果 120例MCI患者中a MCI型76例,na MCI型44例;肾虚髓减证38例,痰浊阻窍证36例,心脾两虚证18例,气滞血瘀证18例,心肝阴虚证10例。a MCI型中痰浊阻窍证最多(26例,34.2%),na MCI型中肾虚髓减证最多(18例,40.9%)。Mo CA总分由低到高依次为肾虚髓减证、痰浊阻窍证、气滞血瘀证、心脾两虚证、心肝阴虚证,肾虚髓减证分别与心肝阴虚证、心脾两虚证、气滞血瘀证比较差异均有统计学意义(P<0.05)。相关分析显示,肾虚髓减证与视空间执行、定向力受损存在相关性(P<0.05),痰浊阻窍证与语言表达、延迟回忆受损存在相关性(P<0.05),心肝阴虚证、心脾两虚证、气滞血瘀证与各认知域受损均无显著相关性(P>0.05)。结论肾虚髓减证、痰浊阻窍证是MCI最常见证型,且肾虚髓减证患者视空间执行、定向力受损明显,痰浊阻窍证患者语言表达、延迟回忆受损明显。

Objective To explore the relationship between Chinese medicine syndrome and cognitive impairment characteristics in patients with mild cognitive impairment（ MCI）. Methods One hundred and twenty MCI patients were divided into amnestic MCI（ a MCI） and non amnestic MCI（ na MCI） according to different area of cognitive impairment. Patients were taken syndrome differentiation following the Chinese medicine syndrome typing standard of senile dementia. Distribution situation of patients with different Chinese medicine syndromes in different subtypes was calculated. The cognitive domains（ including visuospatial execution, naming, attention, language expression,abstract,delayed recall and orientation） of patients with different Chinese medicine syndromes were scored with Montreal Cognitive Assessment（ Mo CA）. Correlation analysis was made on Chinese medicine syndromes and cognitive domains damage. Results Among 120 MCI patients,76 cases were of a MCI type,and 44 cases of na MCI type.Thirty- eight cases were with kidney deficiency and marrow reduction syndrome,36 cases with phlegm obstructing orifices syndrome,18 cases with deficiency of heart and spleen syndrome,18 cases with Qi stagnation and blood stasis syndrome,and 10 cases with Yin deficiency of heart and liver syndrome. The most common Chinese medicine syndrome was phlegm obstructing orifices syndrome in a MCI type（ 26 cases,34. 2%）,and kidney deficiency and marrow reduction syndrome in na MCI type（ 18 cases,40. 9%）. Rank of the total Mo CA scores of each syndrome from low to high were as follows,kidney deficiency and marrow reduction syndrome,phlegm obstructing orifices syndrome,Qi stagnation and blood stasis syndrome,deficiency of heart and spleen syndrome,and Yin deficiency of heart and liver syndrome.（ P 〈 0. 05） There were significant differences between kidney deficiency and marrow reduction syndrome and Yin deficiency of heart and liver syndrome（ or deficiency of heart and spleen syndrome,or Qi stagnation and blood stasis syndrome）（ P 〈 0. 05）. Correlation analysis showed that kidney deficiency and marrow reduction syndrome had correlation with damage of visuospatial executive function and orientation（ P 〈 0. 05）. Phlegm obstructing orifices syndrome had correlation with damage of language expression and delayed recall（ P 〈 0. 05）. There were no significant correlation between Yin deficiency of heart and liver syndrome,deficiency of heart and spleen syndrome,as well as Qi stagnation and blood stasis syndrome and all cognitive domains damage（ P 〉 0. 05）. Conclusion Kidney deficiency and marrow reduction syndrome and phlegm obstructing orifices syndrome were the most common syndromes in MCI. Patients with kidney deficiency and marrow reduction syndrome might have obvious damage in visuospatial executive and orientation function. Patients with phlegm obstructing orifices syndrome might have obvious damage in language expression and delayed recall.