慢性阻塞性肺疾病认知功能障碍的初步分析

Analysis of cognitive function in patients with chronic obstructive pulmonary disease

目的探讨稳定期慢性阻塞性肺疾病(COPD)患者认知功能障碍的发生率及其相关影响因素。方法采集35例COPD稳定期患者(COPD组)及35例健康志愿者(对照组)的临床资料,通过Mo CA量表对两组研究对象进行认知功能评估,研究COPD稳定期患者认知功能障碍的发生率;采用Pearson偏相关分析、χ~2检验,按肺功能、呼吸困难分级标准对患者进行亚组分析,明确患者肺功能、血气分析相关临床指标与COPD患者认知障碍的相关性。采用Logistic多因素回归分析对COPD患者认知障碍相关影响因素进行分析。结果 COPD患者组评分较对照组评分显著降低,P<0.05,其认知障碍发病率为60.0%,高于对照组28.6%(P<0.05);按肺功能分级,轻中度组(FEV1≥50%)和重度组(FEV1<50%)COPD患者的认知障碍发生率无明显差异(P>0.05);按呼吸困难程度(m MRC)评分分级的COPD患者认知障碍发生率有统计学意义(P<0.05)。COPD患者Mo CA量表评分与PaO_2值之间呈正相关(r=0.386,P=0.047),Mo CA量表评分与PaCO_2值之间呈负相关(r=-0.398,P=0.040)。单因素分析显示,稳定期COPD患者的文化程度、CAT评分、PaO_2、PaCO_2与COPD患者认知功能障碍的发生具有相关性(P<0.05)。Logistic回归多因素分析显示,受教育程度、吸烟指数是COPD稳定期患者发生认知障碍的独立危险因素(P<0.05)。结论 COPD患者发生认知障碍的风险明显增高,其病情严重程度与认知功能下降程度有明显相关性,受教育程度、吸烟指数是COPD患者发生认知功能障碍的独立危险因素。

Objective To investigate the incidence of cognitive impairment in patients with stable chronic obstructive pulmonary disease （COPD） and related influencing factors. Methods Clinical data of 35 COPD stable patients （COPD group） and 35 healthy volunteers （control group） were collected. The cognitive impairment was assessed by the Montreal cognitive assessment （MoCA） scale in both groups to study the cognitive impairment in COPD patients at stable stage. Incidence rate; using Pearson correlation, Chi-square analysis, according to lung function, dyspnea grading criteria for patients in a subgroup analysis, clear the patient＇s lung function, blood gas analysis and cognitive impairment in COPD patients. Logistic multivariate regression analysis was used to analyze the influencing factors of cognitive impairment in patients with COPD. Results The score of patients in COPD group was significantly lower than control group （ P 〈0.05）, and the incidence of cognitive impairment （60.0%） was higher in the COPD patients group than in the control group （28.6%） （ P 〈0.05）. According to the classification of lung function, there was no significant difference in the incidence of cognitive impairment among patients with mild to moderate （FEV 1≥50%） and recurrent （FEV 1〈50%） COPD （ P 〉0.05）. There was a significant difference in the incidence of known disorders （ P 〈0.05）. There was a positive correlation between the MoCA scale score and the PaO 2 value in COPD patients （ r = 0.386 , P =0.047）. There was a negative correlation between the MoCA scale score and the PaCO 2 value（ r = -0.398 , P =0.040）. Single factor analysis showed that education blood oxygen partial pressure （PaO 2）, CO 2 partial pressure （PaCO 2） and CAT were associated with cognitive ysfunction in patients with COPD（ P 〈0.05）. Logistic regression multivariate analysis showed that education level and smoking index were correlated with cognitive impairment in patients with stable COPD （ P 〈0.05）. Conclusion The risk of cognitive impairment in patients with COPD is significantly higher. The severity of COPD patients is related to the degree of decline in cognitive function. Education level and smoking index are independent risk factors for cognitive impairment in patients with COPD.