营养不良对稳定期慢性阻塞性肺疾病患者认知功能的影响

Effect of malnutrition on cognitive function of patients with chronic obstructive pulmonary disease in stable period

目的观察营养不良对稳定期慢性阻塞性肺疾病(COPD)患者认知功能的影响。方法以微型营养评定表(MNA)>17分和≤17分为依据,将120例稳定期慢性阻塞性肺疾病患者分为对照组和营养不良组,根据简易精神状态法(MMSE)测定患者认知功能障碍,并测定患者血氧饱和度、肺功能以及血清神经元特异性烯醇化酶(NSE)和S-100β蛋白水平。结果与对照组比较,营养不良组病程较长,第1秒用力呼气容积(FEV_1)实测值/预计值(FEV_1实预比)和血氧饱和度显著下降,2组性别、年龄及受教育程度差异无统计学意义(P>0.05)。2组MMSE总分、定向力、记忆力、注意力和计算力、回忆能力以及语言比较,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,MMSE评分主要与年龄、受教育程度、FEV_1实预比、血氧饱和度以及MNA评分相关。血清S-100β、NSE水平与MMSE评分呈显著负相关(r=-0.365、-0.441,P<0.05)。结论营养不良可加重稳定期COPD患者的认知功能损害,血清S-100β与NSE水平可能成为评估营养不良COPD患者合并认知功能障碍的预测指标。

Objective To observe the effect of malnutrition on cognitive function of patients with chronic obstructive pulmonary disease(COPD)in stable period.Methods According to score of Mini Nutritional Assessment(MNA)>17 points and≤17 points,120 patients with stable COPD were divided into control group and malnutrition group.The mini-mental stat examination(MMSE)was used to detect the cognitive function of patients,and oxygen saturation,pulmonary function,serum NSE and S-100βwere detected as well.Results Compared with the control group,the disease course of the malnutrition group was longer,and measured value to expected value of the first second forced expiratory volume(FEV 1)and blood oxygen saturation were significantly lower,but there were no significant differences in the age and education level between the two groups(P>0.05).There were significant differences in total score,directive force,delayed memory,attention and calculating ability,recollection ability,language between two groups(P<0.05).Multiple Logistic regression analysis showed that the MMSE score was mainly related to age,education,measured value to expected value of FEV 1,blood oxygen saturation,and MNA score.Both NSE and S-100βprotein were negatively correlated with MMSE score(r=-0.365、-0.441,P<0.05).Conclusion Malnutrition can aggravate the cognitive impairment of COPD patients in stable stage.Serum S-100βand NSE levels may be used as predictors for cognitive impairment in COPD patients with malnutrition.