多系统萎缩患者认知功能障碍及影响因素分析

Clinical analysis of cognitive dysfunction and its influencing factors in patients with multisystem atrophy

目的研究多系统萎缩(MSA)患者认知功能障碍及相关因素。方法纳入2015年1月至2020年1月我院收治的143例住院的MSA患者,采用简明精神状况量表(MMSE)和蒙特利尔认知量表(MoCA)评价认知功能,并分析影响认知功能的相关因素。结果MMSE总分9~30分,认知障碍86例(60.1%),轻度58例(40.6%)、中度27例(18.9%)、重度1例(0.7%)。MoCA总分5~30分,认知障碍111例(77.6%),轻度69例(48.3%)、中度35例(24.5%)、重度7例(4.9%)。单因素分析显示,MMSE总分及MoCA总分与年龄、发病年龄、老年、性别、病程、MSA类型、直立性低血压(OH)、尿潴留、肛门括约肌肌电图(ASEMG)阳性、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、糖化血红蛋白(HbA1c)、血尿酸及残余尿量无明显相关(均P>0.05)。Logistic回归显示空腹血糖是MMSE评分提示的认知障碍的危险因素(OR=2.224,95%CI:1.108~4.462,P=0.024);MSA-C型(OR=3.905,95%CI:1.302~11.713,P=0.015)和TG(OR=3.494,95%CI:1.061~11.501,P=0.040)是MoCA评分提示的认知障碍的危险因素;TG是MMSE评分提示的中-重度认知障碍的危险因素(OR=17.624,95%CI:2.596~119.669,P=0.003),而TC是保护因素(OR=0.006,95%CI:0.000~0.714,P=0.036)。Logistic回归分析未发现MoCA评分所提示的中重度认知障碍的影响因素。结论MSA患者认知障碍的发生率高,MSA-C型、血糖、血脂可能是MSA患者认知障碍的影响因素,而发病年龄、老年、性别、病程、自主神经病变、血尿酸则与MSA患者认知障碍无明显相关。

Objective To analyze the cognitive dysfunction and its influencing factors in patients with multisystem atrophy(MSA).Methods A total of 143 hospitalized patients with MSA in our hospital from January 2015 to January 2020 were selected as the research objects.The cognitive function was evaluated by Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scales,meanwhile,the influencing factors of cognitive function were analyzed.Results The average score of MMSE scale of 143 MSA patients ranged from 9 to 30 points,and the MMSE test identified 86 patients(60.1%)with cognitive impairment,including 58 cases(40.6%)with mild cognitive impairment,27 cases(18.9%)with moderate cognitive impairment and 1 case(0.7%)with severe cognitive impairment.The average score of MoCA scale of 143 MSA patients ranged from 5 to 30 points,among which 111 cases(77.6%)had cognitive impairment,including 69 cases with mild cognitive impairment(48.3%),35 cases with moderate cognitive impairment(24.5%)and 7 cases with severe cognitive impairment(4.9%).Both the total scores of MMSE and MoCA scores of MSA patients were not correlated with age of onset,old age,gender,disease duration,type of MSA(MSA-C),orthostatic hypotension(OH),urinary retention,positivity of anal sphincter electromyography(ASEMG),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose and glycosylated hemoglobin,serum uric acid and residual urine volume(all P>0.05).Logistic regression analysis showed that fasting blood glucose was a risk factor for cognitive impairment identified by MMSE(OR=2.224,95%CI:1.108-4.462,P=0.024);MSA-C(OR=3.905,95%CI:1.302-11.713,P=0.015)and TG(OR=3.494,95%CI:1.061-11.501,P=0.040)were risk factors for cognitive impairment identified by MoCA.There were no significant differences in above clinical characteristics between moderate to severe cognitive impairment patients and mild cognitive impairment patients identified by MMSE scale(P>0.05).Similarly,there were no significant differences in the above clinical characteristics between moderate to severe cognitive impairment patients and mild cognitive impairment patients by MoCA scale(P>0.05).Logistic regression analysis showed that TG was a risk factor for moderate to severe cognitive impairment identified by MMSE(OR=17.624,95%CI:2.596-119.669,P=0.003),while TC was a protective factor(OR=0.006,95%CI:0.000-0.714,P=0.036).Logistic regression analysis did not find the influencing factors of moderate to severe cognitive impairment as suggested by MoCA score.Conclusions There is a high incidence of cognitive impairment in MSA patients.The type of MSA(MSA-C),blood glucose and blood lipid may be influence factors of cognitive impairment in MSA patients.Age of onset,old age,gender,disease duration,autonomic dysfunction,and uric acid have no significant correlation with cognitive impairment of MSA.