遗忘型轻度认知损害患者证候要素与认知功能的关系

摘要

目的：探讨遗忘型轻度认知功能损害（ aMCI）的中医证候要素与认知功能的相关性，为aMCI的辨证治疗提供理论依据。方法2012年5月—2015年6月从北京中医药大学东直门医院脑三科和记忆门诊以及张贴海报招募的附近社区受试者344例，对受试者进行神经心理学、生化及脑磁共振检查，排除血管性痴呆患者5例，血管性轻度认知损害患者2例，合并甲状腺功能减退患者1例，合并抑郁患者43例，年龄＞80岁患者13例，剩余受试者根据轻度认知功能损害（ MCI）和很可能阿尔茨海默病（ AD）诊断标准，分为正常组（ NC组）127例、aMCI组95例和很可能AD组58例，采集3组受试者的中医证候要素。采用双变量相关分析aMCI的中医证候要素与认知功能的相关性。结果3组之间简易精神状态检查（MMSE）总分比较差异有统计学意义（P＜0．05），可能AD组＜aMCI组＜NC组；年龄可能AD组明显高于NC组（P＜0．05）；受教育年限可能AD组显著低于NC组（P＜0．05）。 aMCI组气虚分布比率显著高于NC组和可能AD组（P均＜0.05）。可能AD组髓减积分明显高于NC组（P＜0．05），并且髓减积分与年龄呈正相关（r＝0．358，P＜0．05），可能AD组≥65岁人群髓减积分明显高于＜65岁人群（P＜0．05）。 aMCI患者MMSE中词语即刻回忆得分与气虚和脾虚均呈负相关（r＝－0．20，－0．25，P均＜0．05）；aMCI患者定向力得分与阴虚呈负相关（r＝－0．22，P＜0．05）。结论 aMCI的主要证候要素为脾虚、气虚与阴虚；随着病情加重，年龄越大，髓减程度越重，认知损害程度也加重。 aMCI患者MMSE中词语即刻回忆能力与脾虚、气虚相关，脾虚、气虚越重，词语即刻回忆能力下降越明显；定向力与阴虚相关，阴虚越重，定向力下降越明显。%Objective It is to investigate the correlation between cognitive function and Chinese Medicine syndrome ele-ment of amnestic mild cognitive impairment ( aMCI) , and provide a theoretical basis for the treatment of aMCI.Methods 344 subjects from Dongzhimen Hospital and near communities in Beijing from May 2012 to June 2015 were recruited, who were ac-cepted neuropsychological assessments, biochemical and imaging examinations, excluded 5 cases of vascular dementia, 2 ca-ses of vascular mild cognitive impairment, 1 case of hypothyroidism patients, 43 cases with depression, and 13 cases of age>80 years old, the remaining subjects who according to the diagnosis standard for mild cognitive impairment and likely Alzhei-mer’s disease were classified as normal group (n=127), aMCI group (n=95) and AD group (n=58).The TCM syndrome elements were collected, and the correlation between the cognitive functions and syndrome elements in aMCI patients was ana-lyzed.Results There were significant differences in the mini mental state examination ( MMSE) scores among the three groups ( all P>0.05) , AD group