目的：研究稳定期慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）患者认知功能障碍类型及脑灰质密度改变，并探讨COPD患者灰质密度改变与认知功能障碍的联系。方法：从2014年6月—2016年6月招募25例稳定期COPD患者做为COPD组和26例健康志愿者做为健康对照组，对COPD组和健康对照组被试进行神经心理学量表检查和磁共振检查。利用基于体素的形态学测量（Voxel-based morphometry，VBM）的方法比较两组大脑灰质密度。结果：与对照组比较，COPD患者简易精神状态检查（MMSE）、MoCA量表、数字广度测试、符号数字模式测验、连线测验A、连线测验B评分明显降低（P＜0.05）。VBM结果显示，COPD患者右侧缘上回、顶下小叶及右侧小脑的灰质密度较对照组显著降低（P＜0.01，Alphasim校正）。右侧小脑的灰质密度值和MoCA评分（r=0.586，P=0.002）以及数字广度逆序测试呈正相关（r=0.603，P=0.001）。结论：稳定期COPD患者以非遗忘型认知功能障碍为主，以执行功能损害为主要表现。稳定期COPD患者存在多个脑区灰质密度减小，并与认知功能下降相关。针对诊断及评估COPD患者认知功能障碍，磁共振检查能够提供有价值的信息。
Abstract
Objective: To investigate the type of cognitive impairment, the change of grey matter density and the relationship between grey matter density change and cognitive impairment in the stable chronic obstructive pulmonary disease(COPD) patients. Methods: Twenty-five stable COPD patients and 26 healthy controls were enrolled from June 2014 to June 2016. MRI examination and neuropsychologic tests were performed in all the subjects. The voxel-based morphometry(VBM) method was used to compare the grey matter density between the two groups. Results: Compared to healthy controls, the COPD patients had a lower score on the mini-mental state examination(MMSE), montreal cognitive assessment(MoCA), digit span, digit symbol test, trail making-A test, and trail making-B test. The VBM results showed that the grey matter density of the right supramarginal gyrus, inferior parietal lobule and right cerebellum were significantly lowered compared to that of the controls. The grey matter density of the right cerebellum was positively correlated with the score of MoCA and digit span backward test. Conclusion: The cognitive impairment of the stable COPD patients lies mainly on non-amnestic cognitive impairment and presents with the impairment of the executive control function. Many brain areas exhibits lowered grey matter density in stable COPD patients. The reduced grey matter density is associated with the cognitive impairment. MRI examination can provide useful information in diagnosis and evaluation of the cognitive impairment in COPD patients.
关键词
肺疾病 /
慢性阻塞性 /
认知障碍 /
磁共振成像
Key words
Pulmonary disease, chronic obstructive /
Cognition disorders /
Magnetic resonance imaging
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study[J]. Lancet, 1997, 349(9064): 1498-1504.
[2]李婧，赵海金，王凤燕，等. 影响慢性阻塞性肺疾病急性加重患者住院病死率的危险因素[J]. 中华医学杂志，2013，93（18）：1374-1377.
[3]Song XW, Dong ZY, Long XY, et al. REST: a toolkit for resting-state functional magnetic resonance imaging data processing[J]. PLoS One, 2011, 6(9): e25031.
[4]Cleutjens FAHM, Wouters EFM, Dijkstra JB, et al. The Cognitive-Pulmonary Disease(Cognitive-PD) study: protocol of a longitudinal observational comparative study on neuropsychological functioning of patients with COPD[J]. Bmj Open, 2014, 4(3): e004495.
[5]Grant I, Heaton RK, Mcsweeny AJ, et al. Neuropsychologic Findings in Hypoxemic Chronic Obstructive Pulmonary Disease[J]. Arch Intern Med, 1982, 142(8): 1470.
[6]Singh B, Mielke MM, Parsaik AK, et al. A Prospective Study of Chronic Obstructive Pulmonary Disease and Risk of Mild Cognitive Impairment[J]. JAMA Neurol, 2014, 71(5): 581.
[7]Singh B, Parsaik AK, Mielke MM, et al. Chronic Obstructive Pulmonary Disease and Association With Mild Cognitive Impairment: The Mayo Clinic Study of Aging?[J]. Mayo Clin Proc, 2013, 88(11): 1222-1230.
[8]Vandierendonck A. A Working Memory System With Distributed Executive Control[J]. Perspect Psychol Sci, 2016, 11(1): 74.
[9]Dodd JW, Getov SV, Jones PW. Cognitive function in COPD[J]. Eur Respir J, 2010, 35(4): 913.
[10]Liang X, Zou Q, He Y, et al. Coupling of functional connectivity and regional cerebral blood flow reveals a physiological basis for network hubs of the human brain[J]. Proc Natl Acad Sci U S A, 2013, 110(5): 1929.
[11]钟敏之，李新春，邹文锦，等. 慢性阻塞性肺疾病患者早期脑灰质体积的体素形态学分析[J]. 广东医学，2017，38（14）：2199-2201.
[12]汪春荣，邱士军，沈比先，等. 稳定期慢性阻塞性肺疾病患者脑灰质体积的改变[J]. 中国医药导报，2016，13（28）：60-63.
[13]Hautzel H, Mottaghy FM, Specht K, et al. Evidence of a modality-dependent role of the cerebellum in working memory? An fMRI study comparing verbal and abstract n-back tasks[J]. Neuroimage, 2009, 47(4): 2073.
