本文選題：多系統(tǒng)萎縮 + 認(rèn)知障礙　； 參考：《中國全科醫(yī)學(xué)》2014年14期

【摘要】：目的探討多系統(tǒng)萎縮(MSA)患者認(rèn)知功能障礙的臨床特點(diǎn)及相關(guān)因素。方法選擇2012年12月—2013年11月在中國人民解放軍總醫(yī)院神經(jīng)內(nèi)科門診就診或住院的MSA患者34例,其中小腦性共濟(jì)失調(diào)為主型(MSA-C)患者21例(MSA-C組),帕金森綜合征為主型(MSA-P)患者13例(MSA-P組);另選擇性別、年齡、受教育程度與MSA患者匹配,生活環(huán)境與之相似的健康老年人18例為對照組。對3組受試者進(jìn)行整體認(rèn)知評估、執(zhí)行功能評估、肛門括約肌肌電圖檢查。結(jié)果 MSA-P組年齡大于MSA-C組和對照組,受教育年限長于MSA-C組和對照組(P0.05)。MSA-C組蒙特利爾認(rèn)知評估量表(MoCA)得分低于對照組(P0.05)。MSA-C組、MSA-P組Stroop測驗(yàn)卡片A、B、D耗時(shí)長于對照組,MSA-C組卡片C耗時(shí)長于對照組(P0.05)。MSA-P組畫鐘試驗(yàn)得分少于對照組(P0.05)。MSA-C組、MSA-P組圖形-符號轉(zhuǎn)換/數(shù)字-符號轉(zhuǎn)換個(gè)數(shù)少于對照組(P0.05)。MSA-P組連線測驗(yàn)完成時(shí)間長于對照組(P0.05)。MSA-C組、MSA-P組語義流暢性得分均少于對照組,MSA-C組語義流暢性得分小于MSA-P組(P0.05)。根據(jù)肛門括約肌肌電圖檢查結(jié)果,將MSA患者分為肌電圖正常組19例,肌電圖異常組15例,肌電圖異常組Stroop測驗(yàn)卡片D耗時(shí)、連線測驗(yàn)完成時(shí)間長于肌電圖正常組,畫鐘試驗(yàn)得分低于肌電圖正常組(P0.05)。多元線性回歸分析結(jié)果顯示,語義流暢性得分與受教育年限呈負(fù)相關(guān)(r=-0.443,P0.05);連線測驗(yàn)完成時(shí)間與年齡呈正相關(guān)(r=0.462,P0.01);肌電圖異常率與畫鐘試驗(yàn)得分呈負(fù)相關(guān)(r=-0.411,P0.05),與連線測驗(yàn)完成時(shí)間、Stroop測驗(yàn)卡片D耗時(shí)均呈正相關(guān)(r=0.473、0.455,P0.05)。結(jié)論 MSA患者可出現(xiàn)認(rèn)知功能障礙,尤其是執(zhí)行功能障礙,肛門括約肌肌電圖異常(神經(jīng)源性損傷)患者認(rèn)知功能障礙程度較重。
[Abstract]:Objective to investigate the clinical features and related factors of cognitive dysfunction in patients with multiple system atrophy (MSA). Methods from December 2012 to November 2013, 34 patients with MSA were enrolled in the Department of Neurology, General Hospital of the Chinese people's Liberation Army (PLA). Among them, 21 patients with cerebellar ataxia (MSA-CC) and 13 patients with Parkinson's syndrome (MSA-P) were treated with MSA-C and MSA-P respectively. 18 healthy elderly people with similar living environment served as control group. Three groups of subjects were assessed with global cognition, functional evaluation and anal sphincter electromyography. Results the age of MSA-P group was larger than that of MSA-C group and control group. The score of Montreal Cognitive Assessment scale (MSA-C) in MSA-C group was longer than that in MSA-C group and control group (P 0.05). The score of MSA-C group was lower than that of MSA-P group (P 0.05). MSA-C group took longer time than control group (P 0.05. MSA-P group) to draw clock test score of MSA-P group. MSA-C group took longer time than control group (P 0.05). MSA-C group (P < 0.05). MSA-C group (P < 0.05) and MSA-C group (P < 0.05). The number of graph-symbol conversion / digital-symbol conversion in MSA-P group was less than that in control group P0.05U. MSA-P group. The completion time of MSA-P group was longer than that of control group P0.05U. MSA-C group. The semantic fluency score of MSA-C group was lower than that of MSA-C group, and the semantic fluency score of MSA-C group was lower than that of MSA-P group. According to the results of anal sphincter electromyography (EMG), the patients with MSA were divided into normal EMG group (n = 19) and abnormal EMG group (n = 15). The Stroop test card D of abnormal EMG group was time-consuming, and the completion time of wired test was longer than that of normal EMG group. The score of clock drawing test was lower than that of normal EMG group (P 0.05). The results of multiple linear regression analysis showed that, There was a negative correlation between the score of semantic fluency and the years of education, the time of completion of the wired test and the age; the abnormal rate of EMG was negatively correlated with the score of the bell drawing test; and the completion time of the Stroop test card D was positively correlated with the time of completion of the test and the time taken by the Stroop test card. Conclusion Cognitive dysfunction may occur in patients with MSA, especially in patients with executive dysfunction. The degree of cognitive dysfunction in patients with abnormal anal sphincter electromyography (neurogenic injury) is serious.
【作者單位】： 中國人民解放軍總醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R749.1

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