【作者】 李静；

【导师】 费广鹤；

【作者基本信息】 安徽医科大学 ， 内科学， 2013， 硕士

【摘要】 目的比较慢性阻塞性肺疾并（chronic obstructive pulmonary disease, COPD）患者与正常人群的肺功能、动脉血气、血清凝聚素水平以及海马体积，评估COPD患者的认知功能以及海马萎缩状态，分析与COPD患者认知功能相关的影响因素。方法采用简易精神智能评定量表（mini mental state examination，MMSE）对25例轻中度COPD患者、30例重度COPD患者及25例健康体检者进行认知功能评定，采用人凝聚素双抗体夹心酶联免疫吸附试剂盒（enzyme-linked immunosorbentassay， ELISA）测定血清凝聚素（clusterin）浓度，采用3.0T超导磁共振成像系统进行左右双侧海马体积的测定，同时对所有受试者进行肺功能以及动脉血气测定。结果轻中度COPD组、重度COPD组以及对照组的MMSE评分分别为：24.80±1.91、22.83±2.78、27.52±2.99；左侧海马体积分别为：2.43±0.28cm³、2.31±0.27cm³、3.62±0.40cm³；右侧海马体积分别为：2.56±0.32cm³、2.46±0.34cm³、3.75±0.46cm³；双侧海马总体积分别为：4.98±0.48cm³、4.77±0.58cm³、7.37±0.82cm³；血清凝聚素浓度分别为：148.40±12.63μg/ml、167.70±19.24μg/ml、119.30±11.70μg/ml。与对照组相比，轻中度组及重度COPD组患者MMSE评分均显著减少（均P<0.01）,左侧、右侧以及双侧海马总体积均显著减少（均P<0.01），血清凝聚素浓度显著升高（均P<0.01）；与轻中度COPD组相比，重度COPD组MMSE评分显著下降（P<0.01），左侧、右侧及双侧海马总体积差异均无显著性（均P>0.05）,血清凝聚素浓度显著升高（P<0.01）。轻中度组及重度COPD组MMSE评分与动脉血氧分压（arterial oxygen tension，PaO₂）成正相关（r=0.45，P<0.05；r=0.39, P<0.05）；轻中度组及重度COPD组的血清凝聚素浓度与动脉血PaO₂（r=-0.51, P<0.01；r=-0.36, P<0.05）及MMSE评分（r=-0.52, P<0.01；r=-0.62, P<0.01）成负相关，且重度COPD组一秒用力呼气容积（forced expiratory volume in one second，FEV₁）与MMSE评分成正相关（r=0.42, P<0.05），与血清凝聚素浓度成负相关（r=-0.41,P<0.05）。结论COPD患者存在明显的认知功能障碍与左、右侧海马体积的萎缩；COPD患者认知障碍程度与病情的严重程度以及血清凝聚素水平相关；PaO₂及FEV1是COPD患者认知功能受损的重要影响因素。COPD导致的轻度认知功能障碍（mildcognitive impairment, MCI）亦可能是阿尔茨海默病（Alzheimer’s disease, AD）的前期基础疾病。更多还原

【Abstract】 ObjectiveTo explore the cognitive states and the relevant factors in patients with chronicobstructive pulmonary disease （COPD）.MethodsTwenty-five mild-to-moderate, thirty severe COPD patients and twenty-five controlsubjects were recruited. Cognitive states were investigated by mini mental stateexamination （MMSE）. Pulmonary function, arterial blood gas, serum clusterinconcentration and MRI volumes of hippocampus were evaluated in each subject.ResultsMMSE scores in mile-to-moderate COPD, severe COPD and control group were:24.80±1.91,22.83±2.78, and27.52±2.99；left hippocampal volumes were:2.43±0.28cm³,2.31±0.27cm³, and3.62±0.40cm³；right hippocampal volumes were:2.56±0.32cm³,2.46±0.34cm³, and3.75±0.46cm³；total hippocampal volumes were:4.98±0.48cm³,4.77±0.58cm³, and7.37±0.82cm³；the concentrations of serum clusterin were：148.40±12.63μg/ml,167.70±19.24μg/ml, and119.30±11.70μg/ml。Lower levels of theMMSE scores and higher concentrations of serum clusterin were found inmild-to-moderate COPD group（P<0.01）, while the lowest level of the MMSE scoresand highest level of serum clusterin were found in severe COPD group（P<0.01）compared to control group. The MRI volumes of hippocampus declined in both of the two COPD groups. The MMSE scores were significantly positively correlated with thelevels of arterial oxygen tension （PaO₂）（r=0.45，P<0.05; r=0.39, P<0.05） and serumclusterin concentrations were negatively associated with PaO₂（r=-0.51, P<0.01;r=-0.36, P<0.05） and MMSE scores（r=-0.52, P<0.01；r=-0.62, P<0.01）in bothmild-to-moderate and severe COPD groups In addition, the forced expiratory volumein one second （FEV₁） was positively related with MMSE scores （r=0.42, P<0.05） andnegatively correlated with the serum clusterin concentrations （r=-0.41, P<0.05） insevere COPD group.ConclusionLower levels of cognitive function and atrophic volumes of hippocampus were foundin COPD patients, which are correlated with the classification of severity, PaO₂, FEV1and concentrations of serum clusterin. The cognitive impairment of COPD may be oneof the basic diseases of preclinical Alzheimer’s disease （AD）.更多还原