文章摘要
认知量表联合颅脑磁共振对维持性透析患者认知功能的评价
Evaluation of cognitive function in maintenance dialysis patients with cognitive scalescombined with brain MRI
投稿时间：2018-03-02  
DOI：10.3969/j.issn.1000-0399.2018.12.008
中文关键词: 维持性透析  简易精神状态量表  蒙特利尔认知评估量表  弥散加权成像  扩散张量成像
英文关键词: Maintenance dialysis  Mental state scale  Montreal cognitive assessment scale  Diffusion weighted imaging  Diffusion tensor imaging
基金项目:安徽省公益性研究联动计划项目（项目编号：1604f0804021），安徽医科大学校临床科学研究项目（项目编号：2015xkj110）
作者单位E-mail
王晓禾 230601 合肥 安徽医科大学第二附属医院肾内科  
郝丽 230601 合肥 安徽医科大学第二附属医院肾内科 haoliqilin@163.com 
张森 230601 合肥 安徽医科大学第二附属医院肾内科  
季蓉 230601 合肥 安徽医科大学第二附属医院肾内科  
郑穗生 230601 合肥 安徽医科大学第二附属医院放射科  
单艳棋 230601 合肥 安徽医科大学第二附属医院放射科  
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中文摘要:
      目的 探讨简易精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）联合颅脑磁共振（MRI）弥散加权成像（DWI）/扩散张量成像（DTI）对透析患者认知功能的评估价值。方法 选择2015年5月至2016年5月于安徽医科大学第二附属医院肾内科进行透析的患者65例，采用MMSE和MoCA评估患者认知功能，MRI扫描脑白质区并计算表观弥散系数（ADC）和部分异向性（FA）量化值；根据MoCA结果分为认知正常组（38例）和认知障碍组（27例），比较两组患者量表评分、ADC值及FA值的差异性。结果 MoCA检出率高于MMSE，差异有统计学意义（χ2=17.725，P=0.001），且MMSE和MoCA总分呈正相关（r=0.660，P=0.001）。认知障碍组患者MMSE评分的定向力、记忆力、注意力、语言和总分低于认知正常组，而MoCA评分的执行力、注意力、语言、延迟回忆、定向力和总分均低于认知正常组，差异有统计学意义（P<0.05）；额叶和顶叶ADC值高于正常组，额叶、顶叶、胼胝体及侧脑室FA值低于正常组，差异有统计学意义（P<0.05）。结论 多认知量表联合评估可提高透析患者认知障碍的检出率；且存在认知障碍的透析患者主要表现为执行力、定向力、注意力、语言和记忆力的下降，和大脑额叶、顶叶、胼胝体和侧脑室白质的损伤相对应。
英文摘要:
      Objective To explore the evaluation value of the mini-mental state scale (MMSE) and the montreal cognitive assessment scale (MoCA) combined with the diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) of brain magnetic resonance (MRI) in the evaluation of cognitive function in dialysis patients. Methods Sixty-five patients with dialysis treated in the Department of Nephrology of theSecond Affiliated Hospital of Anhui Medical University from May 2015 to May 2016 were enrolled in the study. MMSE and MoCA were used to evaluate thecognitive function of patients. On the other hand, MRI was used to scan the white matter region to calculate the apparent diffusion coefficient (ADC) and partial anisotropy (FA) quantified values. Then, all patients were divided into cognitive normal group and impairment group according to the results of MoCA. The t-test was used to compare the differences in scale scores, ADC values and FA values between two groups. Results The detection rate of MoCA was higher than that of MMSE (χ2=17.725, P=0.001) and their total scores were positively correlated (r=0.660, P=0.001). The MMSE scores of cognitive impairment group were lower than those in normal cognitive group in orientation, memory, attention, language and total score. And the MoCA scores of cognitive impairment group were lower than those of normal cognitive group in executive capability, attention, language, delayed recall, orientation and total score.The difference was statistically significant (P<0.05). The ADC values of frontal and parietal lobe in cognitive impairment group were higher than those of normal group, and the FA values in frontal lobe, parietal lobe, corpus callosum and lateral ventricle were lower.The difference was statistically significant (P<0.05). Conclusion Multi-scale joint assessment can improve the detection rate of cognitive impairment in dialysis patients.The dialysis patients with cognitive impairment showa decline in executive capability, orientation, attention, language and memory, corresponding to the damage of frontal lobe, parietal lobe, corpus callosum and lateral ventricles in brain.
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