慢性阻塞性肺病诱导轻度认知功能障碍的回顾性队列研究
Association between chronic obstructive pulmonary disease and the risk for mild cognitive impairment: a retrospective cohort study

摘要：目的 近期研究发现慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者较多合并轻度认知功能障碍(mild cognitive impairment, MCI)。本文拟通过临床队列研究来探明COPD是否导致MCI的发生。方法 2002年1月至2003年12月，于西安交通大学第一附属医院门诊电子数据库中随机挑选850例认知功能正常的COPD研究人群，年龄在70～90岁之间。首次检查确定基线后，每15个月随访一次，接受症状问询、神经生理检测和心理检测。COPD由呼吸内科医师确诊。使用Cox比例风险模型分析MCI的危险因素。结果 本研究随访时间3.5～6年，中位随访期为5.5年。850例受检人群中，265例在随访期出现了MCI。COPD显著增加了轻度认知功能障碍(HR 2.12；95% CI：1.36～3.18；P<0.01)以及其非记忆缺失亚型(non-amnestic mild cognitive impairment, na-MCI)的发生风险(HR 2.65；95% CI：1.86～3.89；P<0.01)。Cox多因素分析发现COPD不是MCI总体和轻度认知功能障碍的记忆缺失亚型(amnestic mild cognitive impairment, a-MCI)发生的独立危险因素。本研究还发现对于长期患有COPD的患者，COPD严重程度与MCI(HR 2.52；95% CI：1.97～3.62；P<0.01)和na-MCI(HR 2.07；95% CI：1.67～2.83；P<0.01)发生率呈正相关关系。结论 COPD明显增加了中老年人群MCI(尤其是na-MCI)的发生率，而且COPD严重程度与MCI发生率呈正相关关系。COPD是MCI发生的危险因素，早期干预COPD可能预防或延缓MCI的发生或进展。
ABSTRACT: Objective Cross-sectional relationship between chronic obstructive pulmonary disease (COPD) and mild cognitive impairment (MCI) has been found according to recent literature. The present study intends to explore whether COPD is an increased risk for MCI. Methods We randomly selected 850 cognitively normal individuals aged 70-90 years from the outpatient department of the First Affiliated Hospital, Xi’an Jiaotong University, using the medical records linkage system. All the individuals were examined with an interview, neurological examination and neuropsychological testing at baseline and every 15 months thereafter. COPD was assessed as a risk factor for MCI and its subtype with the help of Cox proportional hazards models. Results During the follow-up (range: 3.5-6.0 years, median value: 5.5 years ), 265 out of 850 recruited individuals developed MCI. COPD led to an increased risk for MCI (HR 2.12; 95% CI: 1.36-3.18; P<0.01) and non-amnestic mild cognitive impairment (na-MCI) (HR 2.65; 95% CI: 1.86-3.89; P<0.01). Cox multi-factor analysis revealed that COPD was not an independent risk factor for MCI or a-MCI. We found a positive correlation of COPD severity with the incidence of MCI (HR 2.52; 95% CI: 1.97-3.62; P<0.01) and na-MCI (HR 2.07; 95% CI:1.67-2.83; P<0.01) in subjects with chronic COPD. Conclusion The data here support that COPD is a risk factor for MCI and the two are positively correlated. Early intervention is important in preventing or delaying the onset and progression of MCI