年龄相关性黄斑变性患者的认知功能分析

发布时间：2018-08-03 16:11

【摘要】：背景和目的年龄相关性黄斑变性(Age-related Macular Degeneration,AMD),是视网膜色素上皮细胞和神经视网膜退行性变造成的一种不可逆性视力下降或丧失的疾病,已经成为发达国家65岁以上老年人群视力丧失和失明的主要原因。随着我国社会人口老龄化的进程,其患病人数也在不断扩大。阿尔兹海默病(Alzheimer's disease,AD)是最常见和最重要的中枢神经系统变性疾病,与皮层和海马组织中不断增加的淀粉样蛋白、老年斑和神经原纤维缠结有关,临床主要表现为认知功能下降、精神症状和行为障碍、日常生活能力的逐渐下降。作为常见的神经变性疾病,两者有共同疾病诱因(年龄、吸烟等)和病理机理(淀粉样蛋白沉积)。有研究报告年龄相关性黄斑变性患者也存在认知功能的下降,但该结论在不同的研究中存在争议。因此,我们设计本研究以探讨年龄相关性黄斑变性患者的认知功能的改变。方法通过计算机检索发表于2015年10月31日以前下列数据库中的相关文献(无语言限制):1)PubMed;2)Cochrane Library;3)EMBASE;4)ScienceDirect。所有纳入研究必须符合以下四个条件:1)研究类型是病例对照或随机对照试验(RCT)研究;2)研究调查了AMD患者的认知功能;3)必须有明确的AMD的诊断依据;4)有充分的数据资料用于评估病例组和对照组之间的认知功能差异。应用观察性研究文献质量评价方法——Newcastle-Ottawa Scale(NOS)量表评价所有纳入研究的质量。使用stata12.0软件对各纳入研究中amd患者认知功能评分的定量综合分析,进行异质性检验及合并的标准化均数差(standardmeandifference,smd)及其相应的95%置信区间的计算。结果通过筛选,在最初检索到的278篇文献中,最终有6个病例对照研究和1个rct研究符合所有的纳入标准,共计794例amd患者和1227例对照纳入本研究。所有纳入研究的nos量表评分均大于5,表明纳入研究质量较高。其中5项研究使用简易精神状态检查(minimummentalstateexamination,mmse)、2项研究使用动物流畅性测验(animalfluencytest,aft),2项研究使用连线测验(trailmakingtest,tmt-a/b),1项研究使用简易认知分量表(mini-cog)来评价认知功能。较年龄匹配的对照组相比,amd患者mmse评分(smd:-0.32,95%ci:-0.51—-0.13,p=0.001)及mini-cog评分减少(smd:-0.70,95%ci:-0.97—-0.43,p0.001),tmt-a评分增加(smd:0.32,95%ci:0.13—0.51,p=0.001),差异均有统计学意义;aft评分(smd:-0.75,95%ci:-1.73—0.23,p=0.132)及tmt-b评分(smd:0.10,95%ci:-0.10—0.29,p=0.326)差异无统计学意义。亚组分析结果显示,干性amd患者mmse评分(smd:-1.12,95%ci:-1.59—-0.64,p0.001)、mini-cog评分(smd:-0.90,95%ci:-1.21—-0.59,p0.001)及aft评分(smd:-0.89,95%ci:-1.50—-0.27,p=0.005),差异均有统计学意义;tmt-a评分(smd:1.23,95%ci:-0.18—2.63,p=0.087)及tmt-b评分(smd:0.22,95%ci:-0.16—0.61,p=0.250)差异无统计学意义;湿性amd患者mmse评分(smd:-0.58,95%ci:-0.77—-0.38,p0.001)、mini-cog评分减少(smd:-0.56,95%ci:-0.90—-0.22,p=0.001)及tmt-a评分增加(smd:0.76,95%ci:0.13—1.39,p=0.017),差异均有统计学意义;aft评分(smd:-0.04,95%ci:-0.45—0.36,p=0.845)及tmt-b评分(smd:0.32,95%ci:-0.04—0.69,p=0.084)差异无统计学意义。敏感性分析结果表明研究结果具有较高的稳定性,可信度高。结论1.与年龄匹配的对照组相比,经mmse和mini-cog量表评估amd患者认知功能减退;2.亚组分析显示,与湿性AMD患者相比,干性AMD患者认知功能减退更明显;3.其它认知障碍的筛选试验,如AFT和TMT,需要更多的研究来评价。
[Abstract]:Background and objective age related Age-related Macular Degeneration (AMD) is an irreversible visual loss or loss of visual acuity caused by degeneration of retinal pigment epithelial cells and retinal degeneration. It has become the main cause of loss of vision and blindness in the elderly population over 65 years of age in developed countries. Alzheimer's disease (AD) is the most common and most important degenerative disease of the central nervous system, which is associated with increasing amyloidosis in the cortex and hippocampus, senile plaques and neurofibrillary tangles, and the main clinical manifestation is the decline of cognitive function. Mental and behavioral disorders, a gradual decline in daily living ability. As a common neurodegenerative disease, there are common causes of disease (age, smoking, etc.) and pathological mechanism (amyloid deposition). Studies have reported a decline in cognitive function in patients with age-related macular degeneration, but this conclusion is found in different studies. Therefore, we designed this study to explore the changes in cognitive function of patients with age-related macular degeneration. Methods through computer retrieval, the relevant literature published in the following databases (no language restrictions) before October 31, 2015 (1) PubMed; 2) Cochrane Library; 3) EMBASE; 4) all the inclusion studies of ScienceDirect. must be in accordance with The next four conditions: 1) the study types were case-control or randomized controlled trial (RCT) studies; 2) study and investigate the cognitive function of AMD patients; 3) must have a clear diagnostic basis for AMD; 4) sufficient data were used to assess the cognitive function difference between the case group and the control group. The application of observational literature quality evaluation method - Ne The wcastle-Ottawa Scale (NOS) scale evaluated the quality of all the included studies. Using the stata12.0 software, the quantitative comprehensive analysis of the cognitive function scores of the AMD patients in each study, the heterogeneity test and the combined standardized mean number difference (standardmeandifference, SMD) and the corresponding 95% confidence interval were calculated. Of the first 278 documents retrieved, 6 case control studies and 1 RCT studies were in line with all the inclusion criteria. A total of 794 patients with AMD and 1227 controls were included in this study. All the NOS scale scores in all the studies were greater than 5, indicating that the quality of the inclusion study was higher. 5 of them used simple mental state examination (minimummenta Lstateexamination, MMSE), 2 studies used the animal fluency test (animalfluencytest, AFT), 2 studies using the trailmakingtest (tmt-a/b), and 1 studies using a simple cognitive subscale (Mini-Cog) to evaluate the cognitive function. Compared with the age matched pair, the MMSE score of AMD patients (smd:-0.32,95%ci:-0.51 - -0.13, p=0.001) And Mini-Cog score decreased (smd:-0.70,95%ci:-0.97 - -0.43, p0.001), tmt-a score increased (smd:0.32,95%ci:0.13 - 0.51, p=0.001), and the difference was statistically significant; aft score (smd:-0.75,95%ci:-1.73 - 0.23, p=0.132) and TMT-B score (smd:0.10,95%ci:-0.10 - 0.29) were not statistically significant. Subgroup analysis showed that dry sex Amd patients' MMSE score (smd:-1.12,95%ci:-1.59 - -0.64, p0.001), Mini-Cog score (smd:-0.90,95%ci:-1.21 -0.59, p0.001) and aft score (smd:-0.89,95%ci:-1.50 -0.27,) were statistically significant differences. Statistical significance, MMSE score of wet amd patients (smd:-0.58,95%ci:-0.77 - -0.38, p0.001), Mini-Cog score decreased (smd:-0.56,95%ci:-0.90 -0.22, p=0.001) and tmt-a scores increased (smd:0.76,95%ci:0.13 - 1.39, p=0.017), the difference was statistically significant. The i:-0.04 - 0.69, p=0.084) differences were not statistically significant. The results of sensitivity analysis showed that the results showed high stability and high reliability. Conclusion 1. compared with the age matched control group, the MMSE and Mini-Cog scales were used to evaluate the cognitive impairment of the patients with AMD; the 2. subgroup analysis showed that the cognitive function of dry AMD patients was compared with the patients with wet AMD. Reduction is more obvious; 3. other screening tests for cognitive impairment, such as AFT and TMT, require more research to evaluate.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R774.5

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