影响老年额叶胶质瘤认知功能的因素及手术治疗对认知功能的影响

Influencing factors for cognitive function in elderly patients with frontal glioma and the effect of surgical treatment on cognitive function

摘要:

目的 探讨手术干预是否影响老年额叶胶质瘤患者认知功能。方法 前瞻性分析于首都医科大学附属北京天坛医院行手术治疗的33例老年额叶胶质瘤患者的临床资料。在术前、术后1周、术后3月指导患者完成MoCA、MMSE认知评估量表。采用独立样本t检验、成对样本t检验及多因素回归分析认知功能变化。结果 入组患者的MoCA、MMSE评分与术前相比，在术后1周及术后3月的下降无统计学意义（P>0.05）。在术前，高级别胶质瘤组的MoCA、MMSE评分（15.33±5.723）、（20.444±5.0028）低于低级别胶质瘤组（21.58±6.178）、（25.167±4.8245）（P<0.05）。复发胶质瘤组（13.14±4.259）、（19.000±4.0415）低于首发胶质瘤组（21.69±5.945）、（25.192±4.7835）（P<0.05）。在术后1周，延迟回忆能力较术前下降（P<0.05）。术后3月，延迟回忆能力较术前及术后1周明显改善，计算力较术后1周改善（P<0.05）。结论 手术治疗后患者总体认知功能未出现恶化。复发和高级别胶质瘤导致更严重的认知功能障碍。在术后3月，延迟回忆能力及计算力较术前改善。

Abstract:

Objective To investigate the effect of surgical intervention on cognitive function in elderly patients with frontal glioma.Methods A prospective analysis was performed for the clinical data of 33 elderly patients with frontal glioma who underwent surgical treatment in Beijing Tiantan Hospital, Capital Medical University. The patients were instructed to complete Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) cognitive assessment scale before surgery and at 1 week and 3 months after surgery. The independent samples t-test, the paired-samples t-test, and a multivariate regression analysis were used to investigate the change in cognitive function.Results There were no significant reductions in MoCA and MMSE scores at 1 week and 3 months after surgery (P>0.05). Compared with the low-grade glioma group before surgery, the high-grade glioma group had significantly lower MoCA score (15.33±5.723 vs 21.58±6.178, P<0.05) and MMSE score (20.444±5.0028 vs 25.167±4.8245, P<0.05). The recurrent glioma group had significantly lower MoCA and MMSE scores than the first-episode glioma group (MoCA:13.14±4.259 vs 21.69±5.945, P<0.05; MMSE:19.000±4.0415 vs 25.192±4.7835, P<0.05). At 1 week after surgery, there was a significant reduction in delayed recall ability (P<0.05). Delayed recall ability at 3 months after surgery was significantly better than that before surgery and at 1 week after surgery, and computational ability at 3 months after surgery was significantly better than that at 1 week after surgery (P<0.05).Conclusions No deterioration of global cognitive function is observed in patients after surgical treatment. Recurrent and high-grade glioma tend to lead to more severe cognitive impairment. Delayed recall ability and computational ability are improved at 3 months after surgery.