蒙特利尔认知评估量表和国际人类免疫缺陷病毒痴呆量表在男男同性性行为人类免疫缺陷病毒感染者不同程度认知功能障碍筛查中的应用  

Utility of the Montreal cognitive assessment and international human immunodeficiency virus dementia scale to screen human immunodeficiency virus-associated neurocognitive disorders among men who have sex with men

作　　者：康婧[1] 耿文清[1] 姜拥军[1] 丁海波[1] Kang Jing;Geng Wenqing;Jiang Yongjun;Ding Haibo(Department of Laboratory Medicine,NHC Key Laboratory of AIDS Immunology(China Medical University),National Clinical Research Center for Laboratory Medicine,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院检验科,国家卫生健康委员会艾滋病免疫学重点实验室(中国医科大学),国家临床医学研究中心,沈阳110001

出　　处：《中华传染病杂志》2020年第6期348-352,共5页Chinese Journal of Infectious Diseases

基　　金："十三五"国家科技重大专项(2017ZX10201101)。

摘　　要：目的探索蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)和国际人类免疫缺陷病毒痴呆量表(international human immunodeficiency virus dementia scale,IHDS)筛查人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染男男同性性行为者(men who have sex with men,MSM)无症状认知功能损伤(asymptomatic neurocognitive impairment,ANI)和人类免疫缺陷病毒相关性痴呆(human immunodeficiency virus-associated dementia,HAD)的效能。方法根据排除标准纳入2016年12月至2018年12月在沈阳中国医科大学附属第一医院就诊的HIV感染MSM 210例和自愿咨询检测的HIV阴性MSM 84例。分别采用MoCA和IHDS对HIV感染MSM和HIV阴性MSM进行横断面认知功能评估,分析各量表在ANI和HAD中的筛查效能。统计学分析采用t检验、单因素方差分析、χ2检验。结果HIV阳性MSM的MoCA和IHDS总分[(26.04±3.41)分和(11.15±1.44)分]均低于HIV阴性MSM[(27.58±1.85)分和(11.67±0.52)分],差异均有统计学意义(t=-4.970、-4.542,均P<0.01)。不同认知功能的HIV感染者MoCA、IHDS总分差异均有统计学意义(F=117.982、49.291,均P<0.05),MoCA<26分、IHDS≤10分所占比例差异均有统计学意义(χ2=115.917、70.155,均P<0.05)。ANI筛查中,MoCA以<26分为阈值,灵敏度为79%,特异度为91%,约登指数为0.70;IHDS以≤11分为阈值,灵敏度为74%,特异度为75%,约登指数为0.49。HAD筛查中,MoCA以<24分为阈值,灵敏度为88%,特异度为87%,约登指数为0.75;IHDS以≤10分为阈值,灵敏度为68%,特异度为87%,约登指数为0.55。结论MoCA比IHDS更适用于HIV感染MSM认知功能障碍的筛查,对于不同程度认知功能障碍应采用不同分数阈值。Objective To investigate the efficiency of the Montreal cognitive assessment(MoCA)and international human immunodeficiency virus dementia scale(IHDS)in asymptomatic neurocognitive impairment(ANI)and human immunodeficiency virus-associated dementia(HAD)screening among human immunodeficiency virus(HIV)-infected men who have sex with men(MSM).Methods According to the exclusion criteria,210 HIV-infected MSM and 84 HIV-negative MSM were recruited from the First Hospital of China Medical University in Shenyang from December 2016 to December 2018.In this cross-sectional study,the MoCA and IHDS were performed among all HIV-positive and HIV-negative MSM,and their efficiency in ANI and HAD screening were analyzed.Student t-test,one-way analysis of variance and chi-square test were used for statistical analysis.Results HIV-positive MSM had lower total scores of MoCA and IHDS[(26.04±3.41)and(11.15±1.44)]than HIV-negative controls[(27.58±1.85)and(11.67±0.52)](t=-4.970 and-4.542,respectively,both P<0.01).The differences of MoCA and IHDS total scores of HIV-infected patients with different cognitive functions were statistically significant(F=117.982 and 49.291,respectively,both P<0.05).The proportions of patients with MoCA<26 points and IHDS≤10 points were statistically significant(χ2=115.917 and 70.155,respectively,both P<0.05).In ANI screening,the cut-off of MoCA<26 points showed a sensitivity of 79%and a specificity of 91%,Youden index was 0.70;and the cut-off of IHDS≤11 points showed a sensitivity of 74%and a specificity of 75%Youden index was 0.49.In HAD screening,the cut-off of MoCA<24 points showed a sensitivity of 88%and a specificity of 87%,Youden index was 0.75;and the cut-off of IHDS≤10 points showed a sensitivity of 68%and a specificity of 87%,Youden index was 0.55.Conclusion The MoCA is prefered to the IHDS in HIV-associated neurocognitive disorders screening among MSM population,and its cut-off score should be set for the purpose to screen different degrees of cognitive impairment.

关 键 词：人类免疫缺陷病毒相关认知功能障碍 人类免疫缺陷病毒相关性痴呆 蒙特利尔认知评估量表 国际人类免疫缺陷病毒痴呆量表 男男同性性行为者 

分 类 号：R512.91[医药卫生—内科学]