不同程度抑郁癥患者認知功能及事件相關(guān)電位P300的研究

段敬利,潘偉盟,穆俊林,田曉杰,張朝輝

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不同程度抑郁癥患者認知功能及事件相關(guān)電位P300的研究

段敬利,潘偉盟,穆俊林,田曉杰,張朝輝

目的探討抑郁癥患者認知功能損害特點,及其與事件相關(guān)電位(ERP)P300的關(guān)系。方法64例診斷符合《國際疾病分類》第10版(ICD-10)的抑郁癥患者分為30例中重度抑郁癥組(A組)和34例輕度抑郁癥組(B組)；對其分別進行威斯康星卡片分類測驗(WCST)、韋氏成人記憶量表(WMS)和ERP-P300檢查,并與30例正常對照者(C組)進行對比,分析WCST、WMS評分與P300指標(biāo)的關(guān)系。結(jié)果A組WCST中完成分類數(shù)(Cc)、持續(xù)性錯誤數(shù)(Rpe)、隨機錯誤數(shù)(NRpe),WMS中長時記憶、短時記憶、瞬時記憶、記憶商數(shù)、P300的N2、P3a、P3b潛伏期和波幅與C組間差異有統(tǒng)計學(xué)意義(P均<0.05)；B組Cc、NRpe、短時記憶、瞬時記憶、記憶商數(shù)、P300的N2、P3a、P3b波幅與C組間差異有統(tǒng)計學(xué)意義(P均<0.05)；A組Cc、Rpe、長時記憶、記憶商數(shù)及P300的N2、P3a、P3b潛伏期與B組之間差異有統(tǒng)計學(xué)意義(P<0.05),且ERP-N2、P3b潛伏期與長時記憶分呈負相關(guān)(r= -0.467,-0.523,P<0.05)；P300的N2、P3a、P3b潛伏期與Rpe呈正相關(guān)(r=0.657,0.573,0.763,P<0.05)；ERP-N2、P3b波幅與短時記憶和瞬時記憶分呈正相關(guān)(r=0.478,0.434,0.532,0.541；P均<0.05 ),與NRpe呈負相關(guān)(r=-0.489,-0.532,P均<0.05 )。結(jié)論抑郁癥患者存在注意轉(zhuǎn)移、記憶、執(zhí)行功能等方面的認知功能障礙,抑郁程度與其認知功能損害的程度相關(guān),P300指標(biāo)的異?？煞从痴J知功能損害。

抑郁癥； 認知功能； 事件相關(guān)電位P300

Abstract：Objective： To explore the characteristic of cognitive impairments in depressive patients and analyze its correlation with the endogenous components of event-related potentials(ERP) P300.Method：64 cases patients meeting international classification of diseases (ICD-10) criteria for the diagnosis of depression were divided into moderate to severe depression group (group A,n=30) and 34 cases of mild depression group(group B,n=30).Wisconsin card sorting test(WCST),Wechsle memory scale(WMS) in adults and ERP-P300 examinations were conducted to them,and the data were compared with 30 cases of normal control group(group C,n=30 )to analyze the differences of them and correlation analysis were performed between the former indicators and the endogenous components of ERP-P300.Results：There were statistical significance between group A and C in the complete number of categories (Cc),perseverative error (Rpe),non-perseverative error(NRpe) of WCST,long-term memory、short-term memory,immediate memory,memory quotient of WMS,latencies and amplitudes of ERP-N2,P3a,P3b(allP<0.05).There were statistical significance between group B and C in Cc,NRpe,short-term memory,immediate memory,memory quotient,the amplitudes of N2,P3a,P3b(allP<0.05).There were statistical significance between group A and B in Cc,Rpe,long-term memory,memory quotient,the latencies of CN2,P3a,P3b(P<0.05).The latencies of N2、P3b had negative correlation with the scores of long-term memory(r=-0.467,-0.523,P<0.05)and the latencies of N2、P3a、P3b had positive correlation with Rpe(r=0.657,0.573,0.763;allP<0.05),the amplitudes of N2、P3b had positive correlation with the scores of short-term memory and immediate memory(r=0.478,0.434,0.532,0.541;allP<0.05 )and negative correlation with NRpe(r= -0.489,-0.532；allP<0.05 ).Conclusion： depressive patients have cognitive dysfunctions in shifting of attention,memory and executive function.The severity of depressive emotion can affect the degree of cognitive impairment.The endogenous components of P300 can reflect different aspects and levels of cognitive impairment.

Keywords： depressive disorder; cognitive function; event related potential P300

抑郁癥是一種常見的情感障礙性疾病,臨床癥狀上主要表現(xiàn)為心境低落、思維遲緩及注意力不集中。抑郁癥?？蓪?dǎo)致患者認知功能的損害[1],而事件相關(guān)電位(ERP)P300是一種常見的檢測認知功能的方法,其內(nèi)源性成份N2和P3波與認知過程密切相關(guān),其中P3波又可分為P3a和P3b兩個亞型,P3a又稱為被動注意狀態(tài)下的P300,P3b則為主動注意狀態(tài)下的P300。本研究通過對30例中重度抑郁癥患者和34例輕度抑郁癥患者進行威斯康星卡片分類測驗(WCST)、韋氏成人記憶量表(WMS)和ERP-P300檢查,并與30名正常對照者進行對比,觀察不同程度抑郁癥患者認知功能損害的特點,及其與ERP-P300指標(biāo)的關(guān)系。

1 對象和方法

1.1 對象 為本院醫(yī)院2014～2016年住院患者中選取64例符合《國際疾病分類第10版》(ICD-10)中抑郁癥診斷標(biāo)……