非致殘性缺血性腦血管事件患者執(zhí)行功能及視覺事件相關(guān)電位P300的臨床研究
發(fā)布時(shí)間：2019-06-26 09:43
【摘要】：目的:本文旨在探討非致殘性缺血性腦血管事件(NICE)患者的執(zhí)行功能損害特征,并進(jìn)行事件相關(guān)電位P300檢測(cè),分析執(zhí)行功能改變與P300的相關(guān)性,為NICE患者的執(zhí)行功能評(píng)估提供客觀的電生理依據(jù)。方法:選取西南醫(yī)科大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科住院病人中確診的NICE患者為病例組,根據(jù)影像學(xué)結(jié)果,顯示為急性梗死病灶≥2個(gè)和(或)顱內(nèi)/外大動(dòng)脈粥樣硬化性狹窄≥50%者預(yù)示復(fù)發(fā)風(fēng)險(xiǎn)顯著增高,記為高危NICE組(HR-NICE組),以上兩項(xiàng)指標(biāo)均未達(dá)到者記為普通NICE組(NR-NICE組),選取性別、年齡、教育程度匹配且無認(rèn)知損害的同期住院患者為對(duì)照組。每組各30例,所有納入對(duì)象均完成:1、總體認(rèn)知功能測(cè)試:采用MMSE量表和MoCA量表;2、執(zhí)行功能測(cè)試:畫鐘測(cè)驗(yàn)(CDT),連線測(cè)驗(yàn)(TMT),Stroop測(cè)驗(yàn)和“2-back任務(wù)”;3、事件相關(guān)電位檢測(cè):視覺P300。將以上結(jié)果進(jìn)行各組比較分析及執(zhí)行功能與事件相關(guān)電位的相關(guān)性分析。結(jié)果:1、總體認(rèn)知比較:(1)MMSE總分:僅HR-NICE組較對(duì)照組降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),NR-NICE組與對(duì)照組、HR-NICE組與NR-NICE組比較均無統(tǒng)計(jì)學(xué)差異(P0.05);(2)MoCA總分:兩病例組均較對(duì)照組降低(P0.05),HR-NICE組較NR-NICE組降低(P0.05),差異具有統(tǒng)計(jì)學(xué)意義。(3)MoCA各分項(xiàng)評(píng)分:與對(duì)照組比較,hr-nice組在多個(gè)分項(xiàng)(視空間/執(zhí)行功能、注意、語言、記憶和抽象)得分均明降低(p0.05),nr-nice組在視空間/執(zhí)行功能、記憶和抽象三項(xiàng)的得分明顯降低(p0.05),具有統(tǒng)計(jì)學(xué)差異;兩病例組比較,hr-nice組各項(xiàng)得分均低于nr-nice組,其中視空間/執(zhí)行功能、注意、語言、記憶四項(xiàng)得分差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。2、執(zhí)行功能比較:(1)畫鐘測(cè)驗(yàn)(cdt):畫鐘測(cè)驗(yàn)得分兩病例組均較對(duì)照組降低(p0.05),hr-nice組較nr-nice組降低(p0.05),差異均具統(tǒng)計(jì)學(xué)意義。(2)連線測(cè)驗(yàn)(tmt):兩病例組與對(duì)照組相比,tmt-a耗時(shí)、tmt-b耗時(shí)延長(zhǎng)(p0.05),干擾量增加(p0.05),均具統(tǒng)計(jì)學(xué)差異;兩病例組間比較,hr-nice組較nr-nice組tmt-b耗時(shí)延長(zhǎng)、干擾量增加(p0.05),tmt-a耗時(shí)無明顯差異(p0.05)。(3)stroop測(cè)驗(yàn):nr-nice組與對(duì)照組相比,沖突條件下反應(yīng)時(shí)間延長(zhǎng)(p0.05),錯(cuò)誤率增加(p0.05),漏報(bào)率無明顯差異(p0.05);hr-nice組與對(duì)照組相比、hr-nice與nr-nice組相比,反應(yīng)時(shí)延長(zhǎng)(p0.05),錯(cuò)誤率、漏報(bào)率增加(p0.05),具統(tǒng)計(jì)學(xué)差異。(4)“2-back任務(wù)”:2-back錯(cuò)誤率兩病例組均較對(duì)照組增加(p0.05),hr-nice組較nr-nice組增加(p0.05),均具統(tǒng)計(jì)學(xué)差異。3、視覺p300檢測(cè):(1)視覺p300潛伏期:兩病例組均較對(duì)照組延長(zhǎng)(p0.05),hr-nice組較nr-nice組延長(zhǎng)(p0.05),差異具有統(tǒng)計(jì)學(xué)意義;(2)視覺p300波幅:兩病例組均較對(duì)照組降低(p0.05),hr-nice組較nr-nice組降低(p0.05),差異具有統(tǒng)計(jì)學(xué)意義。4、相關(guān)性分析:tmt-a耗時(shí)、tmt-b耗時(shí)、tmt干擾量、stroop反應(yīng)時(shí)、Stroop錯(cuò)誤率、Stroop漏報(bào)率、2-back錯(cuò)誤率與視覺P300潛伏期呈正相關(guān),與視覺P300波幅呈負(fù)相關(guān),均具有較好的相關(guān)性。結(jié)論:1、NICE患者存在認(rèn)知功能損害,Mo CA量表在檢測(cè)NICE患者認(rèn)知功能障礙方面較MMSE量表更敏感。2、NICE患者執(zhí)行功能(任務(wù)轉(zhuǎn)換、反應(yīng)抑制、記憶刷新)均受損,HR-NICE患者執(zhí)行功能損害較NR-NICE患者更明顯。3、NICE患者視覺P300潛伏期、波幅與連線測(cè)驗(yàn)、Stroop測(cè)驗(yàn)、2-back任務(wù)均具有較好的相關(guān)性,可作為評(píng)估NICE執(zhí)行功能損害的電生理指標(biāo)。
[Abstract]:Objective: To study the functional impairment of non-disabling ischemic cerebrovascular events (NICE), and to conduct event-related potential P300 detection, to analyze the correlation between executive function and P300, and to provide an objective electrophysiological basis for the evaluation of NICE patients. Methods: The patients with NICE diagnosed by the neurology department of the Affiliated Hospital of the Southwest Medical University were selected as the case group. According to the imaging results, it was shown that the risk of recurrence was significantly higher for the two and/ or the intracranial/ extracranial atherosclerotic stenosis in the patients with acute myocardial infarction. As the high-risk NICE group (HR-NICE group), none of the above two indicators were recorded as the general NICE group (NR-NICE group), and the patients with the same period of gender, age, education and no cognitive impairment were selected as the control group. 30 of each group and all the included subjects were completed:1, overall cognitive function test: using the MMSE scale and the MoCA scale;2, performing the function test: the clock test (CDT), the connection test (TMT), the Stroop test and the "2-back task"; and 3, the event-related potential detection: the visual P300. The results were compared and analyzed, and the correlation between executive function and event-related potential was analyzed. Results:1. The overall cognitive comparison: (1) The total MMSE total score: only the HR-NICE group was lower in the control group, the difference had statistical significance (P0.05), the NR-NICE group and the control group, the HR-NICE group and the NR-NICE group had no statistical difference (P0.05); (2) the total score of MoCA: the control group was lower in both cases (P0.05). The difference of HR-NICE group and NR-NICE group was lower (P0.05). (3) The score of each sub-item of MoCA: compared with the control group, the scores of the hr-nice group in a plurality of sub-items (visual space/ executive function, attention, language, memory and abstract) were reduced (p0.05), and the score of the nr-nice group in the visual space/ executive function, memory and abstract was significantly reduced (p0.05). There was a statistical difference; in the two case groups, the scores of the hr-nice group were lower than that of the nr-nice group, and the difference of the four scores of the visual space/ executive function, the attention, the language and the memory was of statistical significance (p0.05).2. The function comparison was performed: (1) the clock test (cdt): The scores of the two groups were lower (p0.05) and the r-nice group decreased (p0.05) compared with the control group (p0.05), and the difference was of statistical significance. (2) Connection test (tmt): compared with the control group, the tmt-a was time-consuming, the tmt-b time was prolonged (p0.05), the amount of interference (p0.05) was increased (p0.05), and the amount of interference increased (p0.05). There was no significant difference in tmt-a (p0.05). (3) There was no significant difference in the reaction time (p0.05), the error rate (p0.05) and the rate of missed report (p0.05) in the r-nice group compared with the control group (p0.05). There was a statistical difference. (4) The "2-back task":2-back error rate increased with the control group (p0.05), and the hr-nice group increased (p0.05) compared with the nr-nice group (p0.05). The visual p300 detection: (1) the visual p300 latency: the two case groups were prolonged (p0.05) and the hr-nice group was prolonged (p0.05) compared with the nr-nice group (p0.05). the difference was of statistical significance; (2) the amplitude of the visual p300: the lower of the control group (p0.05) and the decrease of the r-nice group in the hr-nice group (p0.05), and the difference was of statistical significance.4. The correlation analysis: tmt-a is time-consuming, tmt-b is time-consuming, tmt interference amount, The 2-back error rate was positively correlated with the latency of the visual P300, and there was a negative correlation with the amplitude of the visual P300. Conclusion:1. The cognitive function of NICE patients is impaired, and the Mo CA scale is more sensitive to the detection of the cognitive impairment of NICE patients.2. The NICE patients perform the function (task conversion, reaction inhibition, memory refresh), and the performance of the HR-NICE patients is more obvious than that of the NR-NICE patients. The P300 latency, the amplitude and the connection test, the Stroop test and the 2-back tasks of the NICE patients had good correlation, and can be used as the electrical physiological index to evaluate the NICE performance damage.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2506100
[Abstract]:Objective: To study the functional impairment of non-disabling ischemic cerebrovascular events (NICE), and to conduct event-related potential P300 detection, to analyze the correlation between executive function and P300, and to provide an objective electrophysiological basis for the evaluation of NICE patients. Methods: The patients with NICE diagnosed by the neurology department of the Affiliated Hospital of the Southwest Medical University were selected as the case group. According to the imaging results, it was shown that the risk of recurrence was significantly higher for the two and/ or the intracranial/ extracranial atherosclerotic stenosis in the patients with acute myocardial infarction. As the high-risk NICE group (HR-NICE group), none of the above two indicators were recorded as the general NICE group (NR-NICE group), and the patients with the same period of gender, age, education and no cognitive impairment were selected as the control group. 30 of each group and all the included subjects were completed:1, overall cognitive function test: using the MMSE scale and the MoCA scale;2, performing the function test: the clock test (CDT), the connection test (TMT), the Stroop test and the "2-back task"; and 3, the event-related potential detection: the visual P300. The results were compared and analyzed, and the correlation between executive function and event-related potential was analyzed. Results:1. The overall cognitive comparison: (1) The total MMSE total score: only the HR-NICE group was lower in the control group, the difference had statistical significance (P0.05), the NR-NICE group and the control group, the HR-NICE group and the NR-NICE group had no statistical difference (P0.05); (2) the total score of MoCA: the control group was lower in both cases (P0.05). The difference of HR-NICE group and NR-NICE group was lower (P0.05). (3) The score of each sub-item of MoCA: compared with the control group, the scores of the hr-nice group in a plurality of sub-items (visual space/ executive function, attention, language, memory and abstract) were reduced (p0.05), and the score of the nr-nice group in the visual space/ executive function, memory and abstract was significantly reduced (p0.05). There was a statistical difference; in the two case groups, the scores of the hr-nice group were lower than that of the nr-nice group, and the difference of the four scores of the visual space/ executive function, the attention, the language and the memory was of statistical significance (p0.05).2. The function comparison was performed: (1) the clock test (cdt): The scores of the two groups were lower (p0.05) and the r-nice group decreased (p0.05) compared with the control group (p0.05), and the difference was of statistical significance. (2) Connection test (tmt): compared with the control group, the tmt-a was time-consuming, the tmt-b time was prolonged (p0.05), the amount of interference (p0.05) was increased (p0.05), and the amount of interference increased (p0.05). There was no significant difference in tmt-a (p0.05). (3) There was no significant difference in the reaction time (p0.05), the error rate (p0.05) and the rate of missed report (p0.05) in the r-nice group compared with the control group (p0.05). There was a statistical difference. (4) The "2-back task":2-back error rate increased with the control group (p0.05), and the hr-nice group increased (p0.05) compared with the nr-nice group (p0.05). The visual p300 detection: (1) the visual p300 latency: the two case groups were prolonged (p0.05) and the hr-nice group was prolonged (p0.05) compared with the nr-nice group (p0.05). the difference was of statistical significance; (2) the amplitude of the visual p300: the lower of the control group (p0.05) and the decrease of the r-nice group in the hr-nice group (p0.05), and the difference was of statistical significance.4. The correlation analysis: tmt-a is time-consuming, tmt-b is time-consuming, tmt interference amount, The 2-back error rate was positively correlated with the latency of the visual P300, and there was a negative correlation with the amplitude of the visual P300. Conclusion:1. The cognitive function of NICE patients is impaired, and the Mo CA scale is more sensitive to the detection of the cognitive impairment of NICE patients.2. The NICE patients perform the function (task conversion, reaction inhibition, memory refresh), and the performance of the HR-NICE patients is more obvious than that of the NR-NICE patients. The P300 latency, the amplitude and the connection test, the Stroop test and the 2-back tasks of the NICE patients had good correlation, and can be used as the electrical physiological index to evaluate the NICE performance damage.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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