6-13岁就读于常规学校癫痫儿童的认知功能研究

发布时间：2018-06-11 12:49

本文选题：认知功能 + 影响因素　；参考：《北京协和医学院》2012年博士论文

【摘要】：目的观察6-13岁癫痫患儿的认知功能及情绪行为障碍共患状况,分析影响认知功能的相关因素及其对患儿生活质量的影响。方法采用认知功能测试组套对172例6-13岁接受常规学校或学前教育的不同类型的癫痫患儿进行6项认知功能测试,并以172例年龄、性别及受教育地域相严格匹配的正常儿童作为对照,比较组间认知功能状况；六项认知功能测试包括瑞文推理、选择反应时间、简单减法计算、字词押韵、三维旋转空间、数字数量大小比较测试。采用国内经过标准化的儿童抑郁自评量表和焦虑症状筛查量表和DSM-IVADHD症状诊断量表(父母版),对102例8岁及以上年龄的癫痫患儿进行情绪、行为障碍评估。采用经过我国信效度检验的癫痫患者生活质量量表QOLIE-31问卷测试,调查105例8岁以上儿童的生活质量。统计学方法,癫痫儿童组及正常儿童对照组间比较采用独立样本t检验、χ2检验或fisher精确检验法及Z-标准分一般线性回归模型检验。结果(1)、癫痫儿童与正常对照组儿童相比,癫痫儿童在瑞文推理、选择反应时间、字词押韵、简单减法计算、数字数量大小比较等5项认知测试原始分均低于正常儿童对照组,差异具有极其显著统计学意义,p0.001,三维旋转空间测试原始分两组间差异无统计学意义,p0.05。(2)、在癫痫儿童组,6项认知功能测试均正常者96例(55.8%),存在一项及以上认知功能损害者76例(44.2%),正常儿童对照组6项认知功能测试均正常者147例(85.5%),存在一项及以上认知功能损害者25例(占14.5%),二者相比,差异具有极显著统计学意义,χ2=36.5,p0.001。(3)、61例新诊断癫痫儿童与严格匹配的正常儿童组相比,癫痫儿童瑞文推理、选择反应时、押韵、简单减法计算、数字数量大小比较5项认知测试原始分低于正常儿童对照组,差异具有极其显著统计学意义,p0.001,三维视觉空间测试原始分两组间差异无统计学意义,p0.05。(4)、在本研究中,与癫痫疾病有关的诸因素,如起病年龄、发作类型及抗癫痫药物治疗等对患儿组的认知功能均无明显影响,p均0.05。(5)、能进行生活质量评定8岁及以上癫痫患儿105例,其中既无认知损害亦无共病的患儿生活质量总分最高(60.5±0.9),依次降低者为存在认知损害而无共病组(58.7±1.0)、有共病而无认知损害组(54.9±0.9),而既有认知损害亦存在共病组的患儿生活质量总分(54.6±1.5)最低,差异有极为显著的统计学意义,p0.001,两两比较,既无认知损害亦无共病组患儿生活质量总分明显高于有共病而无认知损害组及既有认知损害亦有共病组患儿,差异有统计学意义,p0.05。结论近半数6-13岁常规学校的癫痫儿童存在不同程度的认知功能损害,即使新诊断尚未服用抗癫痫药物的患儿,与正常同龄儿童相比,其认知功能明显低下,认知损害与起病年龄、发作类型、是否接受抗癫痫药物治疗及情绪行为障碍共患与否均无明显相关。新诊断癫痫患儿认知损害的机制仍需进一步研究。癫痫患儿情绪行为障碍共患率颇高。存在情绪行为共患病及认知功能损害的患儿的生活质量较无共病及认知损害的患儿明显下降,故应对癫痫患者进行全面的神经心理评估,在控制发作的同时,避免或减轻认知损害并改善认知功能,重视情绪行为共病的治疗,才能提高癫痫患儿的生活质量。
[Abstract]:Objective To observe the cognitive function of 6 - 13 years old children with epilepsy and the status of emotional behavior disorder , analyze the factors influencing cognitive function and their influence on the quality of life of children .
Six cognitive function tests included Swedish reasoning , selective reaction time , simple subtraction , word rhyme , three - dimensional rotational space , and digital number size comparison test .

Results ( 1 ) In the children with epilepsy , the children with epilepsy were compared with those of the normal control group . There were no significant differences between the five cognitive tests in children with epilepsy than those in the normal children ( 55.8 % ) , the difference was statistically significant ( P < 0.05 ) . ( 4 ) In the study , there were no significant effects on the cognitive function of children with epilepsy , such as age of onset , type of attack and anti - epileptic drugs , p = 0.05 . ( 5 ) . There were 105 cases of children aged 8 years and above , with no cognitive impairment and no cognitive impairment ( 54.9 卤 0.9 ) . There was no cognitive impairment and no cognitive impairment group ( 54.9 卤 0.9 ) .

Conclusion There is no obvious correlation between cognitive impairment and cognitive impairment in children aged 6 - 13 years old . Even if the new diagnosis has not taken anti - epileptic drugs , the mechanism of cognitive impairment in children with epilepsy is significantly lower .
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R742.1

【参考文献】