听觉事件相关电位P300在胼胝体膝部梗塞中的研究

发布时间：2018-10-29 09:26

【摘要】：目的:探讨胼胝体膝部梗塞患者听觉事件相关电位P300(auditory event-related potential,P300)的特征,以P300为参考诊断胼胝体膝部梗塞的敏感性、特异性及诊断的受试者工作特征曲线(Receiver Operating Characteristic,ROC)下面积(Area under the ROC curve,AUC),进一步了解胼胝体膝部梗塞患者听觉事件相关电位P300的特点,为临床应用其判断胼胝体膝部梗死提供神经电生理诊断依据。方法:选取2012年2月至2016年10月天津医科大学总医院神经内科门诊和住院患者进行分析。筛选其中脑CT和/或脑MRI确诊为胼胝体膝部梗塞患者24例(病例组),与同期健康正常人群26例(对照组)为对照,进行对比研究。应用Nicolet Spirit脑电生理仪对胼胝体膝部梗塞患者及健康对照组进行听觉事件相关电位P300(auditory event-related potential,P300)检测。比较胼胝体膝部梗塞患者及健康对照组听觉事件相关电位P300的特征包括潜伏期、波幅等有无差别。根据贝叶斯定理,以听觉事件相关电位P300潜伏期和波幅为参考指标,计算P300诊断胼胝体膝部梗塞的敏感性、特异性、阳性预测值、阴性预测值、诊断优势比及受试者工作特征曲线(ROC)下面积(AUC)。结果:1.病例组和对照组P300潜伏期分别为339.9±35.3ms和296.9±9.6ms,病例组显著长于对照组(t=4.85,P0.05)。2.病例组和对照组波幅分别为6.1±0.9μV和8.4±0.7μV,病例组显著低于对照组且差别有统计学意义(t=8.79,P0.05)。3.病例组简易精神状态检查表(MMSE)评分平均为23.82±2.48,病例组患者MMSE评分与P300波幅存在明显的相关性(rspreason=0.63,P0.05),但mmse与潜伏期无明显相关性(rspreason=-0.07,P=0.78)。4.以潜伏期为指标,诊断胼胝体膝部梗塞的敏感性为100%,特异性为83.3%,ROC曲线下面积为0.88。5.以波幅为参考指标诊断诊断胼胝体膝部梗塞的敏感性为100%,特异性为95.8%,ROC曲线下面积为0.98。结论:1.胼胝体膝部梗塞患者组与对照组比较听觉事件相关电位P300潜伏期存在差异,胼胝体膝部梗塞患者P300潜伏期明显延长。2.胼胝体膝部梗塞患者组与对照组比较听觉事件相关电位P300波幅存在差异,胼胝体膝部梗塞患者P300波幅显著低于健康人群组。3.胼胝体膝部梗塞患者简易精神状态检查表(MMSE)评分与听觉事件相关电位P300波幅存在正相关性,即随着波幅的增高,MMSE评分升高。4.以听觉事件相关电位P300潜伏期为指标,诊断胼胝体膝部梗塞的敏感性较高,特异性尚可。5.以听觉事件相关电位P300波幅为指标,诊断胼胝体膝部梗塞的敏感性和特异性均较高。
[Abstract]:Objective: to investigate the characteristics of auditory event-related potential (auditory event-related potential,P300) in patients with genu infarction of corpus callosum, and to evaluate the sensitivity, specificity and diagnostic operating characteristic curve (Receiver Operating Characteristic,) of genu infarction of corpus callosum using P300 as reference. To further understand the characteristics of auditory event-related potential (P300) in patients with genu infarction of corpus callosum, and to provide a basis for the clinical diagnosis of genu infarction of corpus callosum. Methods: the outpatients and inpatients of Department of Neurology, General Hospital of Tianjin Medical University from February 2012 to October 2016 were analyzed. Twenty-four patients with genu infarction of corpus callosum were diagnosed by brain CT and / or brain MRI, and 26 healthy subjects (control group) were selected as control group. The auditory event-related potential (auditory event-related potential,P300) was measured by Nicolet Spirit electrophysiological instrument in patients with genu infarction of corpus callosum and healthy control group. To compare the characteristics of auditory event-related potentials (P300) in patients with genu infarction of corpus callosum and healthy controls, including latency and amplitude. According to Bayesian theorem, the sensitivity, specificity, positive predictive value and negative predictive value of P300 in the diagnosis of genu infarction of corpus callosum were calculated by using P300 latency and amplitude of auditory event-related potential as reference indexes. Diagnostic odds ratio and area (AUC). Under operating characteristic Curve (ROC) The result is 1: 1. The latency of P300 in case group and control group was 339.9 卤35.3ms and 296.9 卤9.6 msrespectively, which was significantly longer than that in control group (t = 4.85, P0.05). The amplitudes of the case group and the control group were 6.1 卤0.9 渭 V and 8.4 卤0.7 渭 V, respectively, which were significantly lower than those of the control group (t = 8.79, P 0.05). The average (MMSE) score of mini-mental state examination in the case group was 23.82 卤2.48. There was a significant correlation between MMSE score and P300 amplitude (rspreason=0.63,P0.05), but there was no significant correlation between mmse and latency (rspreason=-0.07,). P0. 78) 4. The sensitivity was 100 and the specificity was 83.3%. The area under the ROC curve was 0.88.5% for the diagnosis of genu infarction of corpus callosum. The sensitivity and specificity of wave amplitude in diagnosing genu infarction of corpus callosum were 100 and 0.98 respectively. Conclusion: 1. Compared with the control group, the latency of P300 was significantly prolonged in the patients with genu infarction of corpus callosum, and the latency of P300 was significantly prolonged in the patients with genu infarction of corpus callosum. 2. The amplitude of P300 in the patients with genu infarction of corpus callosum was significantly lower than that in the control group, and the amplitude of P300 in the patients with genu infarction of corpus callosum was significantly lower than that in the healthy subjects. There was a positive correlation between the (MMSE) score and the P300 amplitude of auditory event-related potential in the patients with genu infarction of corpus callosum, that is, the MMSE score increased with the increase of the amplitude. 4. The latency of auditory event-related potential (P300) was used as an index to diagnose the genu infarction of corpus callosum with a high sensitivity and a specificity of 0.5%. The sensitivity and specificity of P300 amplitude of auditory event-related potential in the diagnosis of genu infarction of corpus callosum were high.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33

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