非致残性缺血性脑血管事件患者执行功能及视觉事件相关电位P300的临床研究
发布时间：2019-06-26 09:43
【摘要】：目的:本文旨在探讨非致残性缺血性脑血管事件(NICE)患者的执行功能损害特征,并进行事件相关电位P300检测,分析执行功能改变与P300的相关性,为NICE患者的执行功能评估提供客观的电生理依据。方法:选取西南医科大学附属医院神经内科住院病人中确诊的NICE患者为病例组,根据影像学结果,显示为急性梗死病灶≥2个和(或)颅内/外大动脉粥样硬化性狭窄≥50%者预示复发风险显著增高,记为高危NICE组(HR-NICE组),以上两项指标均未达到者记为普通NICE组(NR-NICE组),选取性别、年龄、教育程度匹配且无认知损害的同期住院患者为对照组。每组各30例,所有纳入对象均完成:1、总体认知功能测试:采用MMSE量表和MoCA量表;2、执行功能测试:画钟测验(CDT),连线测验(TMT),Stroop测验和“2-back任务”;3、事件相关电位检测:视觉P300。将以上结果进行各组比较分析及执行功能与事件相关电位的相关性分析。结果:1、总体认知比较:(1)MMSE总分:仅HR-NICE组较对照组降低,差异具有统计学意义(P0.05),NR-NICE组与对照组、HR-NICE组与NR-NICE组比较均无统计学差异(P0.05);(2)MoCA总分:两病例组均较对照组降低(P0.05),HR-NICE组较NR-NICE组降低(P0.05),差异具有统计学意义。(3)MoCA各分项评分:与对照组比较,hr-nice组在多个分项(视空间/执行功能、注意、语言、记忆和抽象)得分均明降低(p0.05),nr-nice组在视空间/执行功能、记忆和抽象三项的得分明显降低(p0.05),具有统计学差异;两病例组比较,hr-nice组各项得分均低于nr-nice组,其中视空间/执行功能、注意、语言、记忆四项得分差异具有统计学意义(p0.05)。2、执行功能比较:(1)画钟测验(cdt):画钟测验得分两病例组均较对照组降低(p0.05),hr-nice组较nr-nice组降低(p0.05),差异均具统计学意义。(2)连线测验(tmt):两病例组与对照组相比,tmt-a耗时、tmt-b耗时延长(p0.05),干扰量增加(p0.05),均具统计学差异;两病例组间比较,hr-nice组较nr-nice组tmt-b耗时延长、干扰量增加(p0.05),tmt-a耗时无明显差异(p0.05)。(3)stroop测验:nr-nice组与对照组相比,冲突条件下反应时间延长(p0.05),错误率增加(p0.05),漏报率无明显差异(p0.05);hr-nice组与对照组相比、hr-nice与nr-nice组相比,反应时延长(p0.05),错误率、漏报率增加(p0.05),具统计学差异。(4)“2-back任务”:2-back错误率两病例组均较对照组增加(p0.05),hr-nice组较nr-nice组增加(p0.05),均具统计学差异。3、视觉p300检测:(1)视觉p300潜伏期:两病例组均较对照组延长(p0.05),hr-nice组较nr-nice组延长(p0.05),差异具有统计学意义;(2)视觉p300波幅:两病例组均较对照组降低(p0.05),hr-nice组较nr-nice组降低(p0.05),差异具有统计学意义。4、相关性分析:tmt-a耗时、tmt-b耗时、tmt干扰量、stroop反应时、Stroop错误率、Stroop漏报率、2-back错误率与视觉P300潜伏期呈正相关,与视觉P300波幅呈负相关,均具有较好的相关性。结论:1、NICE患者存在认知功能损害,Mo CA量表在检测NICE患者认知功能障碍方面较MMSE量表更敏感。2、NICE患者执行功能(任务转换、反应抑制、记忆刷新)均受损,HR-NICE患者执行功能损害较NR-NICE患者更明显。3、NICE患者视觉P300潜伏期、波幅与连线测验、Stroop测验、2-back任务均具有较好的相关性,可作为评估NICE执行功能损害的电生理指标。
[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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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