摘要
背景我国腔隙性脑梗死患者约占所有缺血性脑卒中患病人数的42.3%,其中认知功能损伤发生率为47%~75%,其起病隐匿,可导致血管性痴呆,因此早期识别该类患者的神经电生理变化特征已成为亟须解决的重大科学问题。目的探讨腔隙性脑梗死患者轻度认知功能损伤的神经电生理特征及临床意义。方法选取2014—2019年华北理工大学附属开滦总医院神经内科收治的腔隙性脑梗死患者464例,根据简明智能状态量表(MMSE)评分分为观察1组(MMSE评分为27~30分,352例)和观察2组(MMSE评分为21~26分,112例);另选取本院同期体检健康者100例作为对照组。比较三组心脑血管疾病危险因素(包括吸烟、饮酒、高血压、糖尿病、高脂血症、高同型半胱氨酸血症)、脑梗死病灶分布情况及脑听觉事件相关电位(ERP)波群P1、N1、P2、N2、P3波峰潜伏期、波幅在FZ、CZ、PZ导联时的变化情况,另比较三组记忆力、注意力/计算力及执行力情况。结果观察1组、观察2组吸烟率、饮酒率及高血压、高同型半胱氨酸血症发生率高于对照组(P<0.05);观察2组高同型半胱氨酸血症发生率高于观察1组(P<0.05);观察1组、观察2组额叶、颞叶、顶叶、枕叶、半卵圆中心、丘脑、海马、基底核、侧脑室梗死发生率比较,差异无统计学意义(P>0.05)。观察2组脑听觉ERP波群P1在PZ导联时波峰潜伏期长于对照组,N2、P3在FZ、CZ、PZ导联时波峰潜伏期长于对照组、观察1组,观察1组脑听觉ERP波群N2、P3在FZ、CZ、PZ导联时波峰潜伏期长于对照组(P<0.05)。三组脑听觉ERP波群P1在FZ、CZ导联时波峰潜伏期及N1、P2在FZ、CZ、PZ导联时波峰潜伏期比较,差异无统计学意义(P>0.05)。观察2组脑听觉ERP波群N2在FZ导联时波幅小于对照组,观察1组、观察2组脑听觉ERP波群P3在FZ、CZ、PZ导联时波幅小于对照组,观察2组脑听觉ERP波群P3在PZ导联时波幅小于观察组1(P<0.05)。三组脑听觉ERP波群P1、N1、P2在FZ、CZ、PZ导联时波幅及N2在CZ、PZ导联时波幅比较,差异无统计学意义(P>0.05)。观察2组记忆力、注意力/计算力减退发生率高于对照组(P<0.05);观察2组记忆力、注意力/计算力、执行力减退发生率高于观察1组(P<0.05)。结论腔隙性脑梗死患者脑听觉ERP波群P1、N1、P2无明显电生理改变,但脑听觉ERP波群N2、P3波峰潜伏期可随患者认知功能减退而延长、波幅明显降低,即认知电位改变是腔隙性脑梗死患者轻度认知功能损伤的亚临床状态。
Background Patients with multiple lacunar infarction in China account for about 42.3%of all ischemic stroke patients,of which the incidence of cognitive impairment is 47%to 75%.It is often hidden and can lead to vascular dementia,so early identification of the characteristics of neuroelectrophysiological of those patients has become a major scientific problem.Objective To observe the neurophysiological characteristics and clinical significance of mild cognitive impairment in patients with lacunar infarction.Methods 464 patients with lacunar infarction admitted to the Department of Neurology,Kailuan General Hospital Affiliated to North China University of Science and Technology from 2014 to 2019,and they were divided into observation group 1〔Mini-Mental State Examination(MMSE)score was 27~30,n=352〕and observation group 2(MMSE score was 21~26,n=112)according to the MMSE score;another 100 cases of health examinations in our hospital during the same period were selected as control group.The risk factors of cerebrovascular diseases(including smoking,drinking,hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia),the distribution of cerebral infarction lesions and the changes of wave groups associated with brain auditory event related potential(ERP)P1,N1,P2,N2,P3 peak latency and amplitude in FZ,CZ,PZ leads were compared in the three groups.In addition,the memory,attention/computing ability and execution ability of the three groups were compared.Results Smoking rate,drinking rate and incidence of hypertension and hyperhomocysteinemia in observation group 1 and observation group 2 were higher than those in control group(P<0.05).Incidence of hyperhomocysteinemia in observation group 2 was higher than those in observation group 1(P<0.05).There was no statistically significant difference in incidence of infarction of the frontal lobe,temporal lobe,parietal lobe,occipital lobe,semi-oval center,thalamus,hippocampus,basal ganglia or lateral ventricle between observation group 1 and observation group 2(P>0.05).Brain auditory ERP wave group P1 peak latency in PZ lead in observation group 2 was longer than that in control group,N2,P3 peak latency in FZ,CZ,PZ leads in observation group 2 were longer than those in control group and observation group 1,brain auditory ERP wave group N2,P3 peak latency in FZ,CZ,PZ leads in observation group 1 were longer than those in control group(P<0.05).There was no statistically significant difference in brain auditory ERP wave group peak latency of P1 in FZ and CZ leads and peak latency of N1 and P2 in FZ,CZ and PZ leads in the three groups(P>0.05).The amplitude of brain auditory ERP wave group N2 in FZ lead in observation group 2 was smaller than that in control group,amplitude of brain auditory ERP wave group P3 in FZ,CZ and PZ leads in observation group 1 and observation group 2 were smaller than that in control group,amplitude of the brain auditory ERP wave group P3 in PZ lead in observation group 2 was smaller than that in observation group 1(P<0.05).There was no statistically significant difference in amplitudes of brain auditory ERP wave group P1,N1 and P2 in leads of FZ,CZ,PZ and N2 in leads of CZ and PZ in the three groups(P>0.05).The incidence of memory,attention/computing ability decline in observation group 2 was higher than that in control group(P<0.05);the incidence of memory,attention/computing ability,and execution ability decline in observation group 2 was higher than that in observation group 1(P<0.05).Conclusion There is no obvious electrophysiological change in the brain auditory ERP wave group P1,N1,P2 in patients with lacunar infarction,but the brain auditory ERP wave group N2,P3 peak latency can be extended with the decline of the patients'cognitive function,and the amplitude is significantly reduced,that is,cognitive potential changes can early suggest a subclinical state of mild cognitive impairment in patients with lacunar infarction.
作者
郑慧
元小冬
张萍淑
王京
张健
李雪梅
刘业松
ZHENG Hui;YUAN Xiaodong;ZHANG Pingshu;WANG Jing;ZHANG Jian;LI Xuemei;LIU Yesong(Department of Neurology,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Key Laboratory of Neurobiological Function in Hebei Province,Tangshan 063000,China)
出处
《实用心脑肺血管病杂志》
2020年第7期65-70,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
2020年度河北省医学科学研究课题计划(20201283,20201289)。
