多发性硬化患者的认知障碍与磁共振成像和事件相关电位的相关性研究  

The Study of Cognitive Impairment in Patients with Multiple Sclerosis and Its Relationship with MRI and ERP

作　　者：李莉莉[1] 张星虎[2] 

机构地区：[1]北京垂杨柳医院神经内科,北京市100022 [2]首都医科大学附属北京天坛医院神经内科

出　　处：《中国全科医学》2011年第8期845-848,共4页Chinese General Practice

摘　　要：目的对多发性硬化(multiple sclerosis,MS)患者的认知状态、神经电生理、影像学特点进行综合评价,初步探讨MS患者认知障碍的发生率、特点和发生机制。方法对28例复发缓解型MS患者进行神经心理评价、事件相关电位(ERP)检查,磁共振成像(MRI)检查。观察MS患者认知障碍发生情况,分析其与ERP及MRI检查异常发现的相关关系。结果 MS患者认知障碍的发生率为71.4%(20/28),其中韦氏成人(或儿童智力)量表测查,全量表智商(FIQ)低于正常(<90分)者17例(60.7%);临床记忆量表检查,记忆商(MQ)低于正常(<90分)者18例(64.3%)。韦氏智力测查,智力有缺损者与无缺损者的MRI病灶等级评分〔分别为(2.5±1.6)分和(1.4±1.5)分〕比较,差异无统计学意义(P>0.05),而临床记忆量表测查病灶等级评分〔分别为(2.7±1.3)分和(0.9±1.4)分〕、额叶病灶评分〔分别为(1.11±0.83)分和(0.40±0.84)分〕间差异均有统计学意义(P<0.05)。综合分析有无认知障碍者病灶等级评分间差异有统计学意义(P<0.05)。有认知障碍与无认知障碍者P300潜伏期间差异有统计学意义(P<0.01)。结论 MS患者有较高的认知功能损害发生率,神经功能缺损、病灶等级评分与之相关。ERP检查也是评价认知功能的有效方法。Objective To evaluate the cognitive impairment,results of neuro-electrophysiological and magnetic resonance image（MRI） and to discuss the frequency,characteristic and mechanism of cognition disorder in patients with multiple sclerosis. Methods Twenty-eight patients with remitting-relapsing multiple sclerosis underwent Event-Related Potentials（ERP）,MRI scan.Wechsler Intelligence Tests and Clinical Memory Scale were used to assess the degree of cognition and affective disorder.The incidence of cognitive disorder was observed and the correlation between the abnormalities and ERP and MRI was analyzed. Results Twenty patients（71.4%） had cognitive disorder,and 17（60.7%） patients′ full intelligence quotient（FIQ） and 18（64.3%） patients′ memory quotient（MQ） were abnormal.MRI lesion grade scale（respectively（2.5±1.6） and（1.4±1.5）） had no significant difference between those with and without intelligence damage according to Wechsler Intelligence Tests（lesion grade scores respectively（2.7±1.3） and（0.9±1.4）,frontal lobe lesion grade scores respectively（1.11±0.83） and（0.40±0.84））,but they had significant difference（P0.05） according to Clinical Memory Scale.Comprehensive analysis showed that there was significant difference（P0.05） between those with and without cognitive impairment in lesion grade.The latent period of P300 had significant difference between those with and without cognitive impairment,but amplitude of P300 did not.By regression analysis,we found that EDSS and education time had a significant influence to FIQ,and MRI lesion grade scale and age had a significant influence to memory quotient. Conclusion Cognitive impairment has a high incidence in MS patients,and has a correlation with neurologic impairment and lesion grade.Event-Related Potentials is also an effective tool to evaluate cognitive function.

关 键 词：多发性硬化 认知障碍 事件相关电位 P300 磁共振成像 

分 类 号：R744.51[医药卫生—神经病学与精神病学]