皮质下血管认知障碍早期注意损害的关联性负变研究  

The study of sustain attention of CNV in patients with subcortical ischemic vascular cognitive impairment

作　　者：李玲[1] 郑健[1] 周竹娟[1] 陈晓燕[1] 

机构地区：[1]第三军医大学新桥医院神经内科,重庆400038

出　　处：《中国神经精神疾病杂志》2014年第4期193-197,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的观察皮质下缺血性血管性认知损害(subcortical ischemic vascular cognitive impairment,SIVCI)患者关联性负变(contingent negative variation,CNV)变化特征及其与计算机辅助测验-持续操作任务(continuous performance task,CPT)的相关性,探求反映SIVCI早期注意损害的神经电生理指标,促进诊断水平的提高。方法应用意大利EB-Neuro事件相关电位工作站,对15例皮质下缺血性血管性痴呆(subcortical ischemic vascular dementia,SIVD)患者,30例皮质下缺血性血管性认知损害非痴呆型(subcortical ischemic vascular cognitive impairment no dementia,SIVCIND)患者和15名正常对照(normal control,NC)检测CNV命令信号前期待波(expectancy wave,EW)的潜伏期、波幅和面积。结果①与正常对照相比,SIVCI患者CNV波形欠规则;SIVCIND患者CNV EW波幅降低(9.98±4.10μV vs.16.13±2.75μV,P<0.05),平均面积减少(14848.10±3199.16μV·ms vs.20058.87±1025.95μV·ms(P<0.05),潜伏期差异无统计学意义(F(2,57)=1.90,P>0.05);SIVD患者较SIVCIND患者EW波幅进一步降低(6.25±1.52μV vs.9.98±4.10μV,P<0.05),平均面积进一步减少(8474.00±3511.94 vs.14848.10±3199.16μV·ms,P<0.05);②EW潜伏期与CPT反应时呈正相关(R=0.748,P<0.01),与CPT漏报率无相关性(R=0.22,P>0.05);EW波幅与CPT反应时呈负相关(R=-0.616,P<0.01),与CPT漏报率无相关性(R=-0.191,P>0.05);EW平均面积与CPT反应时呈负相关(R=-0.718,P<0.01);与CPT漏报率呈负相关(R=-0.829,P<0.01)。结论 SIVCI患者早期可能即存在注意保持等认知异常;CNV EW平均面积可能为一个较好反映持续注意损害的神经电生理指标。Objective To investigate the characteristics of contingent negative variation （CNV） in patients with subcortical ischemic vascular cognitive impairment （SIVCI） and their relationship with continuous performance task （CPT） to establish a neuroelectrophysiological index of attention impairment in earlier period of Vascular Cognitive Impairment. Methods CNV was assessed in 45 SIVCI patients [30 patients with subcortical ischemic vascular cognitive impairment no dementia （SIVCIND） and 15 patients with subcortical ischemic vascular dementia （SIVD）] and 15 normal control （NC） by using a EB-Neuro ERP Instrument. Results O） CNV in SIVCI group were less regular compared with normal control; CNV in SIVCIND group had decreased Expectancy Wave （EW） amplitudes （9.98± 4.10μV vs. 16.13±2.75 μV） and EW areas （14848.10±3199.16 μV · ms vs 20058.87±1025.95μV· ms） compared with normal control （P〈 0.05）;EW amplitudes （6.25±1.52 μV vs. 9.98± 4.10 μV） and EW areas （8474.00±3511.94 vs. 14848.10±3199.16 μV · ms） of CNV in SIVD group were significantly lower compared with SIVCIND group （P〈 0.05）; However, there was no significant difference in CNV EW latency among three groups （F（2,57）= 1.90, P〉0.05 ） ;②Pearson correlation／Spearman rank correlation analysis revealed that there were significant, positive correlations between EW latency and CPT Reacting time （R=0.748, P〈0.01 ）; there were no significant relationships between CPT missing rate and EW latency （R=0.22, P〉 0.05 ） , EW amplitude （R=-0.191, P〉0.05 ）and there were significant, negative correlations between EW area and CPT Reacting time （R=-0.718, P〈0.01） , CPT missing rate （R=-0.829 , P〈0.01 ）, EW amplitude and CPT Reacting time （R=-0.616, P〈0.01 ）. Coneluslon SIVCI patients in early stage have attention deficits in sustained attention and CNV EW area may be a good neuroelectrophysiological index for sustained attention impairment.

关 键 词：血管性认知损害 关联性负变 持续注意 

分 类 号：R749.13[医药卫生—神经病学与精神病学]