听觉失匹配负波对慢性意识障碍患者脑功能的评估作用分析  

Evaluation of brain function in patients with chronic disorder of consciousness by auditory mismatch negativity

作　　者：夏俊[1] 党圆圆 王俊[1] 苗蔚 张莉[4] 徐立新[1] 杨艺 夏小雨 何江弘 Xia Jun;Dang Yuanyuan;Wang Jun;Miao Wei;Zhang Li;Xu Lixin;Yang Yi;Xia Xiaoyu;He Jianghong(Department of Neurosurgery,First People's Hospital of Changde,Hunan Province,Changde 415000,China;Department of Basic Medicine,School of Medicine,Tsinghua University,Beijing 100084,China;Department of Neurology,First People's Hospital of Changde,Hunan Province,Changde 415000,China;Department of Neurosurgery,Seven Medical Center,General Hospital of People's Liberation Army,Beijing 100700,China)

机构地区：[1]湖南省常德市第一人民医院神经外科,415000 [2]解放军总医院第七医学中心神经外科,北京100700 [3]清华大学医学院基础医学系,北京100084 [4]湖南省常德市第一人民医院神经内科,415000

出　　处：《中华神经医学杂志》2019年第7期715-719,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金青年项目(81600919);北京市科技新星计划(xx2018097).

摘　　要：目的探讨听觉失匹配负波(aMMN)在慢性意识障碍(DOC)患者脑功能评估中的应用价值。方法选择解放军总医院第七医学中心神经外科自2018年4月至6月收治的33例DOC患者与脱离微意识状态(eMCS)患者,通过昏迷恢复量表修订版(CRS-R)评估患者意识水平并将其分成植物状态(VS)、微意识状态(MCS)及eMCS3组;同时纳入14例门诊健康体检者为对照组。比较不同组别患者、不同病因患者及不同侧别大脑aMMN波幅、潜伏期的差异。同时采用Pearson相关性分析明确CRS-R评分与aMMN的相关性。结果(1)VS组、MCS组、eMCS组、对照组中任意2组患者/成员的aMMN波幅差异均有统计学意义(P<0.05);VS组、MCS组潜伏期较对照组明显增加,差异有统计学意义(P<0.05)。(2)按病因分组后,脑外伤组、脑出血组、缺氧性脑病组患者aMMN波幅较对照组明显降低,差异有统计学意义(P<0.05)。(3)按大脑侧别分组后,11例患者病损侧与对侧aMMN波幅差异有统计学意义(t=5.798,P=0.000)。(4)统计结果显示,患者CRS-R评分与aMMN波幅值呈正相关关系(r=0.876,P=0.000);与潜伏期无明显相关性(r=0.018,P=0.922)。结论aMMN波幅值与DOC患者意识水平呈正相关关系,可作为评定DOC患者意识水平、动态评估其意识转归的重要工具。Objective To investigate the application value of auditory mismatch negativity (aMMN) in evaluating the brain function of patients with chronic disorders of consciousness (DOC). Methods Thirty-three patients with DOC or escaped minimally conscious state (eMCS), admitted to our hospital from April to June 2018, were selected in this study. Based on the levels of consciousness assessed by Coma Recovery Scale-Revised (CRS-R), they were divided into vegetative state (VS) group, micro-consciousness state (MCS) group and eMCS group;14 healthy subjects were included as control group. The differences of aMMN amplitude and latency in patients from different groups, patients with different etiologies and different lateral cerebra were compared. Pearson correlation analysis was used to determine the correlation between CRS-R scores and aMMN. Results (1) There was statistically significant difference in aMMN amplitude between patients from any two groups (P<0.05);as compared with that in the control group, the latency of VS group and MCS group was significantly increased (P< 0.05).(2) According to the etiology, the aMMN amplitude of brain injury group, cerebral hemorrhage group and hypoxic encephalopathy group was significantly lower than that of control group (P<0.05).(3) There was significant difference in the amplitude of aMMN between lesion side and contralateral side in 11 patients (t=5.798, P=0.000).(4) Statistical results showed that CRS-R scores were positively correlated with aMMN amplitude (R=0.876, P=0.000), but not with the latency (r=0.018, P=0.922). Conclusion The amplitude of aMMN is significantly positively correlated with levels of consciousness in DOC patients, which can be used as an important tool to assess the levels of consciousness and dynamically estimate the outcomes of consciousness in DOC patients.

关 键 词：失匹配负波 慢性意识障碍 脑功能 植物状态 

分 类 号：R749.1[医药卫生—神经病学与精神病学]