失匹配负波在评估脑外伤所致精神障碍严重程度中的运用  

Application of Mismatch Negative in Evaluation of Severity of Mental Disorders due to Traumatic Brain Injury

作　　者：李豪喆 刘露 张盛宇 陈琛 刘超 樊慧雨 邢燕 戴婧[3] 张钦廷 蔡伟雄 LI Hao-zhe;LIU Lu;ZHANG Sheng-yu;CHEN Chen;LIU Chao;FAN Hui-yu;XING Yan;DAI Jing;ZHANG Qin-ting;CAI Wei-xiong(Shanghai Key Lab of Forensic Medicine,Key Lab of Forensic Science,Ministry of Justice,Shanghai Forensic Service Platform,Academy of Forensic Science,Shanghai 200063,China;Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310000,China;Shanghai Pudong District Mental Health Center,Shanghai 200124,China)

机构地区：[1]司法鉴定科学研究院上海市法医学重点实验室司法部司法鉴定重点实验室上海市司法鉴定专业技术服务平台,上海200063 [2]浙江省中医院,浙江杭州310000 [3]上海市浦东新区精神卫生中心,上海200124

出　　处：《法医学杂志》2019年第6期695-700,共6页Journal of Forensic Medicine

基　　金：十三五国家重点研发计划资助项目(2016YFC0800701);国家自然科学基金资助项目(81801881);中央级科研院所科研专项资金资助项目(GY2018G-7);国家社会科学基金资助项目(13BFX054);上海市法医学重点实验室资助项目(17DZ2273200);上海市司法鉴定专业技术服务平台资助项目(19DZ2290900)

摘　　要：目的探索失匹配负波(mismatch negative,MMN)在评估脑外伤所致精神障碍者严重程度中的应用价值。方法选取符合《ICD-10精神与行为障碍分类》中器质性(脑外伤)精神障碍诊断标准的被鉴定人35名(病例组),年龄、性别构成比、文化程度与之匹配的正常对照24名(正常对照组)。使用日常生活能力量表(Activity of Daily Living Scale,ADL)、社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)进行评估,完成事件相关电位检查。采用SPSS 22.0软件对数据进行统计分析。结果32名被鉴定人和24名正常对照完成研究。病例组的ADL及SDSS评分均高于正常对照组(P<0.05)。病例组Fz、FCz、Cz和Pz的潜伏期较正常对照组延长(P<0.05)。病例组Fz、FCz、Cz和Pz的潜伏期与ADL及SDSS评分呈正相关(P<0.05)。以ADL评分,SDSS评分,Fz、FCz、Cz和Pz的潜伏期和波幅为协变量,是否患有脑外伤所致精神障碍为因变量,可以较好地拟合得到方程。结论MMN的潜伏期可以作为潜在评估脑外伤所致精神障碍严重程度的指标,即MMN潜伏期越长,提示脑外伤所致精神障碍的症状可能更为严重。联合运用ADL、SDSS和MMN可以作为初步判断脑外伤所致精神障碍的客观指标。Objective To explore the applied value of mismatch negative(MMN) in evaluation of severity of mental disorders due to traumatic brain injury. Methods Thirty-five patients(case group) that conform to the diagnostic criteria of organic(traumatic brain injury) mental disorder in ICD-10 Classification of Mental and Behavioural Disorders criteria were selected. Twenty-four healthy subjects(normal control group) that matched the case group in terms of gender, age composition ratio and educational level were selected. All subjects were evaluated by Activity of Daily Living Scale(ADL) and Social Disability Screening Schedule(SDSS) and then examined by Event-Related Potential(ERP). A statistical analysis of the data was made by SPSS 22.0 software. Results The 32 patients and 24 normal control subjects completed the study. The scores of ADL and SDSS were significantly higher in the case group than in the normal control group(P<0.05). The latency of Fz, FCz, Cz and Pz in the case group was significantly longer than that in the normal control group(P<0.05). In the case group,the latency of Fz, FCz, Cz and Pz was positively correlated with the scores of ADL and SDSS(P<0.05). The equation can be well fitted with the scores of ADL and SDSS. The latency and amplitude of Fz, FCz, Cz and Pz were used as concomitant variables and whether or not the subjects had mental disorders due to traumatic brain injury as dependent variables. Conclusion The latency of MMN can be used as an indicator in potential evaluation of the severity of mental disorders due to traumatic brain injury, which means that the longer the latency of MMN is, the more severe mental disorders due to traumatic brain injury may be. The combined application of ADL, SDSS and MMN can be an objective indicator in preliminary judgment of mental disorders due to traumatic brain injury.

关 键 词：司法精神病学 精神障碍 脑损伤 失匹配负波 事件相关电位 

分 类 号：DF795.3[医药卫生—法医学]