癫痫患者深睡期血流动力学改变与认知功能障碍的关系  

Relationship between hemodynamic changes during deep sleep and cognitive impair⁃ment in patients with epilepsy

作　　者：张飞飞[1] 高丽华[2] 丁一[2] 孙妍[2] ZHANG Fei-Fei;GAO Li-Hua;DING Yi;SUN Yan(First Outpatient Department,The 980th Hospital of the Joint Support Force of the Chinese People's Liberation Army,Shijia-zhuang,Hebei 050082,China;Department of Neurology,The 982th Hospital of the Joint Support Force of the Chinese People's Liberation Army,Tang-shan,Hebei 400000,China)

机构地区：[1]中国人民解放军联勤保障部队第980医院第一派驻门诊部,河北石家庄050082 [2]中国人民解放军联勤保障部队第982医院神经内科,河北唐山400000

出　　处：《国际神经病学神经外科学杂志》2021年第3期244-248,共5页Journal of International Neurology and Neurosurgery

基　　金：国家自然科学基金(81874429);湖南省卫生计生委科研课题(20200009,B2019047);湖南省自然科学基金(2019JJ80027,2019JJ80094,2020JJ5294,2020JJ8057);湖南省教育厅科研项目(19B440);湖南省中医药管理局科研计划项目(202145)。

摘　　要：目的探究癫痫患者深睡期血流动力学参数与认知功能障碍关系。方法选取2015年2月至2020年2月该院收治的102例癫痫患者作为癫痫组,按照蒙特利尔认知评估量表(MoCA)将患者分为认知障碍组(35例,MoCA<26分)和无认知障碍组(67例,MoCA≥26分),另选该院体检健康人员32例作为正常对照组。同步监测所有纳入对象深睡期(N3+N4期)脑电波及血流动力学变化,并分析其与患者认知功能的关系。结果认知障碍组初发年龄低于无认知障碍组;病程、每月发作次数、全面发作比例高于无认知障碍组,差异具有统计学意义(P<0.05)。认知障碍组、无认知障碍组REM、N1期、N2期高于正常对照组;N3+N4期低于正常对照组(P<0.05)。认知障碍组REM、N1期高于无认知障碍组;N3+N4期、TST低于无认知障碍组(P<0.05)。认知障碍组深睡期发作期间痫样放电(IED)指数低于无认知障碍组;非快速动眼睡眠期棘波指数(SWI)高于无认知障碍组,差异具有统计学意义(P<0.05)。认知障碍组深睡期大脑中动脉平均血流速度(CBFVm)、CBFV波动程度高于无认知障碍组和正常对照组,差异具有统计学意义(P<0.05);无认知障碍组和正常对照组深睡期CBFVm、CBFV波动程度比较差异无统计学意义(P>0.05)。结论癫痫患者深睡期存在明显的血流动力学变化,其中CBFV波动与患者认知功能下降有关。Objective To explore the relationship between hemodynamic changes during deep sleep and cognitive impair-ment in patients with epilepsy.Methods One hundred and two patients with epilepsy who were admitted to the hospital from February 2015 to February 2020 were enrolled in epilepsy group,which was further divided into cognitive impairment group[n=35,Montreal Cognitive Assessment(MoCA)score<26]and non-cognitive impairment group(n=67,MoCA score≥26);32 healthy subjects who underwent physical examinations in the hospital were enrolled in normal control group.The brain waves and hemodynamic changes during deep sleep(N3+N4 stage)of all included subjects were monitored simul-taneously,and their relationships with cognitive function were analyzed.Results The cognitive impairment group had sig-nificantly lower age of onset and significantly increased duration of disease,number of monthly seizures,and proportion of generalized seizures compared with the non-cognitive impairment group(P<0.05).Compared with the normal control group,the cognitive impairment group and non-cognitive impairment group had significantly longer rapid eye movement(REM),N1,and N2 stages and a significantly shorter N3+N4 stage(P<0.05).The cognitive impairment group had significantly longer REM and N1 stages but significantly shorter N3+N4 stage and total sleep time compared with then on-cognitive impairment group(P<0.05).The cognitive impairment group had a significantly lower interictal epileptiform discharge index during deep sleep and a significantly higher spike-wave index during non-REM sleep compared with the non-cognitive im-pairment group(P<0.05).Compared with the non-cognitive impairment group and normal control group,the cognitive im-pairment group had significantly increased mean cerebral blood flow velocity(CBFVm)of the middle cerebral artery and de-gree of CBFV fluctuation during deep sleep(P<0.05);there were no significant differences in CBFVm and degree of CBFV fluctuation during deep sleep between the non-cognitive impairment group a

关 键 词：癫痫 视频脑电图 深睡期 血流动力学 认知功能 

分 类 号：R742.1[医药卫生—神经病学与精神病学]