焦虑型与忧郁型抑郁障碍患者事件相关电位N400的比较研究  

A Comparative Study of Event-related Potential N400 between Anxious and Melancholic Depression

作　　者：都业铭 张云巧 韩敏 王彦芳[2] DU Yeming;ZHANG Yunqiao;HAN Min;WANG Yanfang(The First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China;Department of Psychiatry,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一临床医学院,山西省太原市030001 [2]山西医科大学第一医院精神卫生科,山西省太原市030001

出　　处：《中国全科医学》2022年第36期4546-4553,共8页Chinese General Practice

基　　金：山西省自然科学基金资助项目(2022140);山西省自然科学基金资助项目(201801D121345);山西省136兴医工程项目;国家重点研发计划(2016YFC1307103)。

摘　　要：背景 重性抑郁障碍(MDD)包含多种亚型,目前亚型区分多基于症状学特征,缺乏客观的生物学指标。目的 探究不同抑郁亚型患者事件相关电位(ERP)N400的差异,为抑郁亚型分型提供客观电生理依据。方法 选取2019年2月至2021年12月山西医科大学第一医院精神卫生科门诊或住院部符合《精神障碍诊断与统计手册第5版》中MDD诊断标准的患者,采用30项抑郁障碍症状量表(IDS-30)、17项汉密尔顿抑郁量表(HAMD-17)对患者进行亚型分型,最终纳入78例单纯焦虑型MDD(ASD+MD-组)、46例单纯忧郁型MDD(ASD-MD+组)、61例焦虑忧郁型MDD(ASD+MD+组)、24例非焦虑忧郁型MDD(ASD-MD-组),同期招募社区健康志愿者35例作为对照组。评估所有受试者HAMD-17、重复性成套神经心理状态测验(RBANS)的总分及因子分;通过句末歧义词诱发N400成分,采集所有受试者N400的潜伏期及波幅。结果 (1)MDD各亚组及对照组的HAMD-17总分及各因子分比较,差异均有统计学意义(P<0.05),其中HAMD-17总分MDD各亚组均高于对照组,ASD+MD+组高于ASD-MD+组和ASD-MD-组,ASD+MD-组高于ASD-MD+组,差异均有统计学意义(P<0.05);焦虑因子分MDD各亚组均高于对照组,ASD+MD-组高于ASD-MD+组、ASD-MD-组,ASD+MD+组高于ASD-MD+组、ASD-MD-组,差异均有统计学意义(P<0.05);体重因子分ASD+MD+组、ASD+MD-组均高于对照组,ASD+MD+组高于ASD-MD+组、ASD-MD-组,差异均有统计学意义(P<0.05);认知障碍因子分MDD各亚组均高于对照组,ASD+MD+组高于ASD-MD+组,差异均有统计学意义(P<0.05);MDD各亚组的阻滞因子分、睡眠障碍因子分均高于对照组,差异有统计学意义(P<0.05)。(2)MDD各亚型组及对照组的RBANS总分及各因子分比较,差异均有统计学意义(P<0.05),MDD各亚组的即刻记忆、视觉广度、言语功能、注意、延时记忆因子分及RBANS总分均低于对照组(P<0.05);ASD+MD+组的即刻记忆因子分低于ASD-MD+组(P<0.05)。(3)不同组别间潜伏Background There are many subtypes of major depressive disorder(MDD).Evidence about the differentiation of them is mostly based on symptomatological characteristics,but rarely by objective biological indicators.Objective To explore the differences in event-related potential (ERP) N400 between patients with different subtypes of depression,providing an objective electrophysiological basis for subtyping depression.Methods Two hundred and nine outpatients and inpatients who met the diagnostic criteria of MDD in Diagnostic and Statistical Manual of Mental Disorders,5th Edition were selected from First Hospital of Shanxi Medical University from February 2019 to December 2021,including 78 with anxious depression (ASD+MD-),46 with melancholic depression (ASD-MD+),61 with anxious and melancholic depression(ASD+MD+),and 24 with non-anxious and melancholic depression(ASD-MD-)subtyped using the 30-item Inventory of Depressive Symptomatology (IDS-30) and 17-item Hamilton Depression Rating Scale (HAMD-17).Thirty-five community-living health volunteers were recruited as controls at the same time.The factor and total scores of the HAMD-17 and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)of all subjects were collected.And the latency and amplitude of N400 component of all subjects were collected by inducing N400 components through understanding ambiguous words at the end of sentences.Results (1)The total score and factor scores of HAMD-17 differed significantly across MDD subgroups and control group (P0.05).There were no significant differences in latency and amplitude of N400 component across different electrode sites (P>0.05),and there were no interaction between no-depression or each of the four subtypes of MDD and electrode sites (P>0.05).(4)The N400 amplitude value at Fz electrode was negatively correlated with the cognitive impairment factor score (r=-0.170,P=0.016).The N400 amplitude value at Cz electrode was positively correlated with the block factor score(r=0.151,P=0.033).The N400 ampli

关 键 词：重性抑郁障碍 亚型 事件相关电位 N400 

分 类 号：R749.4[医药卫生—神经病学与精神病学]