注意缺陷障碍与精神发育迟滞及品行障碍患儿诱发电位的比较

The clinical application of visual evoked potential and auditory evoked potential in patients with attention de-ficit and hyperactive disorder, mental retardation and conduct disorder

目的探讨注意缺陷障碍(ADHD)、精神发育迟滞(MR)及品行障碍(CD)患儿诱发电位指标变异的意义。方法收集37例ADHD(ADHD组)、24例MR(MR组)、22例CD(CD组)患儿及30例正常儿童(NC组),应用美国Nicolet Spirit脑电生理仪以及光、声刺激,完成视觉诱发电位(VEP)和听觉诱发电位(AEP)检查。结果ADHD组、MR组、CD组及NC组在VEP潜伏期N1、P2(Oz脑区),波幅P2、P3(Cz脑区)和波幅P3(Oz脑区)上差异有统计学意义(P<0.05～0.01)。在AEP上,潜伏期N2(Pz脑区)、P3(Oz脑区)以及波幅N1、P2(Pz脑区)和波幅N1(Oz脑区)上差异也有统计学意义(P<0.05～0.01)。与NC组相比[NC组Oz脑区VEP-N1潜伏期(107±22)ms,Pz脑区AEP-N2(219±28)ms],MR组无论是VEP还是AEP均表现为潜伏期延迟[MR组Oz脑区VEP-N1潜伏期(129±29)ms,Pz脑区AEP-N2(244±27)ms,P<0.05～0.01和波幅下降];ADHD组VEP潜伏期P2前移[Oz脑区VEP/P2NC组(188±28)ms,ADHD组(167±30)ms,P<0.01]、AEP/N2、P3延迟,波幅VEP降低,AEP/N1和P2波幅升高[Oz脑区/N1NC组(4.5±1.9)μV,ADHD组(6.3±3.4)μV;Pz脑区/P2NC组(2.3±1.2)μV,ADHD组(4.2±2.2)μV,P均<0.01],CD组变化程度介于ADHD组和MR组之间。结论MR患儿的诱发电位主成份延迟,波幅降低;而ADHD患儿若干主成份前移,波幅增高的现象值得进一步观察。

Objective To investigate the clinical application of various parameters of visual evoked potential （VEP） and auditory evoked potential （AEP） in patients with attention deficit and hyperactive disorder （ADHD）, mental retardation （MR） and conduct disorder （CD）. Methods Thirty-seven ADHD patients, 24 MR patients, 22 CD patients and 36 normal subjects were included in this study. The VEP and AEPwere recorded from every subject and analyzed. Results A significant difference was found among 4 subject groups, with both latencies （Oz/N1, P2） and amplitudes ofVEP （Cz/P2, P3 and Oz/P3） （P 〈0.05 - 0.01）, and significant difference among 4 subject groups was found with both latencies （ Pz/N2 and Oz/P3 ） and amplitudes （Pz/N1, P2 and Oz/N3） （P〈0.05 - 0.01） of AEP. Compared with normal subjects, those in the MR group showed shortened latencies and decreased amplitude of AEP and VEP（ normal subjects： N1 latency of VEP/Oz 107±22 ms, N： latency of AEP/Pz 219 ±28 ms ; MR： N1 latency of VEP/Oz 129±29 ms, N2 latency of AEP/Pz 244±27 ms） （P〈0.01） , ADHD group had shortened VEP/P2 latency （P2 latency of VEP/Oz： 188 ±28 ms in normal group, 167±30 ms in ADHD group, P〈0.01） delayed AEP/N2,P3, decreased VEP amplitude and increased AEP/N1 ,P2 amplitudes（ N1 amplitudes from Oz are 4.5 ± 1.9 μV in normal group, 6.3 ±3.4 μV in ADHD group; P2 amplitudes from Pz are 2.3 ±1.2μV in normal group, 4.2 ±2.2μV in ADHD group, P 〈0.01 ） , while EP changes of CD group intermediated that of ADHD and CD. Conclusion The delayed latencies and decreased amplitudes could be seen in MR group, while the shortened lateneies and increased amplitudes could be observed in the ADHD group. The characteristics of the evoked potentials from ADHD and MR patients deserve more intensive studies.