抑郁症治疗前后认知功能及事件相关电位P300的研究

Cognitive function and event-related potential P300 change in depression prior and post-treatment

目的 研究首发抑郁症患者治疗前后的认知功能,P3潜伏期和波幅的变化及影响因素。方法 对26例符合CCMD-3诊断标准的首发抑郁症患者（试验组）给予米氮平（15-30mg/d）治疗,分别于治疗前和治疗后6周评定24项HAMD、韦氏记忆、韦氏成人智力及进行P300检查,26名健康志愿者（对照组）给予韦氏记忆、韦氏成人智力及P300检查,并将试验组与对照组的结果进行比较。结果 ①治疗后试验组的HAMD的得分均显著下降[治疗前后HAMD总分分别为（29.96±5.41）分,（10.92±3.10）分,P〈0.01];②试验组的HAMD总分与再生因子分的改变呈负相关（r=-0.458,P=0.019）;认识障碍因子分的改变与再生因子分的改变呈负相关（r=-0.464,P=0.017）;日夜变化因子的改变与联想因子分的改变呈负相关（r=-0.476,P=0.014）;阻滞因子分的改变与知识因子分的改变呈负相关（r=-0.466,P=0.016）;睡眠障碍分的改变与再认因子分的改变呈负相关（r=-0.415,P=0.035）;绝望感分的改变与数字广度因子分的改变呈负相关（r=-0.449,P=0.021）;③治疗后的韦氏记忆、韦氏成人智力成绩显著改善,P300的P3潜伏期缩短、波幅升高（P〈0.01）;④治疗后的记忆商（MQ）、P3波幅与对照组相比仍有差异（P〈0.01）。结论 抑郁症患者治疗后认知功能有明显改善;抑郁症认知功能的恢复与临床症状的缓解存在一定的相关性;临床症状缓解后的记忆水平及P3波幅仍未恢复到正常水平。

Objective To study the cognitive function ,P3 amplitude and P3 latency change in depressive patients prior and post-treatment. Methods 26 depressed patients with first-episode were given mirtazapine （ 15 - 30mg/d ） for 6 weeks and their conditions were evaluated by using 24-item Hamilton Depression Scale （HAMD）. The cognition function was determined by using Wechsler memory scale （WMS）, Wechsler adult intelligence scale （WAIS-RC） and by P300 change before and after treatment. Another 26 healthysubjects were involved as controls and they were given simultaneously the same tests. Results The HAMD scores of patients were decreased significantly（ P〈0.01 ）. Alleviation in total HAMD score and cognitive disturbance was negatively correlated to the improvement in regenerate, and as were seen in such factors in negative improvement as day and night change in association memory, stoppage in information, sleeping disorder to recognition and feeling of despair to digit span. The depressed patients made improvements in Wais-RC and WMS after medication, and the latency period of P3 was shortened while the amplitude was prolonged （ P〈 0.01 ）. The memory quotient （ P〈 0.05 ） and P3 amplitude （ P 〈 0.01 ） of patients after treatment were still lower than the controls. Conclusion The cognitive function has improved in patients with first-episode depression after medication. To a certain extent, the alleviation in cognition is correlated to the alleviation of the symptoms. Strangely, the memory and the amplitude in P3 could not be restored to normal level even in a relieved symptom.