额叶底部脑挫裂伤患者认知功能障碍特征及其机制的初步研究

The preliminary research on the characteristics of the cognitive function and the mechanism in frontal bottom laceration patients

目的 通过分析单侧额叶底部脑挫裂伤患者伤后1个月的认知功能变化特征,对其可能发病机制进行初步探索.方法 应用第2版洛文斯顿作业疗法认知量表（LOTCA）、维斯康星卡片分类量表（WCST）、蒙特利尔评估量表中文版（MoCA）、MMSE分别评估45名健康对照和42例单侧额叶底部中度脑挫裂伤患者（病例组）伤后1个月的神经认知功能;应用事件相关电位（EPR）仪测量认知功能电位P300内源性成分N2、P3的潜伏期及波幅;采用ELISA技术测定血清胆碱酯酶E（AChE）浓度及应用速率法测定其活性;多元逐步回归法分析病例组整体认知功能与损伤部位、AChE浓度及活性的相关性.结果 病例组伤后1个月各项神经认知测试分数均显著低于健康对照组,左侧额叶底部损伤患者（A组,23例）主要表现为句子复述能力、词语流畅性、阅读能力、言语理解能力、认知转移能力等显著下降,而右侧额叶底部损伤患者（B组,19例）则主要表现为注意力、动作运用、视运动组织、图形描绘能力、抽象概括能力、逻辑思维能力等显著下降.病例组EPR P300内源性成分N2、P3潜伏期[A组：（322.4±17.0）、（410.1±19.9）ms,B组：（308.4±15.6）、（385.5±17.4）ms]较健康对照组[（268.6±14.7）、（369.2±15.4）ms]延长（F=4.084,P=0.018;F=3.467,P=0.038）,波幅较对照组降低;A组N2、P3潜伏期较B组患者延长,波幅较其升高;病例组血清AChE水平高于健康对照组,其活性与健康对照组比较差异无统计学意义,A、B组患者AChE水平及活性比较差异无统计学意义;病例组整体认知水平与损伤部位、AChE浓度具有线性回归关系（rY1.2=0.584,P=0.039;rY21=0.726,P=0.017）,标准化回归系数及偏相关系数均表明AChE浓度对整体认知功能影响最大（｜Beta｜=0.3601,rY2.1=0.726）.结论 额叶底部损伤患者认知功能障碍具体表现与损伤部位密切相关;神经递质乙酰胆碱可能在认知功能障碍的病理生理机制中发挥一定的作用.

Objective To investigate the possible pathogenesis of the cognitive function in unilateral frontal bottom laceration by follow-up study in patients after one month of the onset. Methods MMSE, Loewenstein Occupational Therapy Cognitive Assessment （LOTCA）, Montreal Cognitive Assessment （MoCA）, Wisconsin Card Sorting Test （WCST） scales were used to evaluate neurocognitie function in 42 patients after one month of onset of unilateral frontal bottom laceration and 45 normal controls. The wave amplitude and the latency of the endogenous composition N2, P3 of P300 were measured at the cognitive potential instrument. Level of AChE was determined by ELISA and active AChE was analyzed by the ration analyses. Stepwise multivariate regression analyzed the correlation of the overall cognitive function and the lever and active of AChE. Results The cognitive test scores in patients were significantly worse than those in normal controls. The ability of recite sentences, fluency of words, reading, understanding language,cognitive transfering decreases in the left frontal bottom laceration patients （Group A, 23 cases）, while the ability of attention, action, organization, graphics depicting, abstract epitoming, logical thinking were all seriously impaired in the patients with right frontal bottom laceration （Group B, 19 cases）. The latency of the endogenous composition N2, P3 in patients （ Group A： （322. 4 ± 17.0）, （410. 1 ± 19.9） ms; Group B：（ 308.4 ± 15.6）, （385.5 ± 17.4） ms） is more lengthen （ F = 4. 084, P = 0. 018; F = 3.467, P = 0. 038 ）than the normal controls （ （268.6 ± 14. 7 ）, （ 369. 2 ± 15. 4 ） ms） and the wave amplitude is lower （ F =2. 986 ,P =0. 047 ;F =3. 313 ,P =0. 041 ）. The latency of N2 ,P3 in Group A of is more lengthen than Group B, while the wave amplitude is higher. The difference of the active of AChE in patients and control groups had no statistical significance, however, the level of AChE in two groups had statistical significance. The comparison of the active and the total AChE in patients has also not statistical significance. The correlation of the overall cognitive function has the linear regression with the parts of the brain and the level of AChE （ rY1.2 = 0. 584, P = 0. 039; rY2.1 = 0. 726, P = 0. 017 ）. The standardized regression coefficients showed the level of AChE has the biggest influence to the overall cognitive function （ ｜Beta｜ =0. 3601, rY2.1 =0. 726）.Conclusions AChE may be one of the important factors in the cognitive function after frontal bottom laceration. The specific damages of cognitive function in unilateral frontal bottom laceration patients closely relate with the lesion locations in the injured frontal bottom laceration.