稳定期双相障碍患者认知功能损害与病程的关系

Relationship between cognitive impairments and duration of illness in patients with bipolar disorder at stationary phase

目的探讨稳定期双相障碍患者认知功能损害与病程的关系。方法共纳入稳定期双相障碍I型患者224例,按病程分为3组I,组(3个月≤病程≤1年)79例;Ⅱ组(1年<病程≤5年)58例;Ⅲ组(病程>5年)87例。采用数字符号、连线测验(Trail Making Test,TMT)、数字广度、视觉图形再生、威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)、言语流畅性测验、汉诺塔(Tower of Hanoi,TOH)评估认知功能。采用卡方检验和方差分析比较组间性别、年龄和受教育年限的差异,采用协方差分析进行组间认知功能的比较,采用spearman相关和偏相关对病程与认知功能进行相关分析。结果以年龄为协变量的协方差分析结果显示,三组间言语流畅性测验的重复数、TMT-B错误数差异有统计学意义(F=5.560,P=0.004;F(2,221)=3.329,P=0.038),其中Ⅲ组患者均差于I组(P<0.05)。将与认知功能相关的年龄和受教育年限作为控制变量纳入到偏相关分析中,结果显示,只有TMT-B错误数与病程的相关性有统计学意义(r=0.20,P<0.05),其余的23个指标均与病程无相关性(P>0.05)。结论稳定期双相障碍患者大部分认知功能损害是稳定存在的,可作为研究内表型指标之一。

Objective To explore the relationship between cognitive impairments and duration of illness in patients with bipolar disorder at stationary phase. Methods 224 patients with bipolar I disorder at stationary phase were divided into 3 groups according to their duration： Group Ⅰ （79 cases with duration ranged form 3 months to 1 year） , Group Ⅱ （58 cases, 1 year to 5 years） and Gruop Ⅲ （87 cases with duration above 5 years）. The cognitive function were assessed with digital symbol, trail marking test （TMT）, digital span, visual reproduction, Wisconsin Card Sorting Test （WCST）, verbal fluency, Tower of Hanoi （TOH）. Spearman correlation and partial correlation were used to analyze the correlation between cognitive impairments and duration of illness. Results Covariance analysis with the covariant as age showed that there were significant differences in number of replication of verbal fluency and number of mistake of TMT-B among the 3 groups （ F = 5. 560, 3. 329 respectively; P = 0. 004, 0. 038 respectively） , and the cognitive function of patients in Gruop m was worse than those in Group I in both tests. Partial correlation analysis with controlled variable as age and education degree showed that only number of mistakes of TMT-B was significantly correlated with duration of illness （ r = 0. 20, P 〈 0.05 ） , other 23 tests had no significant correlation with duration of illness （ P 〉 0.05 ）. Conclusion The cognitive impairment in patients with bipolar disorder at stationary phase is stable. It may be one of the endophenotypes of bipolar disorder.