创伤后应激障碍患者执行功能研究的Meta分析

Meta-analysis of executive functions in patients with post-traumatic stress disorder

目的 对PTSD患者的执行功能损害情况进行系统回顾.方法 通过Meta分析对国外公开发表的PTSD患者与健康人群及创伤暴露者的执行功能比较的文献进行统计.选取连线测验B部分（Trial Making Test B,TMT B）、威斯康星卡片分类测验（Wisconsin Card Sorting Test,WCST）、Stroop测验、Rey-Osterrieth复杂图形测验（Rey-Osterrieth Complex Figure Test,ROCFT）拷贝数、韦氏成人智力量表修订版/韦氏记忆量表数字广度测验作为执行功能测验指标.以 PTSD或posttraumatic stressdisorder和neurocognit＊或neuropsychology＊或cognitive impairment或executive function或workingmemory为关键词对PubMed、EMBase、Web of Knowledge数据库进行相关文献检索.限定文献发表时间为1985年1月至2014年10月,并根据纳入标准和排除标准进行文献筛选,文献类型为论著.通过采用Revman 5.3软件进行统计学分析.结果 最终共纳入35篇文献,PTSD患者1218例（PTSD组）,创伤暴露患者2 570例（创伤暴露对照组）,健康对照者683名（健康对照组）.PTSD组与创伤暴露对照组比较,TMT B分值明显降低[标准化均数差（standardized mean difference,SMD）：0.63,95％CI：0.35～0.91,P=0.00],差异具有统计学意义;PTSD组与健康对照组相比,TMT B （SMD：0.49,95％ CI：0.07～0.90,P=0.02）、WCST分类完成数（SMD：-0.39,95％ CI：-0.74～-0.05,P=0.02）、ROCFT拷贝数（SMD：-0.43,95％CI：-0.76～-0.09,P=0.01）、韦氏成人智力量表修订版/韦氏记忆量表数字广度测验分值降低（顺序数字广度：SMD：-0.28,95％ CI：-0.52～-0.03,P=0.03;逆序数字广度：SMD：-0.32,95％CI：-0.63～0.00,P=0.05;总数字广度：SMD：-0.49,95％CI：-0.85～-0.13,P=0.01）,差异具有统计学意义.PTSD组与创伤暴露对照组在WCST持续错误数和分类完成数、Stroop测验、ROCFT拷贝数、数字广度（包括顺序、逆序及总数字广度）测验方面差异无统计学意义;PTSD组与健康对照组在WCST持续错误数、Stroop测验上差异无统计学意义;创伤暴露对照组与健康对照组在TMT B、顺序数字广度、逆序数字广度测验上差异无统计学意义.结论 PTSD患者存在多项执行功能受损,创伤暴露可能是导致其损害的部分原因.

Objective To take a system review on the impairment of executive functions in patients with post-traumatic stress disorder （PTSD）.Methods A meta-analysis was performed to summarize the literature on the executive functions in patients with PTSD,healthy controls and trauma-exposed controls without any psychiatric disorder.Trial Making Test B （TMT B）,Wisconsin Card Sorting Test （WCST）,Stroop test,Rey-Osterrieth Complex Figure Test （ROCFT） copy,Wechsler Adult Intelligence Scale Revised/ Wechsler Memory Scale digit span were chosen to as the indices of executive functions.The databases of Pubmed,EMBase and Web of Knowledge were searched from January 1985 and October 2014.The key words PTSD or posttraumatic stress disorder and neurocognit＊ or neuropsychology＊ or cognitive impairment or executive function or working memory were used.The literature search was conducted according to the inclusive and exclusive criteria.Original research were published between January 1985 and October 2014-,and selected according to the inclusion criteria and exclusion criteria.Revman 5.3 software was used for statistical analysis.Results A total of 35 primary studies were identified,including 1218 PTSD patients,2 570 trauma-exposed controls and 683 healthy controls.The performance of TMT B in PTSD group were statistically significant worse than that in the trauma-exposed control group （standardized mean difference,SMD：0.63,95%CI：0.35-0.91,P=0.00）.Furthermore,PTSD group showed significant worse performance on TMT B （SMD：0.49,95% CI：0.07-0.90,P=0.02）,WCST categories completed （SMD：-0.39,95% CI：-0.74--0.05,P=0.02）,ROCFT copy （SMD：-0.43,95% CI：-0.76--0.09,P=0.01）,Wechsler Adult Intelligence Scale Revised/Wechsler Memory Scale digit span scores （Digit span forward：SMD：-0.28,95% CI：-0.52--0.03,P=0.03;Digit span backward：SMD：-0.32,95% CI：-0.63-0.00,P=0.05;Digit span total：SMD：-0.49,95%CI：-0.85--0.13,P=0.01） were lower than healthy control group.No significant difference were found between PTSD and trauma-control group in WCST perseverative errors,WCST categories completed,Stroop test,ROCFT copy and Digit span （including Digit span forward,Digit span backward and Digit span total）.The scores of WCST perseverative errors,Stroop test in PTSD group showed no significant difference with those in the healthy control group.The scores of TMT B,Digit span forward,Digit span backward in the trauma-exposed control group showed no significant difference with those in the healthy control group.Conclusion These data support the impaired executive functions of patients with PTSD,which may partially attribute to trauma exposure.