事件相关电位诊断动脉瘤性蛛网膜下腔出血后认知功能障碍的研究

The Diagnosis Value of Event-Related Potentials for Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage

目的评价事件相关电位N200和P300评估动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者早期认知障碍的价值。方法连续纳入2013年10月-2014年12月于首都医科大学附属北京天坛医院住院治疗的aSAH患者,按照入院14±3 d是否存在认知障碍分为aSAH认知障碍组和aSAH无认知障碍组,同时纳入年龄、性别相匹配的正常人群作为对照组。所有入组患者完成MMSE、MoCA量表评定及脑电图事件相关电位N200和P300潜伏期的测定[额中线(frontal midline,Fz)、中央中线(central midline,Cz)、顶中线(parietal midline,Pz)三个部位]。比较对照组、aSAH认知障碍组和aSAH无认知障碍组间N200及P300潜伏期的差异。分析N200和P300诊断aSAH患者认知障碍的敏感性和特异性。另外,通过单因素和多因素分析,明确aSAH患者发生早期认知障碍的独立危险因素。结果共入组62例aSAH患者,存在认知功能障碍者45例(72.6%),无认知障碍者17例(27.4%);对照组30例患者。aSAH无认知障碍组和aSAH认知障碍组Cz、Pz和Fz的P300潜伏期均长于正常对照组,Cz和Pz的N200潜伏期长于正常对照组,aSAH认知障碍组Fz的N200潜伏期长于正常对照组,差异有统计学意义;与aSAH无认知障碍组相比,aSAH认知障碍组Cz、Pz和Fz的P300及N200潜伏期均延长,差异有统计学意义。事件相关电位N200潜伏期分界值为257.0~261.0 ms时,诊断认知障碍的敏感度为67.1%~79.4%,特异度为74.2%~81.5%;事件相关电位P300潜伏期分界值为347.0~349.5 ms时,诊断认知障碍的敏感度为88.1%~94.0%,特异度为78.9%~82.1%。多因素分析结果显示,低受教育年限(OR 1.19,95%CI 1.02~2.15,P=0.037)及Hunt-Hess分级3级(OR 1.65,95%CI 1.05~1.92,P=0.013)是aSAH患者出现早期认知障碍的独立危险因素。结论事件相关电位N200和P300可以作为判断aSAH患者早期认知功能障碍的一种有用的、客观的检查工具。

Objective To evaluate the diagnosis value of event-related potentials N200 and P300 for early cognitive impairment in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The aSAH inpatients at Beijing Tiantan Hospital,Capital Medical University between October 2013 and December 2014 were consecutively enrolled in this study,with sex/age-matched healthy subjects as control.All aSAH patients were divided into cognitive impairment group and no cognitive impairment group,according to the cognitive assessment results.MMSE and MoCA were used to evaluate cognitive function and the latency of frontal midline(Fz),central midline(Cz)and parietal midline(Pz)event-related potential N200 and P300 were measured in all subjects.The latency of N200 and P300 among the three groups were compared.The sensitivity and specificity of the diagnosis of N200 and P300 for cognitive impairment of aSAH inpatients were analyzed.In addition,univariate and multivariate analysis were used to identify the independent risk factors for early cognitive impairment in aSAH patients.Results A total of 62 aSAH inpatients were included,with 45 cases(72.6%)in cognitive impairment group,17 cases(27.4%)in no cognitive impairment group and 30 controls.The P300 latency of Cz,Pz and Fz,N200 latency of Cz and Pz in aSAH patients with or without cognitive impairment were all longer than that in control group,the N200 latency of Fz in aSAH patients with cognitive impairment was longer than that in control group(all P<0.05).The latency of Cz,Pz and Fz P300 and N200 in patients with cognitive impairment were all longer than that in aSAH patients without cognitive impairment(all P<0.05).When the cut-off value range of N200 latency were 257.0-261.0 ms,the corresponding diagnosis sensitivity and specificity range were 67.1%-79.4%and 74.2%-81.5%,respectively.When the cut-off value range of P300 latency were 347.0-349.5 ms,the corresponding diagnosis sensitivity and specificity range were 88.1%-94.0%and 78.9%-82.1%,respectively.Multivariate analysis showed that the lower education degree(OR 1.19,95%CI 1.02-2.15,P=0.037)and Hunt-Hess grade 3(OR 1.65,95%CI 1.05-1.92,P=0.013)were independent risk factors for early cognitive impairment in aSAH patients.Conclusions The event-related potential P300 and N200 can be used as a useful and objective diagnosis tool for detecting early cognitive impairment in aSAH patients.