P300和总脑小血管病评分对脑小血管病患者认知障碍评估的临床价值

Research on the clinical value of P300 and total cerebral small vessel disease(CSVD)score in cognitive impairment assessment in patients with CSVD

目的本研究旨在评估P300、总脑小血管病(CSVD)评分对CSVD患者认知障碍程度的检测作用,并探讨认知功能筛查量表与之匹配程度.方法纳入2018年10月至2020年6月就诊于连云港东方医院神经内科并诊断CSVD的患者72例,同时纳入同期评价的年龄、性别与之匹配的34名健康体检者设为对照组.所有纳入者均在一周内检查简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)和P300、总CSVD评分.CSVD患者根据认知功能筛查量表(MMSE、MoCA)分为认知障碍组和非认知障碍组,分析3组间MMSE、MoCA评分与P300潜伏期、P300波幅、总CSVD评分的关系.结果认知障碍组和非认知障碍组在中央点(Cz)记录的P300潜伏期均长于对照组(P<0.001),认知障碍组P300潜伏期长于非认知障碍组[(397.471±35.911)ms比(342.584±14.502)ms,P<0.001].认知障碍组和非认知障碍组的总CSVD评分高于对照组(P<0.001),认知障碍组总CSVD评分高于非认知障碍组(P<0.001).相关分析显示MMSE、MoCA评分与P300潜伏期(r=-0.768,P<0.001;r=-0.824,P<0.001)、总CSVD评分之间(r=-0.816,P<0.001;r=-0.896,P<0.001)存在强负相关关系.当P300-Cz潜伏期为348.4 ms时,CSVD患者诊断认知障碍的敏感度为94.3%,特异度为83.1%.当总CSVD评分为2分时,CSVD患者诊断认知障碍的敏感度为82.9%,特异度97.2%.结论P300潜伏期、总CSVD评分可能是CSVD患者认知功能障碍的早期预测指标,且较MMSE、MoCA量表可能更客观地反映认知功能.

Objective To evaluate the clinical value of P300 and total cerebral small vessel disease(CSVD)score in detecting the degree of cognitive impairment in patients with CSVD,and to explore their matching degree with cognitive function screening scale.Methods A total of 72 patients diagnosed with CSVD in the Department of Neurology of Lianyungang Oriental Hospital from October 2018 to June 2020 were included,and 34 normal physical examinees matched by age and gender were included as the control group.Mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),P300 and total CSVD scores were examined within one week for all the subjects included.According to the cognitive function screening scale(MMSE,MoCA),CSVD patients were divided into cognitive impairment group and non-cognitive impairment group.The relationship between MMSE and MoCA scores,and P300 latency,P300 amplitude,and total CSVD score among the three groups was analyzed.Results The latency of P300 recorded at the central point(CZ)in cognitive impairment group and non-cognitive impairment group was longer than that in control group(P<0.001).The latency of P300 recorded in cognitive impairment group was longer than that in non-cognitive impairment group[(397.471±35.911)ms vs.(342.584±14.502)ms,P<0.001].The total CSVD score of cognitive impairment group and non-cognitive impairment group was higher than that of control group(P<0.001),and the total CSVD score of cognitive impairment group was higher than that of non-cognitive impairment group(P<0.001).Correlation analysis results showed that MMSE and MoCA scores have strong negative correlations with P300 latency(r=-0.768,P<0.001;r=-0.824,P<0.001)and total CSVD score(r=-0.816,P<0.001;r=-0.896,P<0.001).When the CZ of P300 latency was 348.4 ms,the sensitivity and specificity of CSVD were 94.3%and 83.1%,respectively.When the total CSVD score was 2,the sensitivity and specificity of CSVD were 82.9%and 97.2%,respectively.Conclusions P300 latency and total CSVD score may be the indicator of cognitive impairment in patients with CSVD for the early stage,and can reflect cognitive function more objectively than MMSE and MoCA.