慢性失眠合并焦虑抑郁患者事件相关电位P300研究

Study on event-related potential P300 in patients with chronic insomnia combined with anxiety and depression

目的探究事件相关电位P300对慢性失眠合并焦虑抑郁患者认知功能的临床诊疗意义。方法选择2020年10月至2021年3月在武汉市第一医院就诊的慢性失眠合并焦虑抑郁患者60例作为观察组,选择60例健康志愿者作为对照组。采用汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评估患者的焦虑抑郁状态。采用简易智力状态检查(mini-mental state examination,MMSE)及蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评估被试的认知功能。对所有被试进行事件相关电位P300检测,记录事件相关电位P300的潜伏期和波幅。采用SPSS 25.0软件进行统计分析。组间比较采用独立样本t检验。采用Pearson相关分析认知功能与P300事件相关电位的相关性。结果观察组HAMA评分[(16.65±5.10)分,(9.30±4.42)分]及HAMD评分[(18.07±3.97)分,(8.48±3.21)分]高于对照组(t=8.438,14.545,均P<0.05),MoCA评分[(22.35±4.25)分]低于对照组[(25.65±2.29)分](t=-5.291,P<0.05)。MoCA量表的8个维度中,观察组在视空间与执行能力[(3.38±1.46)分,(4.63±0.69)分]、命名[(2.37±0.78)分,(2.65±0.48)分]、语言[(2.17±0.96)分,(2.53±0.81)分]、延迟回忆[(2.58±1.45)分,(4.17±0.85)分]评分均低于对照组(t=-5.991,-2.394,-2.259,-7.292,均P<0.05)。与对照组相比,观察组患者的P300的潜伏期(N1、N2、P3)明显延长(t=3.281,4.342,4.492,均P<0.01)。P300的潜伏期(N1、N2、P3)与HAMD评分呈正相关(r=0.242,0.301,0.311,均P<0.05)。P300的潜伏期(N2、P3)与HAMA评分呈正相关(r=0.205,0.207,均P<0.05)。P300的潜伏期(N2、P3)与MoCA的延迟回忆评分呈负相关(r=-0.197,-0.236,均P<0.05)。结论慢性失眠合并焦虑抑郁患者伴随不同程度的认知功能减退。慢性失眠合并焦虑抑郁患者的P300呈现出潜伏期延长。P300潜伏期与慢性失眠合并焦虑抑郁患者抑郁焦虑情绪及认知相关。P300事件相关电位或可作为慢性失眠合并焦虑抑郁患者认知障碍的神经生理学客观评价工具。

Objective To explore the clinical significance of event-related potential P300 in the diagnosis and treatment of cognitive function in patients with chronic insomnia combined with anxiety and depression.Methods Sixty patients with chronic insomnia complicated with anxiety and depression treated in Wuhan First Hospital from October 2020 to March 2021 were selected as the observation group,and 60 healthy volunteers were selected as the control group in the same period.Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were used to evaluate the anxiety and depression status of patients.Mini mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA)were used to evaluate the cognitive function of the subjects.All subjects were tested for P300 event-related potential,and the latency and amplitude of P300 event-related potential were recorded.SPSS 25.0 software was used for statistical analysis.Independent sample t-test was used for comparison between groups.Pearson correlation analysis was used to analyze the correlation between cognitive function and P300 event-related potential.Results The scores of HAMA((16.65±5.10),(9.30±4.42))and HAMD((18.07±3.97),(8.48±3.21))in the observation group were higher than those in the control group(t=8.438,14.545,both P<0.05),and the MoCA score(22.35±4.25)was lower than that(25.65±2.29)in the control group(t=-5.291,P<0.05).In the eight dimensions of MoCA,the scores of visual space and executive ability((3.38±1.46),(4.63±0.69)),naming((2.37±0.78),(2.65±0.48)),language((2.17±0.96),(2.53±0.81))and delayed recall((2.58±1.45),(4.17±0.85))in the observation group were lower than those in the control group(t=-5.991,-2.394,-2.259,-7.292,all P<0.05).Compared with the control group,the latencies of P300(N1,N2,P3)in the observation group were significantly prolonged(t=3.281,4.342,4.492,all P<0.01).The latencies of P300(N1,N2,P3)were positively correlated with HAMD score(r=0.242,0.301,0.311,all P<0.05).The latencies of P300(N2,P3)were positively correlated with HAMA score(r=0.205,0.207,both P<0.05).The latencies of P300(N2,P3)were negatively correlated with the delayed recall score of MoCA(r=-0.197,-0.236,both P<0.05).Conclusion There are different degrees of cognitive impairment in patients with chronic insomnia combined with anxiety and depression.P300 in patients with chronic insomnia combined with anxiety and depression shows prolonged latency.P300 latency is related to depression,anxiety and cognition in patients with chronic insomnia combined with anxiety and depression.Event-related potential P300 may be used as a neurophysiological objective evaluation tool for cognitive impairment in patients with chronic insomnia combined with anxiety and depression.