颞叶癫痫患者执行功能特点及其与影响因素相关分析

Analysis of executive function characteristics and its influencing factors in temporal lobe epilepsy patients

目的探讨颞叶癫痫(TLE)患者执行功能特点并分析其与神经心理学测验之间相关性。方法纳入2017年6月至2018年12月天津医科大学总医院与华润武钢总医院诊治的25例颞叶癫痫患者,其中左侧颞叶癫痫8例(LTLE组)、右侧颞叶癫痫17例(RTLE组),分别行神经心理学测验和执行功能测验;Pearson相关分析和偏相关分析探讨执行功能与各项影响因素的相关性,多因素线性逐步回归分析验证二者线性数量关系。结果LTLE组、RTLE组与对照组受试者简易智能状态检查量表(MMSE)评分(P=0.003),数字工作记忆评分(P=0.000)和言语工作记忆评分(P=0.000),颜色反应时间(P=0.001)、词汇反应时间(P=0.009)和色词反应时间(P=0.001),连线测验A和B部分(TMT-A和TMT-B)时间(P=0.010,0.009),词汇流畅性测验(VFT)个数(P=0.000)差异均有统计学意义;其中,LTLE组和RTLE组MMSE评分(P=0.013,0.029)、数字工作记忆评分(P=0.000,0.000)、言语工作记忆评分(P=0.000,0.000)和VFT个数(P=0.000,0.000)低于对照组,颜色反应时间(P=0.047,0.000)、词汇反应时间(P=0.002,0.006)和色词反应时间(P=0.024,0.001)长于对照组,仅RTLE组TMT-A时间(P=0.004)和TMT-B时间(P=0.002)长于对照组。相关分析显示,数字工作记忆评分、颜色反应时间、词汇反应时间、转移注意时间与MMSE评分、汉密尔顿焦虑量表(HAMA)评分、Beck抑郁量表(BDI)评分、年龄、受教育程度、癫痫发作频率、抗癫痫药物种类呈正相关(P<0.05或P<0.01),TMT-A时间、TMT-B时间与MMSE评分、HAMA评分、年龄、受教育程度、癫痫发作频率、抗癫痫药物种类呈正相关(P<0.05或P<0.01),色词反应时间、VFT个数与HAMA评分、年龄、受教育程度呈正相关(P<0.05或P<0.01)。多因素线性逐步回归分析显示,数字工作记忆评分与癫痫发作频率(标准化偏回归系数=0.998,P=0.001)和抗癫痫药物种类(标准化偏回归系数=-1.634,P=0.006),言语工作记忆评分与HAMA评分(标准化偏回归系数=-0.089,P=0.035),颜色反应时间与受教育程度(标准化偏回归系数=-0.097,P=0.002),词汇反应时间(标准化偏回归系数=-0.121,P=0.004)、色词反应时间(标准化偏回归系数=-0.243,P=0.002)、TMT-A时间(标准化偏回归系数=-5.984,P=0.002)、TMT-B时间(标准化偏回归系数=-17.376,P=0.000)、转移注意时间(标准化偏回归系数=-12.413,P=0.000)与MMSE评分,VFT个数与年龄(标准化偏回归系数=0.327,P=0.032)、受教育程度(标准化偏回归系数=1.976,P=0.001)、HAMA评分(标准化偏回归系数=-0.431,P=0.008)等均存在线性回归关系。结论颞叶癫痫患者存在执行功能(工作记忆、抑制控制、认知灵活性)障碍,而右侧与左侧颞叶癫痫患者的执行功能障碍无明显差异;年龄越大,受教育程度越低,整体认知功能障碍越严重,执行功能障碍越明显。

ObjectiveTo investigate the characteristics of temporal lobe epilepsy(TLE)executivefunction and its correlation with neuropsychological tests.MethodsA total of 25 patients with TLE[including 8 patients with left TLE(LTLE)and 17 patients with right TLE(RTLE)]and 15 healthy controlswith matched sex,age and education level admitted to Tianjin Medical University General Hospital andChina Resources&WISCO General Hospital from June 2017 to December 2018 were enrolled.Neuropsychological tests[including Mini-Mental State Examination(MMSE),Hamilton Anxiety RatingScale(HAMA),Beck Depression Inventory(BDI)]and executive function tests[including digital workingmemory,verbal working memory,Stroop Color-Word Test(SCWT),Trail Making Test-A and B(TMT-A andTMT-B),and Verbal Fluency Test(VFT)]were performed.Pearson correlation analysis and partialcorrelation analysis were used to explore the correlation between executive function and various factors,andmultiple linear stepwise regression analysis was used to verify the linear quantitative relationship betweenexecutive function and various factors.ResultsMMSE score(P=0.003),digital working memory score(P=0.000),verbal working memory score(P=0.000),color response time(P=0.001),word response time(P=0.001),color word response time(P=0.001),TMT-A time(P=0.010),TMT-B time(P=0.009)and thenumber of VFT(P=0.000)of LTLE group,RTLE group and control group were significantly different.MMSE score(P=0.013,0.029),digital working memory score(P=0.000,0.000),verbal working memoryscore(P=0.000,0.000)and the number of VFT(P=0.000,0.000)in LTLE group and RTLE group werelower than those in control group.Color response time(P=0.047,0.000),word response time(P=0.002,0.006)and color word response time(P=0.024,0.001)were longer than those in control group,but TMT-Atime(P=0.004)and TMT-B time(P=0.002)in RTLE group were longer than those in control group.Therewere no significant differences in executive function scores between LTLE group and RTLE group(P>0.05,for all).Correlation analysis showed that digital working memory score,color response time,vocabularyresponse time and attention transfer time were positively correlated with MMSE score,HAMA score,BDIscore,age,education level,seizure frequency,type of antiepileptic drugs(P<0.05 or P<0.01).TMT-Atime and TMT-B time were positively correlated with MMSE score,HAMA score,age,education level,seizure frequency,type of anti-epileptic drugs(P<0.05 or P<0.01).There was a positive correlationbetween color word response time and word fluency with HAMA score,age and education level(P<0.05 orP<0.01).Multiple linear stepwise regression analysis showed that there was a linear regression relationshipbetween digital working memory score and seizure frequency(standardized partial regression coefficient=0.998,P=0.001)and type of antiepileptic drugs(standardized partial regression coefficient=-1.634,P=0.006).There was a linear regression relationship between verbal working memory score and HAMA score(standardized partial regression coefficient=-0.089,P=0.035),a linear regression relationship betweencolor response time and education level(standardized partial regression coefficient=-0.097,P=0.002),alinear regression relationship between vocabulary response time(standardized partial regression coefficient=-0.121,P=0.004),color word response time(standardized partial regression coefficient=-0.243,P=0.002),TMT-A time(standardized partial regression coefficient=-5.984,P=0.002),TMT-B time(standardizedpartial regression coefficient=-17.376,P=0.000),attention transfer time(standardized partial regressioncoefficient=-12.413,P=0.000)and MMSE score had linear regression relationship.Vocabulary fluencyand age(standardized partial regression coefficient=0.327,P=0.032),education level(standardized partialregression coefficient=1.976,P=0.001),HAMA score(standardized partial regression coefficient=-0.431,P=0.008)had a linear regression relationship.ConclusionsExecutive function(working memory,inhibitory control and cognitive flexibility)was impaired in patients with TLE,but there was no significantdifference in executive function between RTLE and LTLE.The older the age and the lower the educationlevel,the more severe the overall cognitive dysfunction,the more significant decline in executive function.