麻痹性痴呆患者的脑电图特点与预后相关研究

Analysis of the electroencephalogram characteristics and the prognosis in patients with general paresis of the insane

目的探讨麻痹性痴呆(GPI)患者的EEG特点及其与预后的相关性。方法纳入22例GPI患者(GPI组)和17例健康对照(NC组)的EEG,对比两组δ、θ、β、慢α(8~9 Hz)、快α(9~13 Hz)频段的功率谱密度(PSD)。GPI组出院1年后,对比各频段PSD与预后的关系。结果GPI组δ和θ频段的PSD在中后颞区比NC组明显升高(P<0.01),GPI组α频段的PSD在后头部比NC组明显降低(P<0.01),在快α频段这种差异所累及的电极分布范围比慢α频段更广。β频段上,预后好组比预后差组总体PSD高,在P4差异有统计学意义(P<0.05);预后差组后头部的α频段PSD主要为慢α频段为著,在T6上差异显著(P<0.05),而在全α频段和快α频段上总体比预后好组低。出院随访1年认知障碍发生率无改变(100%),精神症状改善最明显,发生率从86.36%下降至45.45%。急性期CDR评分与预后呈负相关(P<0.001)。结论GPI的EEG主要表现为节律慢化和快波活动减弱。后头部的α节律为慢α频段提示预后较差。1年后预后精神症状改善最明显,而认知障碍症状难以逆转。

Objective To explore the EEG characteristics and its prognosis analysis of patients with general paresis of the insane(GPI).Methods EEG from 22 GPI patients(GPI group)and 17 normal controls(NC group)were included,compared power spectral density(PSD)in two groups ofδ,θ,β,slowα(8-9 Hz)and fastα(9-13 Hz)bands.The relationship between PSD of each band and prognosis was compared 1 year after discharge in GPI group.Results The PSD in theδandθbands in GPI groups were higher in the middle and posterior temporal regions than in the NC group(P<0.01),the PSD in theαband in GPI groups was lower in the posterior head than in the NC group(P<0.01),and the difference in the fastαband was more widespread than in the slowαband.In theβband,the good prognosis group had higher PSD than the poor prognosis group,with a significant difference in P4(P<0.05).In the poor prognosis group,the PSD of the head were mainly slowαband,with significant difference in T6(P<0.05)and in the fullαband and fastαband were lower than the good prognosis group.One year after discharge follow⁃up,the incidence of cognitive impairment was the same as that in the acute phase(100%),the improvement of psychiatric symptoms was most obvious,decreased from 86.36%to 45.45%.The CDR score in the acute phase was negatively correlated with the prognosis(P<0.001).Conclusions The main characteristics of EEG of GPI are slower background rhythm and weakened fast wave activities,slow bandαof posterior area may lead to poor outcome.The psychiatric symptoms improve most significantly in the 1⁃year prognosis,while the cognitive impairment symptoms are difficult to reverse.