颞叶癫痫患者认知功能异常因素及与MRI皮层下结构体积的关系

Cognitive dysfunction in patients with temporal lobe epilepsy and its relationship with MRI subcortical structure volume

目的探讨颞叶癫痫(TLE)患者认知功能异常因素及与MRI皮层下结构体积的关系。方法选取2019-02—2022-05于青海大学附属医院就诊的166例TLE患者作为研究对象,根据是否认知功能异常,分为异常组(n=86)和正常组(n=80)。通过倾向性评分匹配(PSM)法按照1∶1匹配后2组各为50例,比较2组患者的一般资料。多因素Logistic回归分析影响患者认知功能的危险因素。比较2组患者的认知功能,分析2组患者MRI皮层下结构体积情况。以Pearson相关性检验分析TLE患者MRI皮层下结构体积与认知功能的相关性。结果匹配后2组患者仅在癫痫家族史方面差异有统计学意义(P<0.05)。异常组中国修订成人韦氏智力量表算术测试(WAIS-RC)知识、WAIS-RC算术、数字符号测试(DSST)、木块图测验(BDT)、顺背数字广度测试(FDST)、倒背数字广度测试(BDST)、蒙特利尔认知评估量表(MoCA)及言语流畅性测试(VFT)评分相较于正常组均更低(P<0.05)。发作形式为CPS、发作频率>1次/月、癫痫家族史以及皮层下结构体积减小均为影响患者认知功能的独立危险因素(P<0.05)。双侧丘脑、双侧海马以及双侧杏仁核体积与WAIS-RC知识、WAIS-RC算术、VFT、MoCA、FDST、TMT-A以及TMT-B评分存在显著相关性(P<0.05)。结论TLE认知异常者皮层下结构体积较认知正常者少,MRI皮层下结构体积与TLE患者的认知功能密切相关。

Objective To investigate the factors of cognitive dysfunction in patients with temporal lobe epilepsy(TLE)and its relationship with MRI subcortical structure volume.Methods A total of 166 patients with TLE who were treated in the Affiliated Hospital of Qinghai University from February 2019 to May 2022 were selected as the research objects.According to whether they had cognitive dysfunction,they were divided into abnormal group(n=86)and normal group(n=80).The propensity score matching(PSM)method was used to match the two groups according to 1∶1.The general data of the two groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors affecting the cognitive function of patients.The cognitive function of the two groups was compared,and the MRI subcortical structure volume of the two groups of patients was analyzed.Pearson correlation test was used to analyze the correlation between MRI subcortical structure volume and cognitive function in TLE patients.Results After matching,there was significant difference in family history of epilepsy between the two groups(P<0.05).Compared with the normal group,the scores of WAIS-RC knowledge,WAIS-RC arithmetic,DSST,BDT,FDST,BDST,MoCA and VFT in the abnormal group were lower than those in the normal group(P<0.05).CPS,seizure frequency of 1 time/month,family history(of epilepsy and reduction of subcortical structure volume were independent risk factors affecting cognitive function P<0.05).The volume of bilateral thalamus,bilateral hippocampus and bilateral amygdala was significantly correlated with WAIS-RC knowledge,WAIS-RC arithmetic,VFT,MoCA,FDST,TMT-A and TMT-B scores(P<0.05).Conclusion The volume of subcortical structures in patients with abnormal TLE cognition was less than that in patients with normal cognition.The volume of MRI subcortical structure is closely related to the cognitive function of TLE patients.