基于Thinc-it工具分析抑郁症不同证型患者认知功能

An Analysis of Cognitive Function of Patients with Different Syndromes of Depression Based on Thinc-it Tool

目的:通过Thinc-it工具探讨抑郁症不同证型患者认知功能特点。方法:从2020年6月至2022年7月宁波市第一医院心身医学科确诊为抑郁症的患者中选取肝气郁结、气郁化火、痰气郁结、心脾两虚证型患者各50例为受试者,并选取同期在医院健康体检志愿者50例为健康对照组。应用汉密尔顿抑郁量表(hamilton depression scale,HAMD)、汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)对各组受试者临床症状进行评估,并分别通过Thinc-it工具进行认知功能评估,具体包括认知损害5项问卷(5-item questionnaire for cognitive impairment,PDQ-5-D)、选择反应时间任务(selection response time,CRT)、1-Back记忆任务(selection response time,1-Back)、数字符号替代测试(digit symbol substitution test,DSST)和连线测试B(line test B,TMT-B)测试。结果:抑郁症各证型组病程、HAMD评分、HAMA评分比较,痰气郁结证组和心脾两虚证组病程时间相对更长,但组间比较,差异无统计学意义(P>0.05)。郁证各证型组HAMD评分、HAMA评分高于健康对照组,差异具有统计学意义(P<0.05)。郁证各证型组PDQ-5-D评分高于健康对照组(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组CRT计数减少,CRT反应时间延长,差异具有统计学意义(P<0.05)。组间比较,心脾两虚证组CRT计数高于肝气郁结证组,痰气郁结证组CRT反应时间长于肝气郁结证组,差异具有统计学意义(P<0.05)。与健康对照组比较,郁证各证型组1-Back计数减少,痰气郁结证组、心脾两虚证组1-Back反应时间延长,差异具有统计学意义(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组DSST计数减少,DSST反应时间、TMT-B耗时延长,差异具有统计学意义(P<0.05)。心脾两虚证组、痰气郁结证组DSST反应时间长于肝气郁结证组、气郁化火证组,差异具有统计学意义(P<0.05)。结论:抑郁症各证型患者均存在主观认知功能、注意力、记忆力、执行功能、信息加工处理速度等方面的损害,且各证型受损程度不一,且痰气郁结证组、心脾两虚证组在注意力、执行功能、处理速度方面较肝气郁结证组和气郁化火证组受损更严重。

Objective:To explore the cognitive function characteristics of patients with depression of main TCM syndromes by Thinc-it tool.Methods:A total of 50 patients with liver-qi stagnation syndrome,or syndrome of depressed qi transforming into fire,or phlegm-qi stagnation syndrome,or heart-spleen deficiency syndrome were selected as the subjects from the Department of Psychosomatic Medicine of The First Affiliated Hospital of Ningbo University from June 2020 to July 2022,and each 50 healthy volunteers were selected into the healthy control group at the same time.Hamilton depression scale(HAMD) and hamilton anxiety scale(HAMA) were used to evaluate the clinical symptoms of each group of subjects,and the cognitive function was evaluated by Thinc-it tool,including a 5-item questionnaire for cognitive impairment(PDQ-5-D),selection response time(CRT),1-Back memory task(selection response time,1-Back),digit symbol substitution test(DSST) and line test B(TMT-B).Results:Comparing the course of disease,HAMD score and HAMA score of depression groups,the course of disease of the group with stagnation of phlegm-qi and the group with deficiency of heart and spleen was relatively longer,but there was no significant difference between the groups(P>0.05).The HAMD and HAMA scores of the depression syndrome groups were higher than those of the healthy control group,with statistically significant differences(P<0.05).The PDQ-5-D score of each depression syndrome group was higher than that of the healthy control group(P<0.05),but there was no statistically significant difference between the depression syndrome groups(P>0.05).Compared with the healthy control group,the CRT count of each depression syndrome group was decreased,and while the CRT reaction time was prolonged,with statistically significant differences(P<0.05).Compared with different groups,the CRT count of the heart-spleen deficiency group was higher than that of the liver-qi stagnation group,and the CRT reaction time of the phlegm-qi stagnation group was longer than that of the liver-qi stagnation group,with statistically significant differences(P<0.05).Compared with the healthy control group,the 1-Back count of each depression syndrome group was decreased,and the 1-Back reaction time of the phlegm-qi stagnation group and the heart-spleen deficiency group was prolonged,with statistically significant differences(P<0.05),but there were no statistically significant differences between the depression syndrome groups(P>0.05).Compared with the healthy control group,the DSST count of each depression syndrome group was decreased,and the DSST reaction time and TMT-B time were prolonged,with statistically significant differences(P<0.05).The DSST reaction time of the heart-spleen deficiency group and the phlegm-qi stagnation group was longer than that of the liver-qi stagnation group and the qi-stagnation transforming into fire group,with statistically significant differences(P<0.05).Conclusion:All patients with different depression syndromes have damages in subjective cognitive function,attention,memory,executive function,information processing speed and so on,and the degree of damage varies with syndrome type.The damages in attention,executive function and processing speed of the phlegm-qi stagnation group and the heart-spleen deficiency group are more serious than those of the liver-qi stagnation group and the qi-stagnation transforming into fire group.