中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2010年
5期
345-350
,共6页
戴伟川%陈峻严%高宏志%周培萱%林泽涯
戴偉川%陳峻嚴%高宏誌%週培萱%林澤涯
대위천%진준엄%고굉지%주배훤%림택애
脑损伤%认知障碍%事件相关电位,P300%胆碱酯酶类
腦損傷%認知障礙%事件相關電位,P300%膽堿酯酶類
뇌손상%인지장애%사건상관전위,P300%담감지매류
Brain injuries%Cognition disorders%Event-related potentials,P300%Cholinesterases
目的 通过分析单侧额叶底部脑挫裂伤患者伤后1个月的认知功能变化特征,对其可能发病机制进行初步探索.方法 应用第2版洛文斯顿作业疗法认知量表(LOTCA)、维斯康星卡片分类量表(WCST)、蒙特利尔评估量表中文版(MoCA)、MMSE分别评估45名健康对照和42例单侧额叶底部中度脑挫裂伤患者(病例组)伤后1个月的神经认知功能;应用事件相关电位(EPR)仪测量认知功能电位P300内源性成分N2、P3的潜伏期及波幅;采用ELISA技术测定血清胆碱酯酶E(AChE)浓度及应用速率法测定其活性;多元逐步回归法分析病例组整体认知功能与损伤部位、AChE浓度及活性的相关性.结果 病例组伤后1个月各项神经认知测试分数均显著低于健康对照组,左侧额叶底部损伤患者(A组,23例)主要表现为句子复述能力、词语流畅性、阅读能力、言语理解能力、认知转移能力等显著下降,而右侧额叶底部损伤患者(B组,19例)则主要表现为注意力、动作运用、视运动组织、图形描绘能力、抽象概括能力、逻辑思维能力等显著下降.病例组EPR P300内源性成分N2、P3潜伏期[A组:(322.4±17.0)、(410.1±19.9)ms,B组:(308.4±15.6)、(385.5±17.4)ms]较健康对照组[(268.6±14.7)、(369.2±15.4)ms]延长(F=4.084,P=0.018;F=3.467,P=0.038),波幅较对照组降低;A组N2、P3潜伏期较B组患者延长,波幅较其升高;病例组血清AChE水平高于健康对照组,其活性与健康对照组比较差异无统计学意义,A、B组患者AChE水平及活性比较差异无统计学意义;病例组整体认知水平与损伤部位、AChE浓度具有线性回归关系(rY1.2=0.584,P=0.039;rY21=0.726,P=0.017),标准化回归系数及偏相关系数均表明AChE浓度对整体认知功能影响最大(|Beta|=0.3601,rY2.1=0.726).结论 额叶底部损伤患者认知功能障碍具体表现与损伤部位密切相关;神经递质乙酰胆碱可能在认知功能障碍的病理生理机制中发挥一定的作用.
目的 通過分析單側額葉底部腦挫裂傷患者傷後1箇月的認知功能變化特徵,對其可能髮病機製進行初步探索.方法 應用第2版洛文斯頓作業療法認知量錶(LOTCA)、維斯康星卡片分類量錶(WCST)、矇特利爾評估量錶中文版(MoCA)、MMSE分彆評估45名健康對照和42例單側額葉底部中度腦挫裂傷患者(病例組)傷後1箇月的神經認知功能;應用事件相關電位(EPR)儀測量認知功能電位P300內源性成分N2、P3的潛伏期及波幅;採用ELISA技術測定血清膽堿酯酶E(AChE)濃度及應用速率法測定其活性;多元逐步迴歸法分析病例組整體認知功能與損傷部位、AChE濃度及活性的相關性.結果 病例組傷後1箇月各項神經認知測試分數均顯著低于健康對照組,左側額葉底部損傷患者(A組,23例)主要錶現為句子複述能力、詞語流暢性、閱讀能力、言語理解能力、認知轉移能力等顯著下降,而右側額葉底部損傷患者(B組,19例)則主要錶現為註意力、動作運用、視運動組織、圖形描繪能力、抽象概括能力、邏輯思維能力等顯著下降.病例組EPR P300內源性成分N2、P3潛伏期[A組:(322.4±17.0)、(410.1±19.9)ms,B組:(308.4±15.6)、(385.5±17.4)ms]較健康對照組[(268.6±14.7)、(369.2±15.4)ms]延長(F=4.084,P=0.018;F=3.467,P=0.038),波幅較對照組降低;A組N2、P3潛伏期較B組患者延長,波幅較其升高;病例組血清AChE水平高于健康對照組,其活性與健康對照組比較差異無統計學意義,A、B組患者AChE水平及活性比較差異無統計學意義;病例組整體認知水平與損傷部位、AChE濃度具有線性迴歸關繫(rY1.2=0.584,P=0.039;rY21=0.726,P=0.017),標準化迴歸繫數及偏相關繫數均錶明AChE濃度對整體認知功能影響最大(|Beta|=0.3601,rY2.1=0.726).結論 額葉底部損傷患者認知功能障礙具體錶現與損傷部位密切相關;神經遞質乙酰膽堿可能在認知功能障礙的病理生理機製中髮揮一定的作用.
목적 통과분석단측액협저부뇌좌렬상환자상후1개월적인지공능변화특정,대기가능발병궤제진행초보탐색.방법 응용제2판락문사돈작업요법인지량표(LOTCA)、유사강성잡편분류량표(WCST)、몽특리이평고량표중문판(MoCA)、MMSE분별평고45명건강대조화42례단측액협저부중도뇌좌렬상환자(병례조)상후1개월적신경인지공능;응용사건상관전위(EPR)의측량인지공능전위P300내원성성분N2、P3적잠복기급파폭;채용ELISA기술측정혈청담감지매E(AChE)농도급응용속솔법측정기활성;다원축보회귀법분석병례조정체인지공능여손상부위、AChE농도급활성적상관성.결과 병례조상후1개월각항신경인지측시분수균현저저우건강대조조,좌측액협저부손상환자(A조,23례)주요표현위구자복술능력、사어류창성、열독능력、언어리해능력、인지전이능력등현저하강,이우측액협저부손상환자(B조,19례)칙주요표현위주의력、동작운용、시운동조직、도형묘회능력、추상개괄능력、라집사유능력등현저하강.병례조EPR P300내원성성분N2、P3잠복기[A조:(322.4±17.0)、(410.1±19.9)ms,B조:(308.4±15.6)、(385.5±17.4)ms]교건강대조조[(268.6±14.7)、(369.2±15.4)ms]연장(F=4.084,P=0.018;F=3.467,P=0.038),파폭교대조조강저;A조N2、P3잠복기교B조환자연장,파폭교기승고;병례조혈청AChE수평고우건강대조조,기활성여건강대조조비교차이무통계학의의,A、B조환자AChE수평급활성비교차이무통계학의의;병례조정체인지수평여손상부위、AChE농도구유선성회귀관계(rY1.2=0.584,P=0.039;rY21=0.726,P=0.017),표준화회귀계수급편상관계수균표명AChE농도대정체인지공능영향최대(|Beta|=0.3601,rY2.1=0.726).결론 액협저부손상환자인지공능장애구체표현여손상부위밀절상관;신경체질을선담감가능재인지공능장애적병리생리궤제중발휘일정적작용.
Objective To investigate the possible pathogenesis of the cognitive function in unilateral frontal bottom laceration by follow-up study in patients after one month of the onset. Methods MMSE, Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Montreal Cognitive Assessment (MoCA), Wisconsin Card Sorting Test (WCST) scales were used to evaluate neurocognitie function in 42 patients after one month of onset of unilateral frontal bottom laceration and 45 normal controls. The wave amplitude and the latency of the endogenous composition N2, P3 of P300 were measured at the cognitive potential instrument. Level of AChE was determined by ELISA and active AChE was analyzed by the ration analyses. Stepwise multivariate regression analyzed the correlation of the overall cognitive function and the lever and active of AChE. Results The cognitive test scores in patients were significantly worse than those in normal controls. The ability of recite sentences, fluency of words, reading, understanding language,cognitive transfering decreases in the left frontal bottom laceration patients (Group A, 23 cases), while the ability of attention, action, organization, graphics depicting, abstract epitoming, logical thinking were all seriously impaired in the patients with right frontal bottom laceration (Group B, 19 cases). The latency of the endogenous composition N2, P3 in patients ( Group A: (322. 4 ± 17.0), (410. 1 ± 19.9) ms; Group B:( 308.4 ± 15.6), (385.5 ± 17.4) ms) is more lengthen ( F = 4. 084, P = 0. 018; F = 3.467, P = 0. 038 )than the normal controls ( (268.6 ± 14. 7 ), ( 369. 2 ± 15. 4 ) ms) and the wave amplitude is lower ( F =2. 986 ,P =0. 047 ;F =3. 313 ,P =0. 041 ). The latency of N2 ,P3 in Group A of is more lengthen than Group B, while the wave amplitude is higher. The difference of the active of AChE in patients and control groups had no statistical significance, however, the level of AChE in two groups had statistical significance. The comparison of the active and the total AChE in patients has also not statistical significance. The correlation of the overall cognitive function has the linear regression with the parts of the brain and the level of AChE ( rY1.2 = 0. 584, P = 0. 039; rY2.1 = 0. 726, P = 0. 017 ). The standardized regression coefficients showed the level of AChE has the biggest influence to the overall cognitive function ( |Beta| =0. 3601, rY2.1 =0. 726).Conclusions AChE may be one of the important factors in the cognitive function after frontal bottom laceration. The specific damages of cognitive function in unilateral frontal bottom laceration patients closely relate with the lesion locations in the injured frontal bottom laceration.
