CAJ | 학술논문

目的探讨颞叶癫痫(TLE)患者执行功能的改变及其与事件相关电位P300的相关性.方法对天津医科大学总医院50例TLE患者和30名与其年龄、性别、文化程度相匹配的健康志愿者进行神经心理学检查,包括蒙特利尔认知评估(MoCA)、工作记忆、语义流畅性试验、连线试验、数字广度测验、数字符号测验、Stroop色词测验及事件相关电位P300检测.结果 TLE组MoCA、语言及非语言工作记忆、语义流畅性、数字广度、数字符号及Stroop试验评分低于正常对照组,TLE组连线A、连线B时间延长,差异均有统计学意义(均P<0.05).和正常对照组相比,TLE组P300潜伏期[(332±33)ms]延长,P300波幅[(10±8)μV]降低,差异有统计学意义(P<0.05).左侧致痫灶组与右侧相比,语言工作记忆差异有统计学意义(P<0.05).P300潜伏期和MoCA、非语言工作记忆、数字广度测验、数字符号测验评分存在负相关(r=-0.29~-0.45,P<0.05);P300波幅和MoCA、非语言工作记忆、数字符号、Stroop色词测验评分存在正相关(r=0.37~0.47,P<0.05).其中P300波幅与总体认知水平和执行功能相关性更大.结论颞叶参与了执行功能的调控,TLE患者除存在广泛的认知损害外,尚存在多项执行功能损害包括:工作记忆、认知灵活性、注意力和抑制控制能力,其中左侧TLE患者语言工作记忆损害明显.TLE患者常存在P300潜伏期延长和波幅下降,其与执行功能测试存在相关性,P300潜伏期和波幅的检测有可能成为评价TLE患者认知功能损害的客观指标.
목적 탐토섭협전간(TLE)환자집행공능적개변급기여사건상관전위P300적상관성.방법 대천진의과대학총의원50례TLE환자화30명여기년령、성별、문화정도상필배적건강지원자진행신경심이학검사,포괄몽특리이인지평고(MoCA)、공작기억、어의류창성시험、련선시험、수자엄도측험、수자부호측험、Stroop색사측험급사건상관전위P300검측.결과 TLE조MoCA、어언급비어언공작기억、어의류창성、수자엄도、수자부호급Stroop시험평분저우정상대조조,TLE조련선A、련선B시간연장,차이균유통계학의의(균P<0.05).화정상대조조상비,TLE조P300잠복기[(332±33)ms]연장,P300파폭[(10±8)μV]강저,차이유통계학의의(P<0.05).좌측치간조조여우측상비,어언공작기억차이유통계학의의(P<0.05).P300잠복기화MoCA、비어언공작기억、수자엄도측험、수자부호측험평분존재부상관(r=-0.29~-0.45,P<0.05);P300파폭화MoCA、비어언공작기억、수자부호、Stroop색사측험평분존재정상관(r=0.37~0.47,P<0.05).기중P300파폭여총체인지수평화집행공능상관성경대.결론 섭협삼여료집행공능적조공,TLE환자제존재엄범적인지손해외,상존재다항집행공능손해포괄:공작기억、인지령활성、주의력화억제공제능력,기중좌측TLE환자어언공작기억손해명현.TLE환자상존재P300잠복기연장화파폭하강,기여집행공능측시존재상관성,P300잠복기화파폭적검측유가능성위평개TLE환자인지공능손해적객관지표.
Objective To explore the changes of executive function in patients with temporal lobe epilepsy and analyze its correlation with P300 event-related potentials. Methods Fifty patients with temporal lobe epilepsy and 30 age, gender and education-matched healthy control subjects were assessed by neuropsychological tests, including Montreal cognitive assessment (MoCA), working memory, verbal fluency, trail making, digit span, digit symbol and Stroop color-word interference to detect P300 event-related potentials. Results In temporal lobe epilepsy group, the scores in MoCA, verbal and non-verbal working memory, verbal fluency, digit span, digit symbol and Stroop test were lower than those of the normal control group. And trail making tests A and B became prolonged (P<0.05). Comparing with normal control group, temporal lobe epilepsy patients had prolonged latency [(332±33)ms] and decreased P300 amplitude[(10±8)μV] (P<0.05). Comparing epileptogenic focus group on the left and right sides, there was statistically significant difference in verbal working memory (P<0.05). There was a negative correlation of P300 latency and MoCA, non-verbal working memory, digit span and digit symbol test scores (r=-0.29--0.45, P<0.05). And a positive correlation of P300 amplitude and MoCA, non-verbal working memory, digit symbol conversion and Stroop scores was also found (r=0.37-0.47, P<0.05). P300 amplitude was more relevant to overall cognitive level and executive functions. Conclusion Temporal lobe is involved in the regulation of executive functions. Besides a wide range of cognitive impairment, temporal lobe epilepsy patients have a number of executive dysfunctions, including working memory, cognitive flexibility, attention and inhibitory control ability. And an impairment of verbal working memory is evident in left-sided lesion. Their manifestations include decreased latency and amplitude of P300 on executive function tests. Therefore these two objective parameters may be employed to evaluate the cognitive impairment in patients with temporal lobe epilepsy.