中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2015年
4期
208-214
,共7页
张丽%刘帮杉%周建松%李则宣%路晓文%李凌江
張麗%劉幫杉%週建鬆%李則宣%路曉文%李凌江
장려%류방삼%주건송%리칙선%로효문%리릉강
创伤后应激障碍%执行功能%荟萃分析
創傷後應激障礙%執行功能%薈萃分析
창상후응격장애%집행공능%회췌분석
Post-traumatic stress disorder%Executive functions%Meta-analysis
目的 对PTSD患者的执行功能损害情况进行系统回顾.方法 通过Meta分析对国外公开发表的PTSD患者与健康人群及创伤暴露者的执行功能比较的文献进行统计.选取连线测验B部分(Trial Making Test B,TMT B)、威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)、Stroop测验、Rey-Osterrieth复杂图形测验(Rey-Osterrieth Complex Figure Test,ROCFT)拷贝数、韦氏成人智力量表修订版/韦氏记忆量表数字广度测验作为执行功能测验指标.以 PTSD或posttraumatic stressdisorder和neurocognit*或neuropsychology*或cognitive impairment或executive function或workingmemory为关键词对PubMed、EMBase、Web of Knowledge数据库进行相关文献检索.限定文献发表时间为1985年1月至2014年10月,并根据纳入标准和排除标准进行文献筛选,文献类型为论著.通过采用Revman 5.3软件进行统计学分析.结果 最终共纳入35篇文献,PTSD患者1218例(PTSD组),创伤暴露患者2 570例(创伤暴露对照组),健康对照者683名(健康对照组).PTSD组与创伤暴露对照组比较,TMT B分值明显降低[标准化均数差(standardized mean difference,SMD):0.63,95%CI:0.35~0.91,P=0.00],差异具有统计学意义;PTSD组与健康对照组相比,TMT B (SMD:0.49,95% CI:0.07~0.90,P=0.02)、WCST分类完成数(SMD:-0.39,95% CI:-0.74~-0.05,P=0.02)、ROCFT拷贝数(SMD:-0.43,95%CI:-0.76~-0.09,P=0.01)、韦氏成人智力量表修订版/韦氏记忆量表数字广度测验分值降低(顺序数字广度:SMD:-0.28,95% CI:-0.52~-0.03,P=0.03;逆序数字广度:SMD:-0.32,95%CI:-0.63~0.00,P=0.05;总数字广度:SMD:-0.49,95%CI:-0.85~-0.13,P=0.01),差异具有统计学意义.PTSD组与创伤暴露对照组在WCST持续错误数和分类完成数、Stroop测验、ROCFT拷贝数、数字广度(包括顺序、逆序及总数字广度)测验方面差异无统计学意义;PTSD组与健康对照组在WCST持续错误数、Stroop测验上差异无统计学意义;创伤暴露对照组与健康对照组在TMT B、顺序数字广度、逆序数字广度测验上差异无统计学意义.结论 PTSD患者存在多项执行功能受损,创伤暴露可能是导致其损害的部分原因.
目的 對PTSD患者的執行功能損害情況進行繫統迴顧.方法 通過Meta分析對國外公開髮錶的PTSD患者與健康人群及創傷暴露者的執行功能比較的文獻進行統計.選取連線測驗B部分(Trial Making Test B,TMT B)、威斯康星卡片分類測驗(Wisconsin Card Sorting Test,WCST)、Stroop測驗、Rey-Osterrieth複雜圖形測驗(Rey-Osterrieth Complex Figure Test,ROCFT)拷貝數、韋氏成人智力量錶脩訂版/韋氏記憶量錶數字廣度測驗作為執行功能測驗指標.以 PTSD或posttraumatic stressdisorder和neurocognit*或neuropsychology*或cognitive impairment或executive function或workingmemory為關鍵詞對PubMed、EMBase、Web of Knowledge數據庫進行相關文獻檢索.限定文獻髮錶時間為1985年1月至2014年10月,併根據納入標準和排除標準進行文獻篩選,文獻類型為論著.通過採用Revman 5.3軟件進行統計學分析.結果 最終共納入35篇文獻,PTSD患者1218例(PTSD組),創傷暴露患者2 570例(創傷暴露對照組),健康對照者683名(健康對照組).PTSD組與創傷暴露對照組比較,TMT B分值明顯降低[標準化均數差(standardized mean difference,SMD):0.63,95%CI:0.35~0.91,P=0.00],差異具有統計學意義;PTSD組與健康對照組相比,TMT B (SMD:0.49,95% CI:0.07~0.90,P=0.02)、WCST分類完成數(SMD:-0.39,95% CI:-0.74~-0.05,P=0.02)、ROCFT拷貝數(SMD:-0.43,95%CI:-0.76~-0.09,P=0.01)、韋氏成人智力量錶脩訂版/韋氏記憶量錶數字廣度測驗分值降低(順序數字廣度:SMD:-0.28,95% CI:-0.52~-0.03,P=0.03;逆序數字廣度:SMD:-0.32,95%CI:-0.63~0.00,P=0.05;總數字廣度:SMD:-0.49,95%CI:-0.85~-0.13,P=0.01),差異具有統計學意義.PTSD組與創傷暴露對照組在WCST持續錯誤數和分類完成數、Stroop測驗、ROCFT拷貝數、數字廣度(包括順序、逆序及總數字廣度)測驗方麵差異無統計學意義;PTSD組與健康對照組在WCST持續錯誤數、Stroop測驗上差異無統計學意義;創傷暴露對照組與健康對照組在TMT B、順序數字廣度、逆序數字廣度測驗上差異無統計學意義.結論 PTSD患者存在多項執行功能受損,創傷暴露可能是導緻其損害的部分原因.
목적 대PTSD환자적집행공능손해정황진행계통회고.방법 통과Meta분석대국외공개발표적PTSD환자여건강인군급창상폭로자적집행공능비교적문헌진행통계.선취련선측험B부분(Trial Making Test B,TMT B)、위사강성잡편분류측험(Wisconsin Card Sorting Test,WCST)、Stroop측험、Rey-Osterrieth복잡도형측험(Rey-Osterrieth Complex Figure Test,ROCFT)고패수、위씨성인지역량표수정판/위씨기억량표수자엄도측험작위집행공능측험지표.이 PTSD혹posttraumatic stressdisorder화neurocognit*혹neuropsychology*혹cognitive impairment혹executive function혹workingmemory위관건사대PubMed、EMBase、Web of Knowledge수거고진행상관문헌검색.한정문헌발표시간위1985년1월지2014년10월,병근거납입표준화배제표준진행문헌사선,문헌류형위론저.통과채용Revman 5.3연건진행통계학분석.결과 최종공납입35편문헌,PTSD환자1218례(PTSD조),창상폭로환자2 570례(창상폭로대조조),건강대조자683명(건강대조조).PTSD조여창상폭로대조조비교,TMT B분치명현강저[표준화균수차(standardized mean difference,SMD):0.63,95%CI:0.35~0.91,P=0.00],차이구유통계학의의;PTSD조여건강대조조상비,TMT B (SMD:0.49,95% CI:0.07~0.90,P=0.02)、WCST분류완성수(SMD:-0.39,95% CI:-0.74~-0.05,P=0.02)、ROCFT고패수(SMD:-0.43,95%CI:-0.76~-0.09,P=0.01)、위씨성인지역량표수정판/위씨기억량표수자엄도측험분치강저(순서수자엄도:SMD:-0.28,95% CI:-0.52~-0.03,P=0.03;역서수자엄도:SMD:-0.32,95%CI:-0.63~0.00,P=0.05;총수자엄도:SMD:-0.49,95%CI:-0.85~-0.13,P=0.01),차이구유통계학의의.PTSD조여창상폭로대조조재WCST지속착오수화분류완성수、Stroop측험、ROCFT고패수、수자엄도(포괄순서、역서급총수자엄도)측험방면차이무통계학의의;PTSD조여건강대조조재WCST지속착오수、Stroop측험상차이무통계학의의;창상폭로대조조여건강대조조재TMT B、순서수자엄도、역서수자엄도측험상차이무통계학의의.결론 PTSD환자존재다항집행공능수손,창상폭로가능시도치기손해적부분원인.
Objective To take a system review on the impairment of executive functions in patients with post-traumatic stress disorder (PTSD).Methods A meta-analysis was performed to summarize the literature on the executive functions in patients with PTSD,healthy controls and trauma-exposed controls without any psychiatric disorder.Trial Making Test B (TMT B),Wisconsin Card Sorting Test (WCST),Stroop test,Rey-Osterrieth Complex Figure Test (ROCFT) copy,Wechsler Adult Intelligence Scale Revised/ Wechsler Memory Scale digit span were chosen to as the indices of executive functions.The databases of Pubmed,EMBase and Web of Knowledge were searched from January 1985 and October 2014.The key words PTSD or posttraumatic stress disorder and neurocognit* or neuropsychology* or cognitive impairment or executive function or working memory were used.The literature search was conducted according to the inclusive and exclusive criteria.Original research were published between January 1985 and October 2014-,and selected according to the inclusion criteria and exclusion criteria.Revman 5.3 software was used for statistical analysis.Results A total of 35 primary studies were identified,including 1218 PTSD patients,2 570 trauma-exposed controls and 683 healthy controls.The performance of TMT B in PTSD group were statistically significant worse than that in the trauma-exposed control group (standardized mean difference,SMD:0.63,95%CI:0.35-0.91,P=0.00).Furthermore,PTSD group showed significant worse performance on TMT B (SMD:0.49,95% CI:0.07-0.90,P=0.02),WCST categories completed (SMD:-0.39,95% CI:-0.74--0.05,P=0.02),ROCFT copy (SMD:-0.43,95% CI:-0.76--0.09,P=0.01),Wechsler Adult Intelligence Scale Revised/Wechsler Memory Scale digit span scores (Digit span forward:SMD:-0.28,95% CI:-0.52--0.03,P=0.03;Digit span backward:SMD:-0.32,95% CI:-0.63-0.00,P=0.05;Digit span total:SMD:-0.49,95%CI:-0.85--0.13,P=0.01) were lower than healthy control group.No significant difference were found between PTSD and trauma-control group in WCST perseverative errors,WCST categories completed,Stroop test,ROCFT copy and Digit span (including Digit span forward,Digit span backward and Digit span total).The scores of WCST perseverative errors,Stroop test in PTSD group showed no significant difference with those in the healthy control group.The scores of TMT B,Digit span forward,Digit span backward in the trauma-exposed control group showed no significant difference with those in the healthy control group.Conclusion These data support the impaired executive functions of patients with PTSD,which may partially attribute to trauma exposure.