梗死灶大小对急性颞叶或枕叶梗死患者认知障碍的影响及其与事件相关电位P300潜伏期的关系

目的 探讨急性颞叶或枕叶梗死患者梗死灶的大小对认知功能障碍发生率的影响,以及认知障碍与事件相关电位P300潜伏期的相关性。方法 前瞻性研究。纳入2020年1月—2021年7月蚌埠市第三人民医院神经内科急性颞叶或枕叶梗死患者100例为观察组,其中男52例、女48例,年龄50~82（70.2±7.9）岁,受教育年限5~9（5.3±0.9）年,有吸烟史21例、饮酒史17例,合并高血压36例、糖尿病24例、冠心病10例。观察组患者均行头颅MR扫描并测量梗死灶大小,按照测量结果分组：梗死灶≥30 cm³为观察A组（41例）,梗死灶<30 cm³为观察B组（59例）。选取同时期年龄、性别与观察组患者相匹配的50例健康体检者为对照组,其中男25例、女25例,年龄50~82（71.3±7.2）岁。对比3组受试者性别、年龄、受教育年限、吸烟史、饮酒史,以及合并高血压、糖尿病、冠心病情况等临床基线资料;采用蒙特利尔认知评估（MoCA）量表评估所有受试者认知功能,并测定所有受试者的事件相关电位P300潜伏期,观察组在住院1周后病情稳定情况下进行测试,对照组在体检当天进行测试;采用Spearman相关分析法评估观察组中认知障碍患者的P300潜伏期与MoCA评分的相关性。结果 3组受试者基线资料比较差异均无统计学意义（P值均>0.05）。观察A组、观察B组与对照组MoCA评分分别为27（23,28）分 、28（27,29）分和29（28,30）分,P300潜伏期分别为380（320,380） ms、310（ 290,350） ms和290（280,300） ms,认知障碍患者分别占43.9%（18/41）、32.2%（19/59）和2%（1/50）,对照组患者较2个观察组的MoCA评分高、P300潜伏期短、认知障碍发生率低,3组间比较差异均有统计学意义（Z=34.29、64.00,χ²=23.34,P值均<0.001）;与观察B组比较,观察A组患者的MoCA评分低、P300潜伏期长,差异有统计学意义（P值均<0.001）。Spearman相关分析显示,观察组中37例认知障碍患者的MoCA评分25（22,27）分]与P300潜伏期360（320,416）ms]呈负相关（r_s=-0.36,P<0.05）。结论 急性颞叶或枕叶梗死患者梗死灶的大小对患者认知障碍的发生有影响;合并认知障碍的患者事件相关电位P300潜伏期与MoCA量表评分呈负相关,两者对患者认知功能的评估结果具有较好的一致性。

Effect of infarct size on cognitive impairment in patients with acute temporal and occipital lobe infarction and its relationship with event-related potential P300 latency

Objective This study aimed to explore the effect of the size of acute temporal lobe or occipital lobe infarction on cognitive dysfunction, and analyze the relationship between event-related potential P300 latency and cognitive dysfunction. Methods In this study, a prospective study design was used. A total of 100 patients with acute temporal lobe or occipital lobe infarction who were admitted to the Department of Neurology, Bengbu Third People's Hospital, from January 2020 to July 2021 were included as the research objects, including 52 males and 48 females, with an age range of 50-82 years (70.2±7.9). All patients had 5-9 (5.3±0.9) years of education; 21 patients had a history of smoking; 17 patients had a history of drinking; 36 patients had a history of hypertension; 24 patients had a history of diabetes, and 10 patients had a history of coronary heart disease. In addition, all patients underwent brain MRI scans, and they were grouped on the basis of the size of the infarct: observation group A (41 cases) with infarction ≥30 cm³ and observation group B (59 cases) with infarction <30 cm³. Fifty age-matched healthy subjects in the same hospital were selected as the control group, including 25 males and 25 females, aged 50-82 (71.3±7.2) years old. The clinical baseline data such as gender, age, years of education, smoking history, drinking history, hypertension, diabetes mellitus, and coronary heart disease history were compared among the three groups; the Montreal Cognitive Assessment (MoCA) scale was used to evaluate the cognition of all subjects, and the P300 incubation period of all subjects was measured. The observation group was tested when the condition was stable after 1 week of hospitalization, and the control group was tested on the day of physical examination. Spearman correlation analysis was used to evaluate the correlation between P300 latency and MoCA score of cognitive impairment patients in the observation group. Results No significant difference in baseline data was found among the three groups (all P>0.05). The MoCA scores of observation group A, observation group B, and the control group were 27(23,28), 28(27,29), and 29(28,30), respectively. The P300 latency was 380(320,380) ms、310( 290,350) ms and 290(280,300) ms, respectively, and the incidence of cognitive disorder was 43.9% (18/41), 32.2% (19/59), and 2% (1/50), respectively. Compared with the two observation groups, patients in the control group had higher MoCA score, shorter P300 latency, and lower incidence of cognitive impairment, with statistically significant differences among the three groups (Z=34.29, Z=64.00, χ²=23.34, all P values <0.001). Compared with observation group B, observation group A had lower MoCA score and longer P300 latency, and the differences were statistically significant (all P values <0.001). Spearman correlation analysis showed that the MoCA score 25(22, 27)] of patients with cognitive impairment in the observation group was negatively correlated with P300 latency 360(320, 416) ms] (r_s=-0.36, P <0.05). Conclusion The size of acute temporal lobe or occipital lobe infarction has an influence on the cognitive impairment of patients. In addition, the P300 latency is negatively correlated with the score of MoCA scale which shows consistent results during evaluation.