【作者】 赵宏伟；

【导师】 吕玉丹；

【作者基本信息】 吉林大学 ， 临床医学硕士（神经病学）（专业学位）， 2021， 硕士

【摘要】 目的:焦虑、抑郁可导致记忆、注意力、信息处理速度或执行功能异常,在失眠症患者中经常出现。ERP作为一种有效的脑电图技术已被应用于皮层信息处理的研究;在ERPs中,MMN、ASSRs、P50可能是焦虑、抑郁的有效检测方法。在我们的研究中,我们将MMN、ASSRs、P50结合研究皮层的抑制和习惯化特性,探索失眠患者伴发焦虑、抑郁的病理生理学机制。方法:最终本研究纳入PI患者30例,健康对照组(normal control,NC)30例,严格执行纳入标准或排除标准。使用PSG记录睡眠和睡眠效率、觉醒指数、总的睡眠时间、各睡眠阶段百分比和心率,作为PSG的客观参数。MMN、ASSRs、P50按国际10-20系统记录,选取不同脑区成分记录,如FZ、CZ、PZ、T7、T8等的波幅、潜伏期进行分析。分析PSG客观参数和一般临床资料:如、焦虑抑郁程度、病程、性别、受教育年限等与MMN、ASSRs、P50在各脑区的波幅和潜伏期之间的关系。统计学相关性分析选取未配对t检验、秩和检验。结果:1.PI组与NC组在年龄、性别、BMI等方面无明显差异。比NC组相比,PI组有明显的抑郁倾向。2.PI组在T7、Pz的ASSRs潜伏期存在显著的性别差异,无论是20Hz还是40Hz,在T7女性比男性潜伏期明显延长,在Pz男性比女性潜伏期明显延长。3.PI组在Pz的P50振幅门控抑制比(S2/S1)存在性别差异,女性比男性门控抑制比率小。4.PI组,在T7,20Hz ASSRs潜伏期与BMI、睡眠效率、觉醒指数、总睡眠时间、N1%、心率成负相关;40Hz ASSRs振幅与觉醒指数、N1%成正相关,与心率成负相关。在F3,40Hz ASSRs潜伏期与抑郁程度、睡眠潜伏期、REM%成负相关;40Hz ASSRs振幅与睡眠效率、总睡眠时间、N3%成正相关。5.PI组,在T7的P50S2/S1潜伏期与觉醒指数、N1%成正相关,S1潜伏期与觉醒指数成正相关,S2/S1振幅与REM成正相关。位于TP7的S1潜伏期与睡眠潜伏期、快速眼动期正相关。位于P3的S2振幅、S2/S1振幅分别与觉醒指数、N1%、心率相关。右侧颞叶TP8的P50S1潜伏期与BMI负相关,S1波幅与心率相关,S2/S1波幅与REM相关。位于P4的S1和S2/S1潜伏期与受教育程度相关。位于额叶的FPz、FP2的S1潜伏期和FP2、F4的S2/S1潜伏期与抑郁程度成正相关。6.与NC组相比,PI组的MMN潜伏期明显延长。并且,Fz、Cz、Pz等中线部位的MMN潜伏期与抑郁程度显著正相关。7.PI组,位于FPz、Cz、Pz部位的女性比男性有更高的MMN振幅。8.Pi组在Fz的MMN振幅分别与BMI、睡眠效率、N1%成正相关;Cz的MMN振幅与BMI、N1%、N3%成正相关;Pz的MMN振幅与BMI、睡眠效率、N3%成正相关;位于右侧颞叶的T8、TP8的MMN潜伏期与N1%、N2%成正相关。结论:1.ASSRs、P50、MMN可以作为检测PI患者认知障碍的电生理指标;可以多维度的检测PI患者的不同认知障碍。2.ASSRs反应信息的整合功能,可作为评价PI患者信息输入、整合的指标,也可作为评价PI患者情绪缺陷的指标。3.P50反应对外界信息的滤过功能,可作为PI患者对外界环境抗干扰能力的评定,也可作为PI患者情绪缺陷的评价指标。4.MMN反应信息的匹配、处理功能,可作为PI患者认知功能评价的稳定指标。更多还原

【Abstract】 Objective:Anxiety and depression can lead to abnormal memory,attention,speed of information processing or executive function,which often appear in patients with insomnia.ERP,as an effective EEG technique,has been used in cortical information processing.In ERPs,MMN,ASSRs and P50 may be effective detection methods for anxiety and depression.In our study,MMN,ASSRs and P50 were combined to study the inhibitory and habitualization characteristics of cortex,and to explore the pathophysiological mechanism of anxiety and depression in insomnia patients.Methods:30 primary insomnia patients(PI)and 30 healthy control group(NC)were included in this study,and the inclusion criteria or exclusion criteria were strictly implemented.Sleep and sleep efficiency,arousal index,total sleep time,percentage of each sleep stage and heart rate were recorded with PSG as objective parameters.MMN,ASSR and P50 were recorded according to the international 10-20 system,and the amplitude and latency of different brain regions,such as FZ,CZ,PZ,T7 and T8,were selected for analysis.Objective parameters of PSG and general clinical data,such as the degree of anxiety and depression,course of disease,gender,years of education,etc.,were analyzed in relation to the amplitude and latency of MMN,ASSR and P50 in various brain regions.Unpaired t test and rank sum test were used for statistical correlation analysis.Results:1.There was no significant difference in age,gender and BMI between PI group and NC group.Compared with the NC group,the PI group was significantly more prone to depression.2.There were significant gender differences in the ASSR latency at T7 and PZ in the PI group.No matter it was 20 Hz or 40 Hz,the latency was significantly longer for women at T7 than for men at PZ,and the latency was significantly longer for men than women at PZ.3.There was a gender difference in the P50 amplitude gated inhibition ratio(S2/S1)of PZ in the PI group,and the gated inhibition ratio in females was lower than that in males.4.In the PI group,at T7,20 h ZASSRs latency was negatively correlated with BMI,sleep efficiency,wakefulness index,total sleep time,N1% and heart rate;The40HZASSRs amplitude was positively correlated with arousal index and N1%,and negatively correlated with heart rate.In F3,the 40 HZASSRs latency was negatively correlated with the degree of depression,stage IV sleep latency,and REM%.The40 HZASSRs amplitude was positively correlated with sleep efficiency,total sleep time and N3%.5.In the PI group,the P50S2/S1 latency at T7 was positively correlated with arousal index and N1%,S1 latency was positively correlated with arousal index,and S2/S1 amplitude was positively correlated with REM.The S1 latency at TP7 was positively correlated with sleep latency and rapid eye movement.The S2 amplitude and S2/S1 amplitude at P3 were correlated with arousal index,N1% and heart rate,respectively.The P50S1 latency of TP8 in the right temporal lobe was negatively correlated with BMI,S1 amplitude was correlated with heart rate,and S2/S1 amplitude was correlated with REM.The incubation period of S1 and S2/S1 at P4 correlated with education level.The S1 latencies of FPZ and FP2 in the frontal lobes and S2/S1 latencies of FP2 and F4 were positively correlated with the degree of depression.6.Compared with NC group,the incubation period of MMN in PI group was significantly longer.In addition,MMN latency in the midline of FZ,CZ and PZ was positively correlated with the degree of depression.7.In the PI group,women located in FPZ,CZ and PZ had higher MMN amplitudes than men.8.The MMN amplitude of PI group in FZ was positively correlated with BMI,sleep efficiency and N1%,respectively;The MMN amplitude of CZ was positively correlated with BMI,N1% and N3%.MMN amplitude of PZ was positively correlated with BMI,sleep efficiency and N3%.The MMN latency of T8 and TP8 in the right temporal lobe was positively correlated with N1% and N2%.Conclusion:1.ASSRs,P50 and MMN can be used as electrophysiological indexes to detect cognitive impairment in patients with PI;Different cognitive impairments of patients with PI can be detected in multiple dimensions.2.The integration function of ASSRs response information can be used as an index to evaluate the information input and integration of patients with PI,as well as an index to evaluate the emotional defects of patients with PI.3.The filtering function of P50 response to the external information can be used as the evaluation of PI patients’ anti-interference ability to the external environment,as well as the evaluation index of emotional defects of PI patients.4.The matching and processing function of MMN response information can be used as a stable index for cognitive function evaluation of PI patients.更多还原