【摘要】 背景:关联性负变是与精神医学和心理学关系最为密切的一种脑诱发电位。目的:探讨情感障碍患者与正常成人在关联性负变检测中的不同表现。设计:病例-对照实验。单位:山东省淄博市精神病医院功能科。对象:选择2005-02/2006-01在山东省淄博市第五人民医院就诊和住院的情感障碍患者29例,男14例,女15例,监护人均知情同意,所有患者均符合精神病诊断与分类手册DSM-IV的躁狂抑郁症诊断标准。将情感障碍患者按入院时的精神状态分为躁狂相和抑郁相2组。躁狂相组11例,Bech-Rataelson躁狂量表评分大于16分。抑郁相组18例,分为单相(目前抑郁以往无躁狂)11例及双相(目前抑郁有过躁狂)7例,汉密顿抑郁量表评分大于24分。选择27例身心健康的医院职工作为对照组,男14例,女13例,年龄21～53岁,平均年龄(32.5±5.9)岁,3组受试者年龄、性别差异无显著性。方法:实验在屏蔽的隔音室中进行,被试者坐于软椅上,双眼向前看一目的物,在实验过程中,保持清醒。记录电极用8mm铂金头皮电极,位置参照国际脑电图学会10/20标准。颅顶有效电极置于Cz,参考电极置于右乳突。两眉中点上2cm处接地。关联性负变波形用函数记录仪描记。标准的关联性负变模式由光信号及短声信号组成。闪光灯和扬声器置于被试者正后方,被试者双耳接受短声信号后,即用右手指按手握式电键,瞬时切断短声。从同步光信号发出开始,全程持续2500ms为一次关联性负变记录,每20次叠加为一轮实验。每例被试者接受2轮实验,实验结束后,以20μV标准电压输入上述系统作同样次数叠加处理,作为波幅测量标准。主要观察指标:各组受试者的关联性负变的潜伏期、波幅B、指令信号前负相期待波面积、指令信号后负变化面积。结果:纳入患者56例全部进入结果分析。躁狂相组患者关联性负变波幅B较对照组高[(22.8±4.8)μV;(16.0±5.7)μV;P<0.01],抑郁相组患者指令信号前负相期待波面积较对照组小[(292.8±161.6)μV2;(412.8±159.9)μV2;P<0.01],抑郁相组患者关联性负变指令信号后负变化潜伏期延长[(261.9±79.3)ms;(211.9±36.3)ms;P<0.05],抑郁相单相组比双相组的关联性负变指令信号后负变化潜伏期显著延长[(344.5±66.9)ms;(230.4±83.8)ms;P<0.01]。结论:关联性负变和指令信号后负变化等提示关联性负变潜伏期延长可能是抑郁相单相患者的素质标记,而关联性负变波幅的变化则可能是情感障碍患者的状态标记。更多还原

【Abstract】 BACKGROUND: Contingent negative variation (CNV) is a kind of cerebral evoked potential,which is closely related with mental medicine and psychology. OBJECTIVE: To investigate the different manifestations between patients with affective disorder and normal adults in CNV detection. DESIGN: Case-control trial. SETTING: Department of Function,Psychiatric Hospital of Zibo,Shandong Province. PARTICIPANTS: Totally 29 inpatients and outpatients including 14 males and 15 females with affective disorder in the Fifth People’s Hospital of Zibo between February 2005 and January 2006 were selected. The guardians were all informed and agreed the content; the diagnosed criteria of the patients were accorded with the criteria of DSM-IV. According to their mental status when hospitalized,the patients were divided into manic episode group and depressive episode group. There were 11 cases in the manic episode group,whose scores of Bech-Rataelson Mania Scale (BRMS) >16; there were 18 cases in the depressive episode group,including unipolar depression (without history of mania episode) and bipolar depression (with history of mania episode) whose Hamilton Depression Scale (HAMD) scores > 24. A total of 27 healthy hospital staff were selected as control group including 14 males and 13 females aged 21-53 years and the mean age was (32.5±5.9) years. There was no significant difference in the age and sex among the three groups. METHODS: The CNV test was carried out in a soundproof room. Seating on a soft chair,the subject kept vigilant and focused on a fixed point in the front. The platinum electrode of 8 mm was attached to the subject’s vertex Cz according to the International 10/20 System,referred to the right mastoid. The middle point of 2 eyebrows was grounded. The CNV waveforms were described by a L2-3 XY Functional Plotter. Standard CNV was composed of light signal and click signal. The flashlight and loudspeaker were located at the right back of the examinee. The subject was asked to press the button with his right finger to cut off the short sound as soon as his ears received the imperative click. It would take 2 500 ms for one CNV trial,and 20 trials as one experiment. Every subject was given the experiment for twice,and the standard amplitude was set by inputting a standard voltage of 20 μV to the same recording system. MAIN OUTCOME MEASURES: The CNV latency,amplitude B,area of negative expectancy wave before command signal,and area of negative change post-imperative negative variation (PINV) latency of the subjects in the two groups. RESULTS: All the 56 patients were involved in the result analysis. Compared with the control group,the mania group showed higher CNV amplitude (22.8±4.8) μV; (16.0±5.7) μV; P < 0.01,and the depression group presented smaller A-S2 area (292.8±161.6) μV2; (412.8±159.9) μV2; P < 0.01,and prolonged PINV latency (261.9±79.3),(211.9±36.3) ms; P < 0.05. The prolonged PINV latency was found in the unipolar depression group compared with the bipolar depression group (344.5±66.9),(230.4±83.8) ms; P < 0.01. CONCLUSION: CNV and PINV suggest that prolonged latency is the trait maker of the patients with unipolar depression,and CNV amplitude changes belong to the state makers of affective disorder.更多还原