【作者】 王晓燕；

【导师】 谢炳玓；

【作者基本信息】 天津医科大学 ， 神经病学， 2017， 硕士

【摘要】 目的:探讨胼胝体膝部梗塞患者听觉事件相关电位P300(auditory event-related potential,P300)的特征,以P300为参考诊断胼胝体膝部梗塞的敏感性、特异性及诊断的受试者工作特征曲线(Receiver Operating Characteristic,ROC)下面积(Area under the ROC curve,AUC),进一步了解胼胝体膝部梗塞患者听觉事件相关电位P300的特点,为临床应用其判断胼胝体膝部梗死提供神经电生理诊断依据。方法:选取2012年2月至2016年10月天津医科大学总医院神经内科门诊和住院患者进行分析。筛选其中脑CT和/或脑MRI确诊为胼胝体膝部梗塞患者24例(病例组),与同期健康正常人群26例(对照组)为对照,进行对比研究。应用Nicolet Spirit脑电生理仪对胼胝体膝部梗塞患者及健康对照组进行听觉事件相关电位P300(auditory event-related potential,P300)检测。比较胼胝体膝部梗塞患者及健康对照组听觉事件相关电位P300的特征包括潜伏期、波幅等有无差别。根据贝叶斯定理,以听觉事件相关电位P300潜伏期和波幅为参考指标,计算P300诊断胼胝体膝部梗塞的敏感性、特异性、阳性预测值、阴性预测值、诊断优势比及受试者工作特征曲线(ROC)下面积(AUC)。结果:1.病例组和对照组P300潜伏期分别为339.9±35.3ms和296.9±9.6ms,病例组显著长于对照组(t=4.85,P<0.05)。2.病例组和对照组波幅分别为6.1±0.9μV和8.4±0.7μV,病例组显著低于对照组且差别有统计学意义(t=8.79,P<0.05)。3.病例组简易精神状态检查表(MMSE)评分平均为23.82±2.48,病例组患者MMSE评分与P300波幅存在明显的相关性(rspreason=0.63,P<0.05),但mmse与潜伏期无明显相关性(rspreason=-0.07,P=0.78)。4.以潜伏期为指标,诊断胼胝体膝部梗塞的敏感性为100%,特异性为83.3%,ROC曲线下面积为0.88。5.以波幅为参考指标诊断诊断胼胝体膝部梗塞的敏感性为100%,特异性为95.8%,ROC曲线下面积为0.98。结论:1.胼胝体膝部梗塞患者组与对照组比较听觉事件相关电位P300潜伏期存在差异,胼胝体膝部梗塞患者P300潜伏期明显延长。2.胼胝体膝部梗塞患者组与对照组比较听觉事件相关电位P300波幅存在差异,胼胝体膝部梗塞患者P300波幅显著低于健康人群组。3.胼胝体膝部梗塞患者简易精神状态检查表(MMSE)评分与听觉事件相关电位P300波幅存在正相关性,即随着波幅的增高,MMSE评分升高。4.以听觉事件相关电位P300潜伏期为指标,诊断胼胝体膝部梗塞的敏感性较高,特异性尚可。5.以听觉事件相关电位P300波幅为指标,诊断胼胝体膝部梗塞的敏感性和特异性均较高。更多还原

【Abstract】 OBJECTIVE: The aim of this study was to evaluate the characteristics of auditory event-related potential P300 in patients with genu of corpus callosum infarction.And by using the auditory event-related potential P300 as the diagnostic index,the diagnostic sensitivity,specificity,and area under the ROC curve were calculated according to the Bayes’ theorem.Further understanding the characteristics of auditory event-related potential P300 in genu of corpus callosum infarction patients which can be useful for the clinical application.METHODS: Patients hospitalization from Feb 2012 to Oct 2016 were deemed as the potential subjects in the neurology department of Tianjin Medical General Hospital.Twenty four patients with genu of corpus callosum infarction and 26 subjects of healthy controls were included in this study.The genu of corpus callosum infarction patients were confirmed by brain CT or MRI.The auditory event-related potential,P300 were performed by using Nicolet Spirit Brain electrophysiological instrument.The general characteristic of auditory event-related potential,P300 such as incubationand amplitude were recorded and compared between the two groups.We using the auditory event-related potential P300 as the index for diagnosis of genu of corpus callosum infarction.The diagnostic sensitivity,specificity,and area under the ROC curve were calculated according to the Bayes’ theorem.RESULTS:1.The incubation of P300 were 339.9±35.3ms and 296.9±9.6ms respectively in the cases and control group with statistical difference(t=4.85,P<0.05).2.The amplitude of P300 were 6.1±0.9μV and 8.4±0.7μV respectively in the cases and control group with statistical difference(t=8.79,P<0.05).3.The MMSE score was 23.82±2.48 in the case group which was associated with the amplitude(rspreason=0.63,P<0.05),but no related with the incubation(rspreason=-0.07,P =0.78).4.The diagnostic sensitivity and specificity were 100% and 83.3% with area under the ROC of 0.88 by using the incubation of P300 for genu of corpus callosum infarction.5.The diagnostic sensitivity and specificity were100% and 95.8%,with area under the ROC of 0.98 by using the amplitude of P300 for genu of corpus callosum infarction.CONCLUSION:1.The incubation for auditory event-related potential P300 was statistical different between the healthy people and patients with genu of corpus callosum infarction.2.The amplitude for auditory event-related potential P300 was statistical different between the healthy people and patients with genu of corpus callosum infarction.3.The MMSE score was associated with amplitude of auditory event-related potential P300.With the increasing of amplitude of auditory event-related potential P300 the score of MMSE was significant decreased.4.By using the incubation for auditory event-related potential P300 for genu of corpus callosum infarction,the diagnostic sensitivity was high,the specificity was acceptable.5.By using the amplitude for auditory event-related potential P300 for genu of corpus callosum infarction,the diagnostic sensitivity and specificity was high.更多还原