伴混合特征的双相障碍抑郁发作患者认知功能与事件相关电位P300的相关性及影响因素分析

Influencing Factors of Cognitive Function and Its Correlation with Event-Related Potential P300 in Patients with Depressive Episode of Bipolar Disorder with Mixed Features

中文关键词:  双相障碍，抑郁发作，混合特征，认知功能，事件相关电位

英文关键词:Bipolar disorder, Depressive episode, Mixed features, Cognitive function, Event-related potentials

中文摘要:

      背景 双相障碍伴混合特征的患者预后更差（如功能受损重、自杀率高），且双相障碍患者存在持续性多维度认知功能损害（执行、记忆、注意等），混合发作时损害尤为严重。目前伴混合特征的双相障碍抑郁发作患者的临床特征，特别是认知功能水平和事件相关电位P300特征以及二者间的相关性研究证据仍有限。目的 研究伴混合特征的双相障碍抑郁发作患者的神经认知功能水平及其与听觉诱发P300特征之间的关联，并进一步探究影响MCCB认知功能评分的相关因素，以期阐明该亚型患者认知损害的电生理机制，为其认知损伤评估、机制探究及临床精准干预提供客观科学依据。方法 于2021年11月—2024年4月收集来自天津市安定医院门诊就诊和住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）双相障碍抑郁发作诊断标准的患者73例。使用汉密尔顿抑郁量表17项版（HAMD-17）评定抑郁症状严重程度，采用临床实用抑郁发作伴混合特征量表（CUDOS-M）评估入组患者是否伴有混合特征，根据CUDOS-M评分结果将患者分为伴混合特征组（n=34）与不伴混合特征两组（n=39）。采用MATRICS共识认知成套测验（MCCB）进行7个维度认知功能测评，并进行听觉诱发P300检测。分析两组间认知功能、P300指标的差异，探究认知功能与P300电位指标间的关联，并筛选影响认知功能各维度的相关因素。结果 伴混合特征的双相障碍抑郁发作患者总病程长于不伴混合特征者，差异有统计学意义（t=2.030，P<0.05）。协方差分析结果显示，伴混合特征组和MCCB信息处理速度、注意警觉、推理和问题解决维度评分均低于不伴混合特征组（P均<0.01），两组P300潜伏期和波幅比较，差异均无统计学意义（P均>0.05）。相关分析结果显示，伴混合特征的双相抑郁发作患者MCCB注意警觉维度评分与P300潜伏期呈负相关（rs=-0.576，P<0.01）。回归分析结果显示，伴混合特征组中P300潜伏期（β=-0.699，P<0.01）及年龄（β=-0.424，P<0.01）负向预测MCCB注意警觉评分。结论 伴混合特征的双相障碍抑郁发作患者病程更长，在信息处理速度、注意警觉、推理和问题解决这三个认知功能维度的表现相较于不伴混合特征的患者更差，伴混合特征双相障碍抑郁发作患者的认知功能维度中的注意警觉功能与P300特征之间的关联性较强。

英文摘要:

      Background Bipolar disorder (BD) patients with mixed features experience poorer prognosis and more severe multidimensional cognitive impairments. However, evidence regarding cognitive function, auditory P300 event-related potential characteristics, and their interrelationship in bipolar depressive episode with mixed features (BDE-MF) subtype remains limited. Objective To investigate the neurocognitive function in patients with BDE-MF, analyze its correlation with the characteristics of auditory event-related potential P300, and further explore the influencing factors for the score of the MATRICS Consensus Cognitive Battery (MCCB), so as to elucidate the electrophysiological mechanism underlying cognitive impairment in this subtype, and provide objective evidence for the assessment, mechanistic research and precise clinical intervention of their cognitive deficits. Methods Seventy-three patients meeting criteria for bipolar depressive episode were assessed using the Clinically Useful Depression Outcome Scale supplemented with questions for DSM-5 Mixed subtype (CUDOS-M), dividing them into BDE-MF (n=34) and non-mixed features (BDE-nMF, n=39) groups. Neurocognitive function was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), and auditory P300 was recorded. Differences in cognitive function and P300 indicators between the two groups were analyzed, correlations between cognitive function and P300 potential indicators were explored, and relevant factors affecting each dimension of cognitive function were screened. Results The differences in illness duration between the two groups had statistical significance (t=2.030, P<0.05), the BDE-MF group had longer illness duration than BDE-nMF. Analysis of covariance revealed that BDE-MF group exhibited significantly lower scores on the MCCB dimensions of speed of processing, attention/vigilance, and reasoning and problem solving compared with BDE-nMF (all P<0.01). There were no statistically significant between-group differences in P300 latency and amplitude (all P>0.05). Within the BDE-MF group, Attention/Vigilance correlated negatively with P300 latency (rs=-0.576，P<0.01). Regression confirmed these associations: Attention/Vigilance was negatively predicted by P300 latency (β=-0.699, P<0.01) and age (β=-0.424, P<0.01). Conclusion BDE-MF patients exhibited a longer disease course and poorer performance in Speed of Processing, Attention/Vigilance, Reasoning and Problem Solving domains compared with BDE-nMF. No significant difference in P300 characteristics was observed between the two groups. Among cognitive domains in patients with mixed features, only attentional function showed a strong correlation with P300 characteristics.