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

Correlation between cognitive function and event-related potential P300 and its influencing factors in patients with depressive episodes 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 双相障碍患者存在持续的多领域认知功能受损，涉及执行功能、记忆、注意力等，伴混合特征的双相障碍患者预后更差。目前，伴混合特征的双相障碍抑郁发作患者的认知功能和事件相关电位P300特征以及二者相关性的研究证据有限。目的 探索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之间的相关性，分析其认知功能的影响因素，以期为该亚型患者认知功能的改善提供参考。方法 纳入2021年11月—2024年4月在天津市安定医院门诊就诊和住院治疗的、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。采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）评定患者是否伴有混合特征。根据CUDOS-M评分，将患者分为伴混合特征组（n=34）与不伴混合特征组（n=39）。采用MATRICS共识认知成套测验（MCCB）评定认知功能，并进行听觉事件相关电位P300检测。采用Spearman相关分析检验P300指标与MCCB评分之间的相关性。采用多元线性回归分析考查认知功能的影响因素。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MCCB信息处理速度、注意/警觉、推理和问题解决评分均低于不伴混合特征组（F=3.650、3.520、4.213，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，伴混合特征的双相障碍抑郁发作患者MCCB注意警觉维度评分与P300潜伏期呈负相关（r_s=-0.576，P<0.01）。多元线性回归分析结果显示，在伴混合特征组中，受教育年限（β=0.378，P<0.05）可正向预测信息处理速度；P300潜伏期（β=-0.699，P<0.01）及年龄（β=-0.424，P<0.01）可负向预测注意/警觉功能。结论 伴混合特征的双相障碍抑郁发作患者病程更长，信息处理速度、注意/警觉、推理和问题解决三个认知领域功能受损更严重，P300潜伏期可能是伴混合特征的双相障碍抑郁发作患者注意/警觉功能的影响因素。

英文摘要:

      Background Patients with bipolar disorder exhibit persistent cognitive impairment across multiple domains， including executive function， memory， and attention. Furthermore， those with mixed features tend to have a poorer prognosis. Currently， research evidence regarding the characteristics of cognitive function and event-related potential P300， as well as their correlation， in patients with depressive episodes of bipolar disorder with mixed features remains limited.Objective To explore the correlation between cognitive function and event-related potential P300 in patients with depressive episodes of bipolar disorder with mixed features， analyze the influencing factors of cognitive function， so as to provide references for the improvement of cognitive function in this subtype of patients.Methods A total of 73 patients who met the diagnostic criteria for depressive episodes of bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were enrolled from the outpatient and inpatient departments of Tianjin Anding Hospital from November 2021 to April 2024. The Hamilton Depression Scale-17 item（HAMD-17） was used to assess the severity of depressive symptoms， and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier （CUDOS-M） was used to evaluate whether patients presented with mixed features. Based on the CUDOS-M total scores， patients were divided into two groups： the mixed features group （n=34） and the non-mixed features group （n=39）. The MATRICS Consensus Cognitive Battery （MCCB） was used to assess cognitive function， and auditory event-related potential P300 testing was performed. Spearman correlation analysis was used to examine the correlations between P300 indicators and MCCB scores. Multiple linear regression analysis was conducted to investigate the influencing factors of cognitive function.Results Patients with depressive episodes of bipolar disorder with mixed features had a longer total illness duration than those without mixed features， and the difference was statistically significant （t=2.030， P<0.05）. Analysis of covariance showed that the MCCB scores for processing speed， attention/vigilance， and reasoning and problem solving were all lower in the mixed features group than those in the non-mixed features group （F=3.650， 3.520， 4.213， P<0.01）. However， no significant difference was found between the two groups in P300 latency or amplitude （P>0.05）. Correlation analysis revealed that the MCCB attention/vigilance score was negatively correlated with P300 latency in patients with depressive episodes of bipolar disorder with mixed features （r_s=-0.576， P<0.01）. Multiple linear regression analysis showed that， in the mixed features group， years of education positively predicted processing speed （β=0.378， P<0.05）， while P300 latency （β=-0.699， P<0.01） and age （β=-0.424， P<0.01） negatively predicted attention/vigilance function.Conclusion Patients with depressive episodes of bipolar disorder with mixed features have a longer illness duration and more severe impairment in three cognitive domains： processing speed， attention/vigilance， and reasoning and problem solving. P300 latency may be an influencing factor of attention/vigilance function in patients with depressive episodes of bipolar disorder with mixed features ［Funded by Tianjin Key Medical Discipline Construction Project （number， TJYXZDXK-3-015B）； Hospital-level Scientific Research Project of Tianjin Anding Hospital （number， ADYKHT2021010）］