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非器质性失眠症是国际疾病分类第10版(ICD-10)使用的术语,指一组以情绪为原发病因或主要诱因的一种失眠症亚型,据相关研究表明,全球33%~50%的成人主诉每年有数夜失眠,长期的失眠对人类的注意力控制、警觉性、脑力负荷状态等带来显著的负面影响[1],更是心血管疾病、广泛性焦虑、抑郁、人体免疫力降低等疾病的危险因素[2-3],严重降低生活质量、工作效率,损害社会功能,甚至导致恶性意外事故的发生,是一个亟需解决的公共卫生健康问题。与其他疾病的诊断不同,非器质性失眠症的临床诊断目前是严格基于主观报告,缺乏客观便捷的评估方法[4]。而脑电波的发现和记录使得睡眠成为一种可量化的行为,可以准确判断和分析人类睡眠状态[5-6],暂时临床上公认多导睡眠监测(polysomnography,PSG)是监测睡眠的金标准[4]。但是由于主观报告的不准确性、PSG的复杂不便性,急需探求一种更为便捷客观的评估手段来丰富对非器质性失眠症的诊断。本研究采集非器质性失眠症和健康人群任务态脑电,分析事件相关电位P300成分的振幅和潜伏期差异性,并通过溯源分析方法探讨二者脑区溯源的特征,为临床提供一种更为客观准确的评估方法和日后睡眠障碍精准医学奠定基础。
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非器质性失眠症组PSQI总分及其各个组成部分评分、HAMA评分、HAMD评分均高于健康对照组(P < 0.05~P < 0.01)(见表 1)。2组在0-back、1-back任务中的正确率、反应时间差异均无统计学意义(P>0.05),2组在2-back任务中的正确率、反应时间差异均有统计学意义(P < 0.05)(见表 2)。
分组 n PSQI总分 主观睡眠质量 睡眠潜伏期 睡眠时间 习惯睡眠效率 睡眠紊乱累加问题 催眠药物 日间功能障碍 HAMA评分 HAMD评分 非器质性失眠症组 10 11.90±1.52 2.20±0.42 2.70±0.48 1.70±0.68 1.50±0.85 1.70±0.68 0 2.10±0.88 13.20±8.47 18.30±12.34 健康对照组 10 4.10±0.74 1.00±0.47 0.90±0.74 0.20±0.42 0.30±0.48 1.00±0.00 0 0.70±0.68 4.40±3.57 3.50±2.72 t — 14.57 600 6.45 5.96 3.88 3.28 — 4.01 3.03 3.7 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 — < 0.01 < 0.01 < 0.05 表 1 2组神经心理学评估结果比较(x±s;分)
N-back 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back 正确率/% 96.00±4.11 97.40±3.27 1.54 >0.05 反应时间/ms 605.82±49.01 659.21±91.42 1.63 >0.05 1-back 正确率/% 90.20±5.45 93.40±4.43 3.40 >0.05 反应时间/ms 722.09±103.29 722.57±81.50 0.01 >0.05 2-back 正确率/% 75.40±7.55 81.20±3.80 4.95 < 0.05 反应时间/ms 970.64±154.28 842.34±98.79 2.22 < 0.05 表 2 2组行为学数据结果比较(x±s)
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非器质性失眠症组在0-back任务中Fz点、1-back任务中Fz点的P300振幅均低于健康对照组(P < 0.05和P < 0.01)(见表 3)。非器质性失眠症组在2-back任务中Fz、Cz、Pz点的P300潜伏期均长于健康对照组(P < 0.05)(见表 4)。
相关因素 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back Fz 2.90±1.63 5.60±2.93 2.55 < 0.05 Cz 3.53(2.11,4.88) 3.46(2.83,3.83) -0.08△ >0.05 Pz 4.23(2.45,12.80) 7.48(1.96,11.56) -0.38△ >0.05 1-back Fz 2.82±2.12 6.72±3.74 2.87 < 0.01 Cz 2.57(1.94,3.54) 2.72(0.04,3.94) -0.45△ >0.05 Pz 4.69(3.34,6.94) 5.53(4.01,9.08) -1.06△ >0.05 2-back Fz 3.91(2.53,5.47) 4.50(3.55,10.37) -0.98△ >0.05 Cz 2.37±0.98 2.66±1.83 0.43 >0.05 Pz 4.19(1.09,6.89) 1.93(0.99,5.88) -0.53△ >0.05 △示uc值 表 3 2组P300振幅比较(x±s;μV)
相关因素 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back Fz 271.50(253.75,325.00) 291.50(277.75,346.75) -1.44△ >0.05 Cz 293.00(259.75,436.25) 396.50(283.00,444.25) -0.91△ >0.05 Pz 464.10±29.96 431.70±47.32 1.83 >0.05 1-back Fz 315.40±70.23 307.40±56.01 0.28 >0.05 Cz 346.70±78.86 371.70±86.35 0.68 >0.05 Pz 455.30±48.02 473.50±22.32 1.09 >0.05 2-back Fz 380.20±94.99 289.70±37.80 2.80 < 0.05 Cz 404.50(360.00,446.75) 264.50(250.00,332.50) -2.44△ < 0.05 Pz 408.70±84.25 334.40±47.14 2.43 < 0.05 △示uc值 表 4 2组P300潜伏期比较(x±s;ms)
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任务态溯源脑区主要集中在额叶部分,非器质性失眠症组激活区域较为分散,且在0-back和2-back中激活区域电流强度明显低于健康对照组(P < 0.01)(见图 1、表 5)。
分组 n 0-back 1-back 2-back 非器质性失眠症组 10 0.07(0.06,0.10) 0.08(0.07,0.22) 0.08±0.04 健康对照组 10 0.16(0.11,0.24) 0.14(0.08,0.19) 0.29±0.20 uc — -2.80 -0.68 3.15△ P — < 0.01 >0.05 < 0.01 △示t值 表 5 2组溯源激活区域电流强度比较[M(P25,P75);nA]
基于P300的非器质性失眠症ERP特征及溯源分析
ERP characteristics and source analysis of non-organic insomnia based on P300
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摘要:
目的探讨非器质性失眠症在事件相关电位下的P300特征和溯源分析。 方法将受试者分为健康对照组和非器质性失眠症组, 各10例, 采用EGI高密度脑电设备记录受试者任务态脑电及行为学数据, 其中任务态脑电选择数字N-back任务。通过Net Station软件分析事件相关电位, 提取Fz、Cz、Pz电极点的P300潜伏期、振幅以及行为学数据, 并在GeoSource工具栏中进行溯源定位。比较2组溯源特征属性。 结果非器质性失眠症组匹兹堡睡眠质量指数总分及其各个组成部分评分、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分均高于健康对照组(P < 0.05~P < 0.01)。2组在0-back、1-back任务中的正确率、反应时间差异均无统计学意义(P>0.05), 2组在2-back任务中的正确率、反应时间差异均有统计学意义(P < 0.05)。非器质性失眠症组在0-back任务中Fz点、1-back任务中Fz点的P300振幅均低于健康对照组(P < 0.05和P < 0.01)。非器质性失眠症组在2-back任务中Fz、Cz、Pz点的P300潜伏期均长于健康对照组(P < 0.05)。任务态溯源脑区主要集中在额叶部分, 非器质性失眠症组激活区域较为分散, 且在0-back和2-back中激活区域电流强度明显低于健康对照组(P < 0.01)。 结论非器质性失眠症受试者大脑工作记忆略有受损, 分散了大脑认知资源, 降低了大脑执行等高级认知能力, 因此基于P300的事件相关电位特征和溯源分析结果可在一定条件下对其进行客观评估, 并且其便捷性值得以后在临床上推广。 Abstract:ObjectiveTo explore the P300 characteristics and source analysis of non-organic insomnia at event-related potential. MethodsThe subjects were divided into healthy control group (n=10) and non-organic insomnia group (n=10).The task state electroencephalogram and behavioral data of the subjects were recorded with EGI high-density electroencephalogram equipment, and the task state electroencephalogram was selected for the digital N-back task.The event-related potential was analyzed through Net Station software to extract P300 latency, amplitude and behavioral data from the Fz, Cz and Pz electrode points, and to to locate the source in the GeoSource toolbar.The source characteristics was compared between the two groups. ResultsThe total score of Pittsburgh sleep quality index and its components, Hamilton anxiety scale score, Hamilton depression scale score in the non-organic insomnia group were higher than those in the healthy control group (P < 0.05 to P < 0.01).There was no significant difference in the accuracy and reaction time between the two groups in the 0-back and 1-back tasks (P>0.05), and there was significant difference in the accuracy and reaction time between the two groups in the 2-back task (P < 0.05).The P300 amplitude of Fz point in 0-back task and Fz point in 1-back task in non-organic insomnia group was lower than that in healthy control group (P < 0.05 and P < 0.01).The P300 latency of Fz, Cz, Pz points in the 2-back task in the non-organic insomnia group was longer than that in the healthy control group (P < 0.05).The source brain regions of task state were mainly concentrated in the frontal lobe.The active regions in the non-organic insomnia group were scattered, and the current intensity of the active regions in 0-back and 2-back was significantly lower than that in the healthy control group (P < 0.01). ConclusionsSubjects with non-organic insomnia have slightly impaired working memory of brain, which distracts the cognitive resources of brain and reduces higher cognitive abilities such as brain execution.Therefore, the characteristics of event-related potential based on P300 and source analysis can be objectively assessed under certain conditions, and the convenience of which warrants future clinical promotion. -
Key words:
- non-organic insomnia /
- event-related potential /
- P300 /
- electroencephalogram source
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表 1 2组神经心理学评估结果比较(x±s;分)
分组 n PSQI总分 主观睡眠质量 睡眠潜伏期 睡眠时间 习惯睡眠效率 睡眠紊乱累加问题 催眠药物 日间功能障碍 HAMA评分 HAMD评分 非器质性失眠症组 10 11.90±1.52 2.20±0.42 2.70±0.48 1.70±0.68 1.50±0.85 1.70±0.68 0 2.10±0.88 13.20±8.47 18.30±12.34 健康对照组 10 4.10±0.74 1.00±0.47 0.90±0.74 0.20±0.42 0.30±0.48 1.00±0.00 0 0.70±0.68 4.40±3.57 3.50±2.72 t — 14.57 600 6.45 5.96 3.88 3.28 — 4.01 3.03 3.7 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 — < 0.01 < 0.01 < 0.05 表 2 2组行为学数据结果比较(x±s)
N-back 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back 正确率/% 96.00±4.11 97.40±3.27 1.54 >0.05 反应时间/ms 605.82±49.01 659.21±91.42 1.63 >0.05 1-back 正确率/% 90.20±5.45 93.40±4.43 3.40 >0.05 反应时间/ms 722.09±103.29 722.57±81.50 0.01 >0.05 2-back 正确率/% 75.40±7.55 81.20±3.80 4.95 < 0.05 反应时间/ms 970.64±154.28 842.34±98.79 2.22 < 0.05 表 3 2组P300振幅比较(x±s;μV)
相关因素 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back Fz 2.90±1.63 5.60±2.93 2.55 < 0.05 Cz 3.53(2.11,4.88) 3.46(2.83,3.83) -0.08△ >0.05 Pz 4.23(2.45,12.80) 7.48(1.96,11.56) -0.38△ >0.05 1-back Fz 2.82±2.12 6.72±3.74 2.87 < 0.01 Cz 2.57(1.94,3.54) 2.72(0.04,3.94) -0.45△ >0.05 Pz 4.69(3.34,6.94) 5.53(4.01,9.08) -1.06△ >0.05 2-back Fz 3.91(2.53,5.47) 4.50(3.55,10.37) -0.98△ >0.05 Cz 2.37±0.98 2.66±1.83 0.43 >0.05 Pz 4.19(1.09,6.89) 1.93(0.99,5.88) -0.53△ >0.05 △示uc值 表 4 2组P300潜伏期比较(x±s;ms)
相关因素 非器质性失眠症组
(n=10)健康对照组
(n=10)t P 0-back Fz 271.50(253.75,325.00) 291.50(277.75,346.75) -1.44△ >0.05 Cz 293.00(259.75,436.25) 396.50(283.00,444.25) -0.91△ >0.05 Pz 464.10±29.96 431.70±47.32 1.83 >0.05 1-back Fz 315.40±70.23 307.40±56.01 0.28 >0.05 Cz 346.70±78.86 371.70±86.35 0.68 >0.05 Pz 455.30±48.02 473.50±22.32 1.09 >0.05 2-back Fz 380.20±94.99 289.70±37.80 2.80 < 0.05 Cz 404.50(360.00,446.75) 264.50(250.00,332.50) -2.44△ < 0.05 Pz 408.70±84.25 334.40±47.14 2.43 < 0.05 △示uc值 表 5 2组溯源激活区域电流强度比较[M(P25,P75);nA]
分组 n 0-back 1-back 2-back 非器质性失眠症组 10 0.07(0.06,0.10) 0.08(0.07,0.22) 0.08±0.04 健康对照组 10 0.16(0.11,0.24) 0.14(0.08,0.19) 0.29±0.20 uc — -2.80 -0.68 3.15△ P — < 0.01 >0.05 < 0.01 △示t值 -
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