P300与慢性意识障碍患者经颅直流电刺激响应的相关性研究

关键词：慢性意识障碍  事件相关电位  经颅直流电刺激  P300  改良昏迷恢复量表

Keywords:prolonged disorders of consciousness  event-related potential  transcranial direct current stimulation  P300  coma recovery scale-revised

摘要：

      摘要 目的：利用两组加工深度递增式变化的事件相关电位（ERP）Oddball范式探讨经颅直流电刺激（tDCS）响应慢性意识障碍患者的电生理学特征。 方法：研究纳入17例无反应觉醒综合征（UWS）和30例微意识状态（MCS）患者，对其进行两组加工深度递增式变化范式的ERP检查，后在连续10个工作日内接受20次左侧前额叶背外侧（DLPFC）区域tDCS治疗，根据改良昏迷恢复量表（CRS-R）评估结果分为响应者和非响应者，分析干预响应者一般情况特征及电生理学特征。 结果：在UWS患者中，性别、年龄、病程、接受手术情况、CRS-R评分、P300出现情况均与tDCS响应性无关（P＞0.05）；而在MCS患者中，CRS-R评分（P=0.015）和反名-正名（DO）范式中P300出现情况（P=0.005）与tDCS响应性相关，而性别、年龄、病程、接受手术情况、纯音—正名（TO）范式中P300出现情况与响应性无关（P＞0.05）。 结论：更高的CRS-R评分和分层听觉ERP范式中P300的存在，特别是DO范式中的P300成分与MCS患者的tDCS响应性有关，推测是由于DO范式中P300成分代表患者残存的语义加工处理能力，因此具有优先恢复的能力。

Abstract:

      Abstract Objective： To explore the electrophysiological characteristics of patients with prolonged disorders of consciousness responded to transcranial direct current stimulation （tDCS） intervention by a hierarchical auditory event-related potential （ERP） Oddball pattern. Method： A hierarchical auditory ERP pattern was applied to seventeen unresponsive wakefulness syndrome （UWS） and thirty-one minimally conscious state （MCS） patients who subsequently received 20 anodal tDCS sessions of the left dorsolateral prefrontal cortex （DLPFC） over 10 consecutive working days. The patients were divided into responders and non-responders according to the Coma Recovery Scale-Revised （CRS-R） behavioral evaluation， and the differences in general conditions and electrophysiological characteristics were compared. Result： Univariable analysis showed that the responders and non-responders did not differ for gender， age， time since onset， operation， CRS-R score and the proportion of P300 （P>0.05） in UWS patients. In MCS patients， CRS-R score （P=0.015） and P300 in DO paradigm （P=0.005） were independently associated with tDCS response， while gender， age， time since onset， operation and P300 in TO paradigm were not associated with responsiveness （P>0.05）. Conclusion： Higher CRS-R total score and presence of P300 in the hierarchical auditory ERP pattern， especially P300 in the DO paradigm， are associated with tDCS response in MCS patients. P300 in the DO paradigm may indicate that these patients possess higher levels of preserved semantic processing capabilities， and had a priority to recover.