摘要：

目的: 探讨失匹配负波联合P300对颅脑创伤患者伤后6个月认知功能障碍的预测价值。方法: 选择2021年1月至2024年1月中南大学湘雅医院收治的75例成年颅脑创伤患者, 伤后7 d内进行事件相关电位失匹配负波及P300监测。伤后6个月采用认知状态电话随访量表评估认知功能, 以 < 27分为存在认知功能障碍。采用单因素和多因素Logistic回归分析筛查颅脑创伤患者伤后6个月认知功能障碍的影响因素; 进一步绘制受试者工作特征(ROC)曲线并计算曲线下面积, 评估影响因素的预测效能。结果: Fz失匹配负波波幅绝对值较低(OR = 0.426, 95%CI：0.188 ~ 0.968;P = 0.041)和Cz P300波幅绝对值较低(OR = 0.399, 95%CI：0.188 ~ 0.847;P = 0.017)是颅脑创伤患者伤后6个月认知功能障碍的危险因素。ROC曲线显示, Fz失匹配负波波幅绝对值的曲线下面积为0.713(95%CI：0.595 ~ 0.830, P = 0.002), 最佳截断值为2.37 μV; Cz P300波幅绝对值的曲线下面积为0.752(95%CI：0.641 ~ 0.863, P = 0.000), 最佳截断值为3.28 μV; 上述2项指标形成的联合指标曲线下面积为0.781(95%CI: 0.676 ~ 0.886, P = 0.000)。Delong检验发现, 联合指标曲线下面积与单纯Fz失匹配负波波幅绝对值(Z = 1.574, P = 0.115)和单纯Cz P300波幅绝对值(Z = 0.939, P = 0.348)比较, 差异无统计学意义, 提示上述3项指标的预测效能相当。结论: 失匹配负波联合P300有望成为预测颅脑创伤患者伤后6个月认知功能障碍的可靠指标。

关键词: 脑损伤, 创伤性, 事件相关电位, P300, 认知功能障碍, 危险因素, Logistic模型, ROC曲线

Abstract:

Objective: To investigate the predictive value of mismatch negativity (MMN) combined with P300 for cognitive dysfunction at 6 months after traumatic brain injury (TBI) in adult patients. Methods: A total of 75 adult TBI patients admitted to Xiangya Hospital, Central South University from January 2021 to January 2024 were enrolled. MMN and P300 were monitored within 7 d after TBI. Cognitive function was assessed at 6 months after TBI using the Telephone Interview for Cognitive Status (TICS), with a score of < 27 indicating cognitive dysfunction. Univariate and multivariate Logistic regression analyses were used to identify influencing factors for cognitive dysfunction at 6 months after TBI. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the identified factors. Results: Lower absolute value of Fz MMN amplitude (OR = 0.426, 95%CI: 0.188-0.968; P = 0.041) and Cz P300 amplitude (OR = 0.399, 95%CI: 0.188-0.847; P = 0.017) were identified as risk factors for cognitive dysfunction at 6 months after TBI. ROC curve showed that the AUC for the absolute value of Fz MMN amplitude was 0.713 (95%CI: 0.595-0.830, P = 0.002), with an optimal cutoff value of 2.37 μV. The AUC for the absolute value of Cz P300 amplitude was 0.752 (95%CI: 0.641-0.863, P = 0.000), with an optimal cutoff value of 3.28 μV. When these 2 indicators were combined for ROC curve, the combined indicator yielded an AUC of 0.781 (95%CI: 0.676-0.886, P = 0.000). Delong test revealed no statistically significant differences in AUC between the combined indicator and the absolute value of Fz MMN amplitude (Z = 1.574, P = 0.115) or the absolute value of Cz P300 amplitude (Z = 0.939, P = 0.348), suggesting comparable predictive performance among the 3 indicators. Conclusions: MMN combined with P300 may serve as a favorable indicator for predicting cognitive dysfunction at 6 months after TBI.

Key words: Brain injuries, traumatic, Event-related potentials, P300, Cognitive dysfunction, Risk factors, Logistic models, ROC curve