Purpose:To investigate the associations between retinal parameters and cognitive impairment and identify retinal biomarkers for detecting cognitive dysfunction in patients with cerebral small vessel disease (CSVD). Methods:This cross-sectional study enrolled 125 patients with CSVD-related white matter hyperintensities. Participants were independent in daily activities and free of significant ophthalmic diseases. Cognition was assessed using the Mini-Mental State Examination (MMSE). Multimodal retinal imaging was employed to evaluate retinal structural and vascular features, including peripapillary retinal nerve fibre layer (pRNFL) and ganglion cell complex thicknesses and vessel densities (VDs) of the radial peripapillary capillary (RPC) network, macular superficial retinal capillary plexus (SRCP), and deep RCP (DRCP). The central retina vascular diameter, mean angle, angle tortuosity, arc length tortuosity, and fractal dimension of the retinal arteries and veins were quantified using a fully automated vessel segmentation and parameter calculation method. Linear and logistic regression models were applied to assess the associations between retinal parameters with general cognitive domains (general cognition, memory, visuospatial space, attention and numeracy, language, and orientation). Receiver operating characteristic (ROC) curves and areas under the ROC curve (AUCs) were used to evaluate the predictive performance of the retinal biomarkers. Results:A smaller central retinal arteriolar equivalent/central retinal venular equivalent ratio [odds ratio (OR) = 0.013, p = 0.035] and lower VDs in whole macular SRCP (OR = 0.864, p = 0.029), perifoveal SRCP (OR = 0.862, p = 0.027), perifoveal superior SRCP (OR = 0.855, p = 0.014), perifoveal nasal SRCP (OR = 0.833, p = 0.008), and inside-disc capillary RPC network (OR = 0.901, p = 0.028) were significantly associated with lower MMSE scores. Attention and orientation scores were significantly correlated with the VDs of the SRCP (β = 0.734, p = 0.027 and β = -9.460, p = 0.037, respectively) and DRCP (β = -0.553, p = 0.004 and p = 0.044, respectively), whereas visuospatial and language function scores were associated with the VD of the inside-disc RPC network (β = 0.018, p = 0.026 and β = 0.068, p = 0.012, respectively). The VDs of the whole macular, perifoveal, perifoveal superior, and nasal SRCPs achieved AUCs of 0.71-0.74 for screening cognitive impairment. Conclusion:Specific retina parameters are associated with cognitive decline in patients with CSVD. These findings suggest that multimodal retinal evaluation might provide an objective, imaging-based adjunct to conventional subjective cognitive tests for screening cognitive impairment in patients with CSVD. Clinical trial registration:https://www.chictr.org.cn/, identifier ChiCTR 2100043346.

BackgroundCerebral small vessel disease (CSVD) attaches people’s attention in recent years. In this study, we aim to explore retinal structure and vessel density changes in CSVD patients.MethodsWe collected information on retinal metrics assessed by optical coherence tomography (OCT) and OCT angiography and CSVD characters. Logistic and liner regression was used to analyze the relationship between retinal metrics and CSVD.ResultsVessel density of superficial retinal capillary plexus (SRCP), foveal density- 300 length (FD-300), radial peripapillary capillary (RPC) and thickness of retina were significantly lower in CSVD patients, the difference only existed in the thickness of retina after adjusted relevant risk factors (OR (95% CI): 0.954 (0.912, 0.997), p = 0.037). SRCP vessel density showed a significant downward trend with the increase of CSVD scores (β: −0.087, 95%CI: −0.166, −0.008, p = 0.031). SRCP and FD-300 were significantly lower in patients with lacunar infarctions and white matter hypertensions separately [OR (95% CI): 0.857 (0.736, 0.998), p = 0.047 and OR (95% CI): 0.636 (0.434, 0.932), p = 0.020, separately].ConclusionSRCP, FD-300 and thickness of retina were associated with the occurrence and severity of total CSVD scores and its different radiological manifestations. Exploring CSVD by observing alterations in retinal metrics has become an optional research direction in future.

Purpose:To discriminate between compressive optic neuropathy with glaucoma-like cupping (GL-CON) and glaucomatous optic neuropathy (GON) by comparing the peripapillary retinal nerve fiber layer (pRNFL) thickness and retinal microvasculature using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).Methods:In this retrospective cross-sectional study, OCT scans were performed on 28 eyes of GL-CON, 34 eyes of GON, and 41control eyes to determine the pRNFL thickness, ganglion cell complex thickness, and cup/disc ratio. OCTA scans were conducted for 12 eyes of GL-CON, 15 eyes of GON, and 15 control eyes to measure the vessel density of the peripapillary and macular areas. Analysis of covariance was used to perform the comparisons, and the area under the curve was calculated.Results:The GON eyes had a significantly thinner pRNFL in the inferior quadrant and greater vertical cup/disc ratio than the GL-CON eyes. In the radial peripapillary capillary segment, the vessel density of the GON in the inferior sectors was significantly lower than in the GL-CON. The superficial macular vessel density in the whole-image, peritemporal, perinasal, and peri-inferior sectors was significantly smaller in the GON group than in the GL-CON group. The best parameter for discriminating between GL-CON and GON was the superficial macular vessel density in the peritemporal sector.Conclusions:GL-CON eyes showed a characteristic pattern of pRNFL and retinal microvascular changes.Translational Relevance:GL-CON can be effectively distinguished from GON by detecting the alterations in the pRNFL and retinal microvasculature using OCT and OCTA.

AIMS:This study aimed to investigate the associations among retinal vessel density (RVD), neuroimaging features and cognitive impairment in patients with sporadic cerebral small vessel disease (CSVD). METHODS:This was a prospective observational study. A total of forty-nine patients with CSVD were recruited. The CSVD imaging burden was calculated by using a scoring system with a total score of 4 that assigns one point each for severe white matter hyperintensities (WMH), lacune, microbleeds (MBs), and basal-ganglia perivascular space (BG-PVS). Patients with a burden score ≥ 2 were classified as having a moderate/severe burden, and those with a score ≤ 1 were classified as the having a none/mild burden. The RVD in the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) was evaluated by using optical coherence tomography angiography (OCTA). The associations among the RVD values, CSVD imaging features, and cognitive impairment were evaluated. RESULTS:Patients with a moderate/severe CSVD burden showed lower RVD values in the para-fovea and peri-fovea areas of the left DRCP than patients with none/mild burden (para-fovea, β coefficient= -0.185 [-0.351~-0.015], P = 0.003; peri-fovea, β coefficient= -0.113 [-0.208~-0.018], P = 0.021). The RVD values in the para-fovea and peri-fovea areas of the left DRCP were significantly associated with the CSVD burden score after adjusting for age and vascular risk factors (P = 0.030 and P = 0.021, respectively) and with severe WMH (para-fovea, R = -0.398, P = 0.005; peri-fovea, R= -0.443, P = 0.001) and BG-PVS (para-fovea, R = -0.445, P = 0.001; peri-fovea, R= -0.396, P = 0.005). Neither para-fovea nor peri-fovea RVD values had a marked association with cognition. CONCLUSION:The RVD in the left DRCP may reflect the presence of cerebral small vessel lesions and might be a useful tool for predicting the neuroimaging-based burden of CSVD.

Pituitary adenomas are known to cause optic chiasmal compression leading to visual field (VF) defects. Herein, we analysed the factors influencing early VF recovery following transsphenoidal surgery and explored the significance of retinal vessel density parameters in predicting prognoses. We collected data of 50 patients with pituitary adenoma and an abnormal VF prior to surgery. Patients were categorised into VF recovery (n = 25) and non-recovery (n = 25) groups within 1 week postoperatively. The VF, optic chiasm form, tumour volume, retinal thickness, and vessel density parameters were measured. The x2 test was used for single-factor analyses, and odds ratios (ORs) for each factor were calculated. Logistic regression was implemented to determine interactions between radial peripapillary capillary (RPC) density and other factors. Tumour volume (>= 5 cm(3), OR = 5.09), duration of visual symptoms (>= 6 months, OR = 6.00), preoperative VF (mean deviation [MD] < -10 dB, OR = 6.77), thin retinal nerve fibre layer (OR = 9.04), ganglion cell layer complex thickness (OR = 7.67), and RPC density (whole <= 48%; OR = 15.58; temporal <= 49.3%; OR = 14.64) were found to be risk factors for postoperative VF recovery. After adjusting for these factors, RPC density was a dependent factor affecting VF recovery in patients with pituitary adenoma. RPC density seemed to be a stronger indicator than preoperative MD, tumour volume, duration of visual symptoms, or retinal thickness for predicting early VF recovery following optic chiasm decompression, thus helping surgeons determine the optimal timing of surgery and formulate effective treatment plans.

目的 分析南疆≥15岁人群各类精神障碍分布特征及影响因素,为制定有效的防治措施提供参考依据.方法 2019年4月至11月按分层、整群、随机抽样方法抽取南疆5个市(县)3883名城乡居民,以国际疾病分类第10版(ICD-10)精神与行为障碍分类为诊断标准,对各类精神障碍进行评估诊断.采用卡方检验对定性资料进行比较、logistic回归分析探讨各类精神障碍的影响因素.结果 各类精神障碍总时点患病率为9.68％.其中情感障碍5.07％、焦虑障碍3.24％、精神分裂症0.67％、器质性精神障碍0.26％、精神发育迟滞0.44％.总时点患病率女性高于男性(x2=24.89,P＜0.05),不同婚姻状况(x2=38.16,P＜0.05)、不同文化程度(x2=147.23,P＜0.05)人群精神障碍患病率有差异.回归分析显示:女性、未婚、丧偶、居住乡村是患精神障碍的风险人群.结论 南疆精神障碍患病率高,应定期在全省范围内评估精神障碍的患病情况,针对性地采取防治措施,合理分配医疗资源,有效降低精神障碍患病率.

目的:了解新疆某县精神疾病的患病情况并分析相关影响因素.方法:以国际疾病分类第10版(ICD-10)精神与行为障碍分类为诊断工具,以量表测评为辅助工具,并根据精神科医生对受访者进行的精神科查体,对精神疾病进行评估诊断.结果:新疆某县15岁以上人群的精神疾病患病率为8.05％;不同性别、城乡、文化程度、婚姻状况和年龄段之间患病率有显著差异(P＜0.05).结论:女性、城市居民和41～65岁年龄组是精神疾病的重要影响因素,需要重点关注上述人群.

Objective:To explore the change characteristics of event-related potential P300 in different violence risk levels of schizophrenic patients and analyze the risk factors of violence in schizophrenic patients.Methods:Totally 158 schizophrenic patients in Lyuzhou hospital of Shihezi City from January 2019 to August 2020 were collected and assessed with the violence risk scale for 3 days.According to the assessment results, the patients who met the inclusion criteria were divided into low-risk group( n=78), medium-risk group( n=51) and high-risk group( n=29). The auditory P300 of patients in each group was completed within 3 days and act of violence was observed and recorded within one week.Data analysis was carried out by SPSS 20.0 software.The changes of P300 in different violence risk groups were analyzed by ANOVA, and the influencing factors of violence in patients with schizophrenia were analyzed by logistic regression. Results:There was no significant difference in latency of P300 among the three groups (χ 2=4.71, P=0.10), but there was significant difference in amplitude of P300( F=6.67, P<0.01). Compared with the low-risk group ((12.14±9.19) μV), the amplitude of P300 in medium-risk group ((8.25±7.13) μV) and high risk group ((6.71±4.97) μV) decreased significantly ( t=-3.14, -5.45, both P<0.05). There was no significant difference in amplitude of P300 between the high-risk group and the middle-risk group( t=-2.31, P>0.05). The latency and amplitude of schizophrenia patients with violent behavior were significantly different from those without violent behavior ( Z=-6.30, 9.78, both P<0.01). High BVC grade (compared with high-risk group, low-risk group: OR=0.03, 95% CI : 0.00-0.35; the middle risk group: OR=0.09, 95% CI : 0.01-0.62), prolonged P300 latency ( OR=1.30, 95% CI : 1.13-1.48) and decreased P300 amplitude ( OR=0.50, 95% CI: 0.36-0.70), delusion of victimization ( OR=0.12, 95% CI: 0.02-0.76)were the risk factors for violent behavior. Conclusion:The latency and amplitude of P300 can be used as the reliable neuroelectrophysiological indicators for evaluating violence risk in patients with schizophrenia.It has important clinical application value for evaluating violence in patients with schizophrenia.

Purpose: To investigate the reconstructive changes in foveal microstructures postoperatively and analyze the visual predictors in eyes with surgically closed traumatic macular holes (TMHs). Methods: Seventy-one eyes with TMHs that underwent vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade were reviewed. Clinical data, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) images were recorded. The length of the ellipsoid zone (EZ) defect and the integrity of postoperative external limiting membrane (ELM) were measured. Preoperative and 1-month postoperative features were analyzed, respectively, as potential predictors of visual acuity at 6 months postoperatively. Results: The primary hole closure rate was 90.14% (64/71). In 43 cases of initially closed TMHs with SD-OCT scans preoperatively and at 1 and 6 months postoperatively, the number of eyes with intact ELM increased from 18 (41.86%) at 1 month to 26 (60.47%) at 6 months (p = 0.08), while the number of eyes with a restored EZ band remained the same in 2 eyes (4.65%). The mean length of the EZ defect progressively decreased postoperatively (p < 0.001). Poorer preoperative visual acuity (p = 0.002), lower mean macular hole (MH) height (p = 0.012), and greater preoperative mean length of EZ defect (p < 0.001) were associated with worse visual acuity 6 months postoperatively, but only the preoperative length of the EZ defect was proved to be a predictor, with the cutoff value of 1,800 μm provided by the receiver-operating characteristics (ROC) curve. Worse visual acuity and greater mean length of the EZ defect at 1 month were also associated with worse final visual acuity. Conclusions: The mean length of the EZ defect both preoperatively and 1 month postoperatively were predictors of visual outcomes at 6 months postoperatively.

To summarize and systematically review the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for depression in patients with stroke.Six databases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until November 15, 2018.Seventeen randomized controlled trials were included for meta-analysis.Two independent reviewers selected potentially relevant studies based on the inclusion criteria, extracted data, and evaluated the methodological quality of the eligible trials using the Physiotherapy Evidence Database.We calculated the combined effect size (standardized mean difference [SMD] and odds ratio [OR]) for the corresponding effects models. Physiotherapy Evidence Database scores ranged from 7 to 8 points (mean=7.35). The study results indicated that HF-rTMS had significantly positive effects on depression in patients with stroke. The effect sizes of the SMD ranged from small to large (SMD, -1.01; 95% confidence interval [CI], -1.36 to -0.66; P<.001; I2, 85%; n=1053), and the effect sizes of the OR were large (response rates, 58.43% vs 33.59%; OR, 3.31; 95% CI, 2.25-4.88; P<.001; I2, 0%; n=529; remission rates, 26.59% vs 12.60%; OR, 2.72; 95% CI, 1.69-4.38; P<.001; I2, 0%; n=529). In terms of treatment side effects, the HF-rTMS group was more prone to headache than the control group (OR, 3.53; 95% CI, 1.85-8.55; P<.001; I2, 0%; n=496).HF-rTMS is an effective intervention for poststroke depression, although treatment safety should be further verified via large sample multicenter trials.

目的 探讨盐酸文拉法辛对PTSD样大鼠认知功能损害及海马组织JNK3表达的影响.方法 将32只成年雄性SD大鼠随机分为4组,Control组、PTSD组、Ven组和PC组,每组8只,PTSD组、Ven组和PC组大鼠给予SPS,Ven组和PC组大鼠在造模6 h内分别通过灌胃给予盐酸文拉法辛6.61 mg/kg和生理盐水6.61 mg/kg,持续14 d.通过拒缚反射评分、旷场实验和Morris水迷宫实验测定大鼠的认知行为变化,通过RT-PCR和Western blot法检测大鼠海马组织中JNK3 mRNA及蛋白水平的变化.结果 (1)与PC组相比,Ven组大鼠拒缚反射评分降低,在旷场实验中站立与跨格次数增多,在Morris水迷宫中潜伏期缩短、穿台次数增多,差异均有统计学意义(P<0.05);(2)RT-PCR和Western blot结果显示,与PC组相比,Ven组大鼠海马组织JNK3 mRNA及蛋白表达降低(P<0.05).(3)PTSD组和PC组大鼠在上述几个方面差异均无统计学意义(P>0.05).结论 盐酸文拉法辛可有效改善PTSD样大鼠的认知功能损害,这可能与下调JNK3基因及蛋白表达有关.

Background: Numerous studies have demonstrated loss of circumpapillary retinal nerve fiber layer (cpRNFL) thickness in patients with chiasmal compression using optical coherence tomography (OCT). This study aimed to evaluate the cpRNFL and ganglion cell compound (GCC) thicknesses in patients suffering pituitary tumors with and without chiasmal compression. Methods: forty-four patients with pituitary adenoma (PA) (twenty-one without chiasmal compression and twenty-three with chiasmal compression) and eighteen controls were enrolled. cpRNFL and GCC thickness were measured in both patients and controls by SD-OCT. Results: three groups (PAs with optic chiasmal compression, PAs without optic chiasmal compression and controls) were closely matched in terms of mean age, sex and IOP (p=0.173, p=0.184 and P=0.343, respectively). The average cpRNFL and GCC thickness was significantly different among three groups (cpRNFL : 94.1±12.5µm, 106.4±7.3µm, 110.7±6.9µm, respectively; GCC: 85.8±6.9µm, 93.8±5.0µm, 97.2±5.6µm, respectively ). The cpRNFL was analyzed in different regions, and significant difference was found in nasal upper and nasal lower between PAs without optic chiasmal compression and controls. Conclusion: Even there is no evidence of compression at the chiasm on magnetic resonance imaging (MRI), GCC and cpRNFL thinning could still be detected in patients of pituitary tumor by SD-OCT. The loss of RNFL is more severe in patients with chiasmal compression.

目的 探讨创伤后应激障碍(PTSD)样大鼠记忆损害与不同时间点海马区氨基末端激酶3(JNK3)、细胞外信号调节激酶5(ERK5)表达的关系.方法 将32只清洁级SD大鼠随机分为两组:Control组8只,PTSD组24只(PTSD2 d组、PISD5 d组与PTSD8 d组,各8只),使用国际认定的单次延长应激(SPS)方法制作大鼠PTSD模型.分别通过拒缚反射评分、旷场实验和Moms水迷宫实验测试大鼠的恐惧反应、焦虑水平和空间记忆能力,采用HE染色观察大鼠海马组织形态变化,通过实时荧光定量PCR(qRT-PCR)和West-em blot法分别检测大鼠海马组织中JNK3/ERK5 mRNA及蛋白水平的变化.结果 与Control组比较,PTSD组大鼠拒缚反射评分升高,站立与跨格次数减少,平均上台潜伏期延长,差异有统计学意义(P＜0.05);HE染色结果表明,PTSD组大鼠海马神经元排列紊乱,结构异常;与Control组比较,PTSD2 d组、PTSD5 d组大鼠海马组织JNK3 mRNA及蛋白表达水平升高,差异有统计学意义(P＜0.05),PTSD2 d、5d与8d组大鼠海马组织ERK5mRNA及蛋白表达水平与Control组相比明显升高,差异有统计学意义(P＜0.05).结论 PTSD样大鼠记忆损害可能与海马区JNK3/ERK5差异性表达有关,ERK5基因及蛋白表达的持续上调,可能对JNK3的表达起抑制作用.

目的 探究阿戈美拉汀对创伤后应激障碍(PTSD)SD大鼠行为表现的影响.方法 将32只SD雄性大鼠随机分为空白对照组(不给药,不应激)、单纯应激组(不给药,应激)、药物组(给药,应激)及单纯药物组(给药,不应激)4组,每组8只.药物组和单纯药物组在应激后12 h内通过灌胃给予阿戈美拉汀2.6 mg∕(kg·d);空白对照组和单纯应激组通过灌胃给予等量生理盐水,共2周.单纯应激组和药物组给予大鼠单次延长结合足底电击应激刺激.第14天在电击箱中检测大鼠的条件性恐惧反应;第15天给予旷场实验,观察其焦虑状态;第16～21天行Morris水迷宫实验,测试其定位航行力和空间探索力.结果 应激后大鼠在电击箱中呆滞时间延长;在旷场实验中穿格和站立次数减少;在Morris水迷宫实验中上台时间延长,穿越平台次数减少.相比单纯应激组,应激后早期给予阿戈美拉汀干预,大鼠呆滞行为、焦虑状态及其在Morris水迷宫中的表现均改善(P<0.05).结论 应激后大鼠警觉性和焦虑性增强,学习记忆功能减退.应激后早期给予阿戈美拉汀干预,能有效减少应激后PTSD模型大鼠恐惧、焦虑表现,并对大鼠的学习记忆能力减退有预防作用.

Objective To investigate the effect of oxytocin on the expression of MKP-1 level in the hippocampus of post-traumatic stress disorder rats.Methods Eighteen SD rats were randomly divided into the control group,administration group and the experimental group with 6 rats in each group.The administration group and the experimental group were treated with internationally recognized single prolongation stress (SPS) method to stimulate the rats in order to establish PTSD models.The 14-day oxytocin intervention was given to rats of the administration group after the SPS stimulation within 8 hours.And the behavioral changes of rats were observed by open-field test and Morris water maze test.The changes of MKP-1 mRNA in the hippocampus of rats were detected by real-time quantitative PCR (qRT-PCR),and the levels of MKP-1 Protein in the hippocampus of rats were detected by Western Blot.Results (1) Compared with the model group (2.50± 1.05 and 22.16±7.14),the times of the standing and crossing grid section quantities in the open-field test in the administration group(5.16± 1.17and 32.83±5.71) and control group (6.67±2.16 and 39.83± 4.62) significantly decreased (P＜0.05).Morris water maze showed that the incubation of the model group was markedly prolonged (P＜0.05) compared with that of the administration group,while in spatial probe test,the incubation period of the rats in administration group was prolonged,and the number of wearing stage decreased (P＜0.05).(2) Compared with the administration group (1.30±0.03),the expression of MKP-1 mRNA in hippocampus of rats in model group (4.04±0.46) was notably up-regulated (P＜0.05).And the protein level of MKP-1 in model group(1.95±0.68) was also increased compared with that in administration group (1.46±0.27) (P＜0.05).Conclusions Oxytocin can protect the learning and memory ability and reduce the stress-related performance of rats via regulating the expression of MKP-1.

目的 探讨创伤后应激障碍(PTSD)样大鼠行为学改变与海马组织中丝裂原活化蛋白激酶磷酸酶-1 ( MKP-1)表达的关系.方法 将30只清洁级SD大鼠随机分为Control组、PTSD 1 d组、PTSD 3 d组、PTSD 7 d 组、PTSD 14 d组,每组各6只,使用国际认定的单次延长应激( SPS)方法制作大鼠PTSD模型.通过旷场试验、Morris水迷宫观察大鼠的行为学变化.采用实时荧光定量 PCR ( qRT-PCR)和 Western blot法分别检测大鼠海马组织中MKP-1 mRNA和蛋白水平的变化.结果 PTSD 7 d组、PTSD 14 d组与Control组相比直立次数、进格次数以及穿台次数减少,潜伏期延长,差异有统计学意义(P<0.05). PTSD 7 d组、PTSD 14 d组与Con-trol组相比,海马组织中MKP-1 mRNA及蛋白表达水平明显升高,差异均具有统计学意义( P<0.05).结论 PTSD样大鼠行为改变、记忆下降考虑与海马组织中MKP-1 基因及蛋白表达增高有关,MKP-1 可能参与了PTSD的发病机制,有望作为PTSD发生发展的参考指标.

目的 探讨MoCA量表在创伤后应激障碍(PTSD)患者认知功能损伤中的应用.方法 纳入PTSD患者28例、经历创伤事件未发生PTSD患者28例和心理健康测评者28例,共3组.均行PTSD自评量表(PCL-C)和认知功能评定量表(MoCA)评估.结果 PCL-C总分与再体验、回避麻木与警觉性增高分项得分PTSD组＞非PTSD组＞对照组(F=164.790,F=98.570,F=124.879,F=138.570,P＜0.05);PTSD组和对照组在MoCA总分和各个分项上的差异具有统计学意义(P＜0.05);除了语言表达能力(2组无统计学差异,F=7.572,P＞0.05),PTSD组和非PTSD组在MoCA总分和各个分项上的差异具有统计学意义(P＜0.05);非PTSD组和对照组在语言表达和注意力上的得分差异具有统计学意义(F=7.572,F=38.626,P＜ 0.05);在空间与执行能力、命名能力、抽象、延时回忆、定向力和MoCA总分的差异无统计学意义(P=0.074,P=0.256,P=0.316,P=0.274,P=0.063,P=0.052);行Spearman相关分析显示,PTSD组PCL-C总分及3个症状群均和MoCA总分和7个认知小分项呈显著负相关(P＜0.01);行多元线性回归分析显示,R2=0.968,F=240.135,表明再体验、麻木回避和警觉性增高联合起来对PTSD患者的认知功能损伤的影响是显著的,在对单个预测变量的回归系数B进行t检验时发现,只有预测变量警觉性增高的P=0.275＞0.05,说明警觉性增高对PTSD患者认知功能损伤的影响是不显著的,而再体验和麻木回避对PTSD患者认知功能损伤的影响是显著的.结论 PTSD患者存在认知功能损伤,且随着PTSD症状加重,认知功能的损伤越明显;其中再体验和麻木回避这两大症状群对认知功能的损伤有显著的影响.

目的 系统评价重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗脑卒中后抑郁(post-stroke depression,PSD)的效果.方法 计算机检索PubMed、Embase、Cochrane Library、Web ofScience、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,限定检索年限为2013年1月-2018年4月,文献类型为随机对照试验,rTMS组为接受rTMS加药物治疗或常规处理的PSD患者,对照组为在药物治疗或常规处理的同时采用或不采用rTMS假刺激的PSD患者.由2名研究员独立进行文献质量评价和资料提取后运用RevMan 5.3和Stata 14.0软件进行Meta分析.结果 纳入18篇文献,共1 376例PSD患者,其中rTMS组687例,对照组689例.rTMS组较对照组能有效降低PSD患者的抑郁评分[标准化均数差(standard meandifference,SMD) =-1.13,95％置信区间(confidence interval,CI) (-1.42,-0.84),P＜0.000 01],rTMS治疗PSD的有效率为91.7％,同时,rTMS组能更好地促进PSD患者神经功能缺损的恢复[SMD=-1.00,95％CI(-1.25,-0.75),P＜0.000 01]和日常生活能力的提高[SMD=1.56,95％CI (0.80,2.32),P＜0.000 01].经亚组分析和Meta回归分析,均未发现异质性来源.纳入研究在rTMS治疗期间,均未出现明显不良反应.结论 rTMS对PSD患者的抑郁情绪、神经功能缺损和日常生活能力减退有积极的治疗作用,限于纳入研究的质量水平,上述结论需进一步验证.