摘要目的 探讨反复发作抑郁症患者认知功能损害的特点.方法 收集2016年9月至2017年12月郑州大学第一附属医院门诊抑郁症患者98例(包括首发患者30例,反复发作患者68例),并同期收集与抑郁症患者年龄、性别及文化程度匹配的健康对照组30例.进一步将反复发作组根据HAMD-24评分分为反复发作-发作期(n=35)和反复发作-缓解期( n=33).使用MATRICS共识认知成套测验(MATRICS Consensus Cognitive Battery,MCCB)对所有受试者进行认知功能的测试.结果 (1)首发组与反复发作组在信息处理速度[(41. 27± 8. 44)分,(37. 00± 11. 68)分]、工作记忆[(40. 53±10. 33)分,(41. 26±9. 37)分]、注意/警觉性[( 40. 50±7. 25)分,( 39. 58±8. 23)分]、词语学习[(38. 83±8. 39)分,(38. 84±9. 57)分]、视觉记忆[(39. 30±14. 03)分,(37. 57±10. 42)分]、推理和问题解决[(37. 80±9. 55)分,(38. 78±8. 66)分]和社会认知[(34. 63±12. 75)分,(34. 02±11. 47)分]低于对照组[信息处理速度(48. 23±7. 63)分,工作记忆(50. 57±7. 84)分,注意/警觉性(51. 63±7. 41)分,词语学习(45. 57±9. 55)分,视觉记忆(50. 57±8. 42)分,推理和问题解决(50. 03±9. 87)分,社会认知(47. 90±19. 01)分](F=12. 818,12. 173,26. 166,6. 004,15. 085,18. 331,10. 218,均P<0. 05);(2)首发组、反复发作组-发作期[工作记忆(37. 89±9. 15)分,社会认知(28. 48±8. 35)分]及反复发作组-缓解期[工作记忆(44. 85±8. 32)分、社会认知(40. 44±11. 36)分] 在工作记忆及社会认知方面差异有统计学意义(P=0. 010,0. 001);进一步两两比较发现,在工作记忆方面,反复发作组-发作期低于反复发作组-缓解期(P=0. 003),社会认知方面,首发组高于反复发作组-发作期组(P=0. 038),反复发作组-缓解期高于反复发作-发作期组(P<0. 01).结论 首次发作抑郁症及反复发作抑郁症均存在认知功能损害,且反复发作患者发作期在社会认知方面损害较首发抑郁更为严重.

abstractsObjective To explore the psychological process of cognitive impairment in patients with recurrent major depression disorder (MDD). Methods Patients with first-episode (n=30) and recurrent MDD (n=68) in the outpatient department of the First Affiliated Hospital of Zhengzhou University from Sep-tember 2016 to December 2017 were collected and healthy controls(n=30) were collected at the same time. According to HAMD-24 score,the group with recurrent attacks was further divided into recurrent attacks-on-set period (n=35) and recurrent attacks-remission period (n=33). All subjects were tested for cognitive function by MATRICS Consensus Cognitive Battery( MCCB). Results (1) In terms of cognitive function assessment,the scores of information processing speed ( 41. 27 ± 8. 44, 37. 00 ± 11. 68), working memory (40. 53±10. 33,41. 26±9. 37),attention/alertness ( 40. 50± 7. 25,39. 58± 8. 23),word learning ( 38. 83± 8. 39,38. 84±9. 57),visual memory(39. 30±14. 03,37. 57±10. 42),reasoning and problem solving(37. 80± 9. 55,38. 78±8. 66),and social cognition (34. 63± 9. 66) in the first-episode group and the recurrent group were lower than those in the control group ( information processing speed ( 48. 23±7. 63),working memory (50. 57±7. 84),attention/alertness (51. 63±7. 41),word learning (45. 57±9. 55),visual memory (50. 57± 8. 42),reasoning and problem solving (50. 03±9. 87) and social cognition (47. 90±19. 01)) (F=12. 818, 12. 173,26. 166,6. 004,15. 085,18. 331,10. 218,P<0. 05); (2) In working memory and social cognition, the difference was statistically significant in the first-episode group,repeated attacks-episodes(working mem-ory:37. 89±9. 15,social cognition:28. 48± 8. 35) and recurrent group-remission( working memory:44. 85± 8. 32,social cognition:40. 44 ± 11. 36, P=0. 010,0. 001). Further comparisons revealed that the score of working memory in repeated attacks-episodes was lower than that in recurrent group-remission (P=0. 003). the score of social cognition in the first-episode group was higher than that in the recurrent-attack period group (P=0. 038). The score of social cognition in the recurrent group-remission was higher than that in re-current-attack period group (P<0. 01). Conclusion There is cognitive impairment in the first episode and the recurrence MDD. The impairment in the recurrent episode is more serious than that in the first episode of depression. The impairment of social cognitive in the recurrent attacks-episodes is more serious than that in the first-episode of depression.