Page 72 - 2022-36-中国全科医学

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Corresponding author：WANG Yanfang，Chief physician；E-mail：wangyanfang123868@163.com
【Abstract】 Background There are many subtypes of major depressive disorder（MDD）. Evidence about the
differentiation of them is mostly based on symptomatological characteristics，but rarely by objective biological indicators.
Objective To explore the differences in event-related potential （ERP） N400 between patients with different subtypes
of depression，providing an objective electrophysiological basis for subtyping depression. Methods Two hundred and nine
outpatients and inpatients who met the diagnostic criteria of MDD in Diagnostic and Statistical Manual of Mental Disorders，
5th Edition were selected from First Hospital of Shanxi Medical University from February 2019 to December 2021，including 78
with anxious depression （ASD+MD-），46 with melancholic depression （ASD-MD+），61 with anxious and melancholic
depression（ASD+MD+），and 24 with non-anxious and melancholic depression（ASD-MD-）subtyped using the 30-item
Inventory of Depressive Symptomatology （IDS-30） and 17-item Hamilton Depression Rating Scale （HAMD-17）. Thirty-five
community-living health volunteers were recruited as controls at the same time.The factor and total scores of the HAMD-17 and
the Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）of all subjects were collected. And the latency
and amplitude of N400 component of all subjects were collected by inducing N400 components through understanding ambiguous
words at the end of sentences. Results （1）The total score and factor scores of HAMD-17 differed significantly across MDD
subgroups and control group （P< 0.05）. The total score of HAMD-17 in each of the four MDD subgroups was much higher than
that in control group （P<0.05）. ASD+MD+ subgroup had significantly higher total score of HAMD-17 than both ASD-MD-
and ASD-MD+ subgroups（P<0.05）.ASD+MD- subgroup had significantly higher total score of HAMD-17 than ASD-MD+
subgroup（P<0.05）. The score of anxiety factor in each of the four MDD subgroups was obviously higher than that in control group
（P<0.05）. ASD+MD- subgroup had obviously higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups
（P<0.05）.ASD+MD+ subgroup had prominently higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups
（P < 0.05）. The score of body weight factor in ASD+MD+ or ASD+MD- subgroup was much higher than that in control group
（P<0.05）.ASD+MD+ subgroup had much higher score of body weight factor than both ASD-MD- and ASD-MD+ subgroups
（P<0.05）. The score of cognitive impairment factor in each of the four MDD subgroups was much higher than that in control
group（P<0.05）.ASD+MD+ subgroup had much higher score of cognitive impairment factor than ASD-MD+ subgroup（P<0.05）.
The scores of block factor and sleep disturbance factor in each of the four MDD subgroups were significantly higher than those in
the control group （P<0.05）.（2）The total score and factor scores of RBANS varied significantly across four MDD subgroups
and control group （P<0.05）.The total score of RBANS and scores of its factors of immediate memory，visual span，speech
function，attention，and delayed memory in each of the four MDD subgroups were much lower than those in the control group
（P<0.05）. The score of immediate memory factor in ASD+MD+ group was notably lower than that in ASD-MD+ group （P<0.05）.
（3）There were no significant differences in latency and amplitude of N400 component across four MDD subgroups and controls
（P>0.05）.There were no significant differences in latency and amplitude of N400 component across different electrode sites
（P>0.05），and there were no interaction between no-depression or each of the four subtypes of MDD and electrode sites （P>0.05）.
（4）The N400 amplitude value at Fz electrode was negatively correlated with the cognitive impairment factor score （r=-0.170，
P=0.016）.The N400 amplitude value at Cz electrode was positively correlated with the block factor score（r=0.151，P=0.033）.
The N400 amplitude valueat Pz electrode was positively correlated with the block factor score（r=0.174，P=0.014）.The N400
amplitude value of the Fz electrode was positively correlated with the immediate memory score（r=0.138，P=0.050）.The N400
latency value at Cz electrode was negatively correlated with the delayed memory score（r=-0.155，P=0.028）. Conclusion
Extensive cognitive impairment was found in MDD patients，including impaired immediate memory，speech function，attention
and delayed memory. ASD+MD+ and ASD+ MD-patients had more severe symptoms，and ASD+MD+ patients had the most severe
cognitive impairment. N400 amplitude value was negatively correlated with cognitive impairment and positively correlated with
block factor in MDD patients. But these patients demonstrated no impaired function of speech integration induced by ambiguous
words at the end of sentences.
【Keywords】 Major depressive disorder；Subtype；Event-related potential；N400

重 性 抑 郁 障 碍（major depressive disorder，MDD） 识别 MDD 亚型对于个体化治疗具有重大临床价值。
是常见的终身疾病，复发率为 80%，预后差，疾病负 MDD 较 常 见 的 亚 型 为 忧 郁 型 抑 郁 障 碍（melancholc
担排名全球第三，临床特征及病理生物学改变具有高 depression，MD）和焦虑型抑郁障碍（anxious-somatizing
度异质性 ［1］ 。不同抑郁亚型对应的治疗方式不同 ［2］ ， depression，ASD）。MD 主要诊断特征是快感缺失、明