摘要
目的探讨左侧前额叶背外侧皮质(L-DLPFC)的间断θ短阵快速脉冲(iTBS)模式重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)和传统模式rTMS对精神分裂症患者阴性症状及认知功能的影响。方法选取2018年9月至2020年3月哈尔滨精神专科白渔泡医院收治的80例精神分裂症患者作为研究对象,按随机数字表法分为iTBS组(n=40)和rTMS组(n=40)。iTBS组接受iTBS刺激联合药物治疗,rTMS组给予传统模式重复经颅磁刺激联合药物治疗。两组均刺激L-DLPFC,5次/周,治疗4周,共20次。治疗前后,采用阳性与阴性症状量表(PANSS)比较两组患者的阴性症状,采用威斯康星卡片分类测验(WCST)测评两组患者的认知功能。结果与治疗前相比,治疗后两组患者的PANSS阴性量表分数[iTBS组:(29.81±4.02)分比(26.22±3.88)分,t=10.540;rTMS组:(30.91±5.53)分比(27.35±4.99)分,t=9.786]、总分[iTBS组:(78.14±7.59)分比(73.65±5.43)分,t=6.219;rTMS组:(78.88±10.00)分比(75.21±9.14)分,t=9.297]、反应缺乏分数[iTBS组:(15.70±1.71)分比(14.76±1.75)分,t=3.641;rTMS组:(15.56±2.44)分比(14.12±2.03)分,t=7.792]、思维障碍分数[iTBS组:(7.68±1.53)分比(7.32±1.18)分,t=2.837;rTMS组:(7.85±1.84)分比(7.21±1.72)分,t=4.875]、WCST中完成第一个分类所需应答数[iTBS组:128.00(50.50,128.00)比106.00(42.00,128.00),Z=-4.92;rTMS组:128.00(98.25,128)比106.50(36.75,128.00),Z=-4.86]、非持续性错误[iTBS组:87.00(62.50,95.00)比74.00(42.00,91.00),Z=-4.55;rTMS组:89.50(80.75,96.50)比68.00(53.00,82.75),Z=-4.33]均显著降低(P<0.05);与治疗前相比,两组治疗后的WCST中正确应答数[iTBS组:40.00(33.50,57.50)比59.00(53.50,79.50),Z=-4.92;rTMS组:39.50(32.75,46.00)比58.00(46.79,75.50),t=-4.86]、概念化水平百分数[iTBS组:0.09(0.05,0.23)比0.18(0.14,0.34),Z=-5.30;rTMS组:0.08(0.05,0.16)比0.19(0.15,0.24),Z=-5.09]均显著升高(P<0.05)。两组治疗后的PANSS、WCST各项目评分及评分差值比较,差异均无统计学意义(P>0.05)。结论在总刺激数一定的条件下,iTBS及传统模式10 Hz rTMS均能改善精神分裂症患者的阴性症状及认知功能,且疗效相当,但iTBS模式耗时更少。
Objective To explore the effects of left prefrontal dorsolateral cortex(L-DLPFC)transcranial magnetic stimulation(rTMS)with intermittent theta burst stimulation(iTBS)paradigm and traditional rTMS on the negative symptoms and cognitive function of patients with schizophrenia.Methods A total of 80 cases were selected from 1183 schizophrenics of Harbin Baiyupao Psychiatric Hospital from September 2018 to March 2020 as objects of study.The 80 schizophrenia patients were randomly divided into iTBS group(40 cases)and rTMS group(40 cases)by random number table.Patients in the iTBS group was given a combination of iTBS and drug therapy,while patients in the rTMS group received a combination of rTMS and drug therapy.The L-DLPFC stimulation was selected as the stimulation site,5 times per week,for 4 weeks of treatment,a total of 20 times.Before and after treatment,Positive and Negative Symptom Scale(PANSS)was used to assess negative symptoms of schizophrenic patients,and Wisconsin Card Sorting Test(WCST)was applied to evaluate the cognitive function of patients with schizophrenia.Results After the treatment,PANSS the negative scale score[iTBS:(29.81±4.02)vs(26.22±3.88),t=10.540;rTMS:(30.91±5.53)vs(27.35±4.99),t=9.786],total score[iTBS:(78.14±7.59)vs(73.65±5.43),t=6.219;rTMS:(78.88±10.00)vs(75.21±9.14),t=9.297],lack of response score[iTBS:(15.70±1.71)vs(14.76±1.75),t=3.641;rTMS:(15.56±2.44)vs(14.12±2.03),t=7.792],thinking disorder score[iTBS:(7.68±1.53)vs(7.32±1.18),t=2.837;rTMS:(7.85±1.84)vs(7.21±1.72),t=4.875]and WCST scores of RF[iTBS:128.00(50.50,128.00)vs 106.00(42.00,128.00),Z=-4.92;rTMS:128.00(98.25,128)vs 106.50(36.75,128.00),Z=-4.86],NRPE[iTBS:87.00(62.50,95.00)vs 74.00(42.00,91.00),Z=-4.55;rTMS:89.50(80.75,96.50)vs 68.00(53.00,82.75),Z=-4.33]in iTBS group and rTMS group were significantly lower than those before the treatment(P<0.05).WCST scores of RC[iTBS:40.00(33.50,57.50)vs 59.00(53.50,79.50),Z=-4.92;rTMS:39.50(32.75,46.00)vs 58.00(46.79,75.50),t=-4.86]and RFP[iTBS:0.09(0.05,0.23)vs 0.18(0.14,0.34),Z=-5.30;rTMS:0.08(0.05,0.16)vs 0.19(0.15,0.24),Z=-5.09]were significantly higher than those before the treatment(P<0.05).After treatment,there were no statistical differences in scores or score difference of PANSS and WCST between iTBS group and rTMS group(P>0.05).Conclusions When the total number of stimuli is fixed,both iTBS and rTMS can improve the negative symptoms and cognitive function of schizophrenia,and the therapeutic effect is equivalent,but the time of iTBS paradigm is less.
作者
刘世鑫
牛伟盼
邬素萍
Liu Shixin;Niu Weipan;Wu Suping(Baiyupao Psychiatric Hospital of Harbin,Harbin 150000,China;Harbin Medical University,Harbin 150000,China)
出处
《神经疾病与精神卫生》
2021年第7期462-467,共6页
Journal of Neuroscience and Mental Health
关键词
精神分裂症
阴性症状
认知功能
间断θ短阵快速脉冲刺激
重复经颅磁刺激
Schizophrenia
Negative symptoms
Cognitive function
Intermittent theta burst stimulation
Repetitive transcranial magnetic stimulation
