CAJ | 학술논문

目的探讨高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对MCI的疗效.方法通过志愿者招募方式,选取石家庄市36名被评估为MCI的患者,采用随机数字表法将其分为试验组(18例)和对照组(18例,脱落3例);采用rTMS(频率为20 Hz)对试验组双侧背外侧前额叶区进行刺激,每次30 min(每侧15 min),每周5次,为期8周;对照组采用相同的治疗频次,使用伪刺激线圈,只产生振动和声音,不产生磁场效应.治疗前后采用MMSE和事件相关电位(event-related potentials,ERPs)听觉oddball范式进行测试,ERPs记录电极置于Fz、Cz和Pz点.采用独立样本t检验和组内(治疗前,治疗后)×组间(试验组,对照组)重复测量方差分析比较2组波幅和潜伏期的变化.结果 (1)与对照组比较,试验组治疗后计数错误率降低[F(1,31)=10.335,P＜0.01].(2) MMSE评分:试验组MMSE分数增加比率大于对照组(t=3.36,P＜0.05);(3)靶刺激P300:治疗后试验组潜伏期[Fz:(395 ±8) ms,Cz:(423 +8)ms,Pz:(422 +8) ms]较治疗前缩短,与对照组治疗后[Fz:(421 +9) ms,Cz:(425 +7) ms,Pz:(427 +9) ms]相比差异有统计学意义[Fz:F(1,31) =30.194,P ＜0.01;Cz:F(1,31)=11.987,P＜0.01;Pz:F(1,31)=43.381,P＜0.01].治疗后试验组波幅[Fz:(8.3±4.4)μV,Cz:(10.9 ±4.1)μV,Pz:(10.6 +3.2) μV]与对照组[Fz:(6.0±2.3)μV,Cz:(8.8±3.4)μV,Pz:(9.7±4.4)μV]相比差异有统计学意义[Fz:F(1,31) =4.852,P＜0.05;Cz:F(1,31) =5.137,P＜0.05;Pz:F(1,31)=6.553,P＜0.05].(4)靶刺激N200:治疗后试验组潜伏期[Fz:(287±8)ms,Cz:(266±34) ms,Pz:(258 +35) ms]较治疗前缩短,与对照组治疗后[Fz:(291 +10) ms,Cz:(281 +35) ms,Pz:(272 +36) ms]相比差异有统计学意义[Fz:F(1,31)=10.475,P ＜0.01;Cz:F(1,31) =8.073,P＜0.01;Pz:F(1,31) =4.431,P＜0.05].治疗后2组N200波幅差异无统计学意义(F≤0.512,P＞0.05).结论 rTMS对MCI患者的认知功能可能有改善作用.
목적 탐토고빈중복경로자자격(repetitive transcranial magnetic stimulation,rTMS)대MCI적료효.방법 통과지원자초모방식,선취석가장시36명피평고위MCI적환자,채용수궤수자표법장기분위시험조(18례)화대조조(18례,탈락3례);채용rTMS(빈솔위20 Hz)대시험조쌍측배외측전액협구진행자격,매차30 min(매측15 min),매주5차,위기8주;대조조채용상동적치료빈차,사용위자격선권,지산생진동화성음,불산생자장효응.치료전후채용MMSE화사건상관전위(event-related potentials,ERPs)은각oddball범식진행측시,ERPs기록전겁치우Fz、Cz화Pz점.채용독립양본t검험화조내(치료전,치료후)×조간(시험조,대조조)중복측량방차분석비교2조파폭화잠복기적변화.결과 (1)여대조조비교,시험조치료후계수착오솔강저[F(1,31)=10.335,P＜0.01].(2) MMSE평분:시험조MMSE분수증가비솔대우대조조(t=3.36,P＜0.05);(3)파자격P300:치료후시험조잠복기[Fz:(395 ±8) ms,Cz:(423 +8)ms,Pz:(422 +8) ms]교치료전축단,여대조조치료후[Fz:(421 +9) ms,Cz:(425 +7) ms,Pz:(427 +9) ms]상비차이유통계학의의[Fz:F(1,31) =30.194,P ＜0.01;Cz:F(1,31)=11.987,P＜0.01;Pz:F(1,31)=43.381,P＜0.01].치료후시험조파폭[Fz:(8.3±4.4)μV,Cz:(10.9 ±4.1)μV,Pz:(10.6 +3.2) μV]여대조조[Fz:(6.0±2.3)μV,Cz:(8.8±3.4)μV,Pz:(9.7±4.4)μV]상비차이유통계학의의[Fz:F(1,31) =4.852,P＜0.05;Cz:F(1,31) =5.137,P＜0.05;Pz:F(1,31)=6.553,P＜0.05].(4)파자격N200:치료후시험조잠복기[Fz:(287±8)ms,Cz:(266±34) ms,Pz:(258 +35) ms]교치료전축단,여대조조치료후[Fz:(291 +10) ms,Cz:(281 +35) ms,Pz:(272 +36) ms]상비차이유통계학의의[Fz:F(1,31)=10.475,P ＜0.01;Cz:F(1,31) =8.073,P＜0.01;Pz:F(1,31) =4.431,P＜0.05].치료후2조N200파폭차이무통계학의의(F≤0.512,P＞0.05).결론 rTMS대MCI환자적인지공능가능유개선작용.
Objective To investigate the therapeutic effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on the mild cognitive impairment (MCI).Methods The study recruited 36 volunteers from Shijiazhuang City,who were diagnosed with MCI,and randomly divided into a treatment group (18) and a control group (18).Magnetic stimulation site was located in the dorsolateral prefrontal cortex with the frequency of 20 Hz,and 30 minutes (15 minutes on each side) each time,5 times a week for 8 weeks.The control group received the same frequency with pseudo-stimulating coil,which produced vibration and sound,but didn't generate a magnetic field.The MMSE was used to measure cognitive functioning,and event-related potentials (ERPs) in Fz,Cz and Pz were recorded using auditory oddball paradigm.Results (1) Compared with the control group,the patients' count error rate in the experimental group was reduced after the intervention (F（1.31) =10.335,P ＜ 0.01).(2) The MMSE scores were significantly improved after intervention than control group (t =3.36,P ＜ 0.05).(3) After the treatment,the latency of P300 (Fz:(395 ± 8) ms,Cz:(423 ± 8) ms,Pz:(422 ± 8) ms) was shortened in experimental group compared with control group (Fz:(421 ±9) ms,Cz:(425 ±7) ms,Pz:(427 ±9) ms),(Fz:F(1,31) =30.149,P ＜0.01; Cz:F(1,31) =11.987,P ＜0.01; Pz:F(1,31) =43.381,P ＜0.01).After the intervention,the amplitude of P300 (Fz:(8.3 ± 4.4) μV,Cz:(10.9 ± 4.1) μV,Pz:(10.6 ± 3.2) μV)was increased in experimental group compared to the control group (Fz:(6.0 ± 2.3) μV,Cz:(8.8 ± 3.4)μV,Pz:(9.7±4.4) μV),(Fz:F(1,31)=4.852,P＜0.05; Cz:F(1,31)=5.137,P＜0.05; Pz:F(1,31) =6.553,P ＜ 0.05).(4) After the treatment,the latency N200 (Fz:(287 ± 8) ms,Cz:(266 ± 34) ms,Pz:(258 ± 35) ms) was shortened in experimental group compared with control group(Fz:(291 ± 10) ms,Cz:(281±35) ms,Pz:(272±36) ms),(Fz:F(1,31)=10.475,P＜0.01; Cz:F(1,31) =8.073,P＜0.01;Pz:F(1,31) =4.431,P ＜ 0.05).For N200 amplitude,no significant effects were observed (F≤0.512,P ＞0.05).Conclusion The 8-week high-frequency repetitive transcranial magnetic stimulation treatment may improve the cognitive function in patients with MCI.