CAJ | 학술논문

目的探讨高频重复经颅磁刺激(rTMS)对精神分裂症患者血清脑源性神经营养因子(BDNF)的影响.方法入组符合美国精神障碍诊断与统计手册第4版中精神分裂症的诊断标准,伴有难治性阴性症状的患者80例(均为解放军第九十一中心医院全军精神疾病防治研究所自2012年9月至2013年10月收治的患者),按照随机数字表法分为真刺激组(n=40)和伪刺激组(n=40),治疗前、治疗4周末对所有患者均完成阳性和阴性症状量表(PANSS)评估和BDNF浓度测定.真刺激组接受4周10 Hz rTMS治疗,刺激部位选择左侧前额叶,伪刺激组给予伪刺激,治疗期间原有抗精神病药物种类及剂量维持不变.另选正常对照组40人,于入组时及第4周末完成BDNF浓度测定.结果真刺激组和伪刺激组治疗前、治疗后BDNF浓度均低于正常对照组,差异有统计学意义(P＜0.05).与治疗前比较,真刺激组的PANSS总分和阴性症状分降低(71.2±13.8vs63.3±11.48,22.8±6.6vs 18.4±5.9)、BDNF浓度升高(6.78±2.16 vs 8.74±2.76),差异均有统计学意义(P＜0.05).真刺激组治疗后阴性症状分低于伪刺激组(18.4±5.9vs 21.8±6.1),BDNF浓度高于伪刺激组(8.74±2.76vs 6.88±2.322),差异有统计学意义(P＜0.05).治疗前后真刺激组PANSS总分、阴性症状分及一般精神病理分变化值高于伪刺激组(7.8±3.5vs 2.0±0.9,4.4±1.9vs 0.5±0.2,2.8±1.0vs 0.9±0.4),差异均有统计学意义(P＜0.05).真刺激组BDNF浓度变化值与PANSS总分及各因子分变化值均无明显相关性(P＞0.05).结论 10 Hz rTMS作用于左侧前额叶可以增加精神分裂症患者的血清BDNF浓度,但其浓度变化与阴性症状的改善无相关性.
목적 탐토고빈중복경로자자격(rTMS)대정신분렬증환자혈청뇌원성신경영양인자(BDNF)적영향.방법 입조부합미국정신장애진단여통계수책제4판중정신분렬증적진단표준,반유난치성음성증상적환자80례(균위해방군제구십일중심의원전군정신질병방치연구소자2012년9월지2013년10월수치적환자),안조수궤수자표법분위진자격조(n=40)화위자격조(n=40),치료전、치료4주말대소유환자균완성양성화음성증상량표(PANSS)평고화BDNF농도측정.진자격조접수4주10 Hz rTMS치료,자격부위선택좌측전액협,위자격조급여위자격,치료기간원유항정신병약물충류급제량유지불변.령선정상대조조40인,우입조시급제4주말완성BDNF농도측정.결과 진자격조화위자격조치료전、치료후BDNF농도균저우정상대조조,차이유통계학의의(P＜0.05).여치료전비교,진자격조적PANSS총분화음성증상분강저(71.2±13.8vs63.3±11.48,22.8±6.6vs 18.4±5.9)、BDNF농도승고(6.78±2.16 vs 8.74±2.76),차이균유통계학의의(P＜0.05).진자격조치료후음성증상분저우위자격조(18.4±5.9vs 21.8±6.1),BDNF농도고우위자격조(8.74±2.76vs 6.88±2.322),차이유통계학의의(P＜0.05).치료전후진자격조PANSS총분、음성증상분급일반정신병리분변화치고우위자격조(7.8±3.5vs 2.0±0.9,4.4±1.9vs 0.5±0.2,2.8±1.0vs 0.9±0.4),차이균유통계학의의(P＜0.05).진자격조BDNF농도변화치여PANSS총분급각인자분변화치균무명현상관성(P＞0.05).결론 10 Hz rTMS작용우좌측전액협가이증가정신분렬증환자적혈청BDNF농도,단기농도변화여음성증상적개선무상관성.
Objective To evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on serum brain-derived neurotrophic factor (BDNF) level in patients with schizophrenia.Methods Eighty hospitalized schizophrenics with refractory negative symptoms,admitted to our hospital from September 2012 to October 2013 and met the diagnostic and statistical manual of Mental Disorders-4th Edition (DSM-Ⅳ),were randomly divided into study group (n=40) and sham-operated group (n=40).The rTMS of 10 Hz on left prefrontal lobe was performed in study group and sham stimulation was used in sham-operated group; and the kinds and dosages of antipsychotics were preserved as before; other 40 healthy subjects were used as control group.Positive and Negative Syndrome Scale (PANSS) was performed and serum BDNF level was measured before and 4 weeks after treatment in all patients.Results BDNF level in both study group and sham-operated group before and after treatment was significantly lower than that in the control group (P＜0.05).The total PANSS scores and negative symptom scale scores in the study group after treatment were significantly decreased as compared with those before treatment (71.2±13.8 vs.63.3±11.4,t=2.721,P=0.008; 18.4±5.9 vs.22.8±6.6,t=3.064,P=0.003),and the BDNF level was statistically increased (8.74±2.76 vs.6.78±2.16,t=3.447,P=0.001).After treatment,the study group had significantly lower negative symptom scale scores and higher BDNF concentration than sham-operated group (t=2.470,P=0.016; t=3.180,P=0.002).For total PANSS scores,negative symptom scale scores and general psychopathology scale scores,the changed values before and after treatment of study group were all significantly higher than those in the sham-operated group (7.8±3.5 vs.2.0±0.9,t=9.893,P=0.000; 4.4±1.9 vs.0.5±0.2,t=12.584,P=0.000; 2.8±1.0 vs.0.9±0.4,t=10.875,P=0.000).For the study group,the changes of BDNF concentration showed no obvious correlation with the total PANSS scores or negative symptom scale scores (r=-0.156-0.247,P＞0.05).Conclusions The rTMS of 10 Hz on the left prefrontal lobe can increase the serum BDNF concentration of the schizophrenia.There is no correlation between the changes of BDNF concentration and improved negative symptoms.