重复经颅磁刺激对精神分裂症患者认知功能的影响
중복경로자자격대정신분렬증환자인지공능적영향
Repetitive transcranial magnetic stimulation and cognitive function in schizophrenia: A randomized, controlled study
  • 万方数据
    中华物理医学与康复杂志 중화물리의학여강복잡지
    CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
    2015年 3期 219-223 ,共5页

    甘景梨%段惠峰%程正祥%史振娟%高存友%祝希泉%梁学军%赵兰民

    감경리%단혜봉%정정상%사진연%고존우%축희천%량학군%조란민

    精神分裂症%经颅磁刺激%认知障碍 精神分裂癥%經顱磁刺激%認知障礙
    정신분렬증%경로자자격%인지장애
    Schizophrenia%Transcranial magnetic stimulation%Cognition%Risperidone
    目的 探讨重复经颅磁刺激(rTMS)治疗不同时间对精神分裂症患者认知功能的影响.方法 搜集2012年9月至2013年5月首次住院的精神分裂症患者71例,按随机数字表法分为rTMS组(35例,给予10 Hz rTMS真刺激联合利培酮治疗)和伪刺激组(36例,给予10 Hz rTMS伪刺激联合利培酮治疗),共治疗4周,刺激部位为左侧前额叶背外侧.最终完成本研究的患者为68例,其中rTMS组33例,伪刺激组35例.分别于治疗前和治疗4周末(治疗后),采用阳性和阴性症状量表(PANSS)评估2组患者的精神症状;且分别于治疗前、治疗2周末(治疗2周)、治疗4周末(治疗后),采用事件相关电位P300(分析指标为Cz点靶刺激的N1、P2、N2、P3潜伏期及P2、P3波幅)和威斯康星卡片分类测验(WCST)对2组患者的认知功能进行评估,并对患者完成分类数(Cc)、正确应答数(Rc)、错误应答数(Re)、持续性错误数(Rpe)和非持续性错误数(nRpe)进行计数统计.结果 ①治疗4周后,rTMS组阴性症状量表评分明显低于伪刺激组(11.3 ±2.6 vs 14.9 ±3.4,=4.88,P＜0.01);rTMS组和伪刺激组治疗后的PANSS总分及各项评分均明显低于组内治疗前(P＜0.01).②利培酮平均治疗剂量、最大剂量比较,rTMS组分别为(3.0±0.9) mg/d和(3.9±0.6) mg/d,伪刺激组分别为(3.8±1.0) mg/d和(4.7±0.7)mg/d,差异均有统计学意义(t=3.46,P＜0.01;t =5.04,P＜0.01).③与治疗前比较,rTMS组治疗4周末的P2(155.4±24.2 vs 171.7±28.5)、N2(205.4±19.4 vs 228.3±23.4)、P3(295.1 ±24.4 vs 317.5 ±25.5)潜伏期缩短,P2(4.1 ±1.6 vs3.1 ±1.2)和P3(6.9±2.1 vs4.9 ±1.8)波幅升高,Cc(4.4±2.4 vs3.1±2.0)和Rc(31.0±10.5 vs 24.1 ±11.2)增加,Re(18.4±8.9 vs 24.8±10.8)、Rpe(5.7±2.7 vs 8.2±4.3)和nRpe(12.2±6.5 vs 16.6±7.8)减少,伪刺激组的P3潜伏期缩短(299.5 ±27.3 vs320.3 ±29.4)、P3波幅升高(6.0±2.2 vs 4.8±1.9),Cc增加(28.7 ±9.6 vs 23.2±10.7),Re(20.4±8.1 vs25.1±9.7)和nRpe(13.1 ±6.2 vs 16.3 ±7.0)减少,且差异均有统计学意义(P＜0.05).治疗4周后,rTMS组P2、N2潜伏期和P3波幅及Cc、Rc、Re、Rpe、nRpe的改善与伪刺激组相比,组间差异均有统计学意义(P＜0.01).结论 rTMS(10 Hz)联合利培酮治疗可以改善精神分裂症患者的认知功能和降低药物的使用剂量.
    목적 탐토중복경로자자격(rTMS)치료불동시간대정신분렬증환자인지공능적영향.방법 수집2012년9월지2013년5월수차주원적정신분렬증환자71례,안수궤수자표법분위rTMS조(35례,급여10 Hz rTMS진자격연합리배동치료)화위자격조(36례,급여10 Hz rTMS위자격연합리배동치료),공치료4주,자격부위위좌측전액협배외측.최종완성본연구적환자위68례,기중rTMS조33례,위자격조35례.분별우치료전화치료4주말(치료후),채용양성화음성증상량표(PANSS)평고2조환자적정신증상;차분별우치료전、치료2주말(치료2주)、치료4주말(치료후),채용사건상관전위P300(분석지표위Cz점파자격적N1、P2、N2、P3잠복기급P2、P3파폭)화위사강성잡편분류측험(WCST)대2조환자적인지공능진행평고,병대환자완성분류수(Cc)、정학응답수(Rc)、착오응답수(Re)、지속성착오수(Rpe)화비지속성착오수(nRpe)진행계수통계.결과 ①치료4주후,rTMS조음성증상량표평분명현저우위자격조(11.3 ±2.6 vs 14.9 ±3.4,=4.88,P＜0.01);rTMS조화위자격조치료후적PANSS총분급각항평분균명현저우조내치료전(P＜0.01).②리배동평균치료제량、최대제량비교,rTMS조분별위(3.0±0.9) mg/d화(3.9±0.6) mg/d,위자격조분별위(3.8±1.0) mg/d화(4.7±0.7)mg/d,차이균유통계학의의(t=3.46,P＜0.01;t =5.04,P＜0.01).③여치료전비교,rTMS조치료4주말적P2(155.4±24.2 vs 171.7±28.5)、N2(205.4±19.4 vs 228.3±23.4)、P3(295.1 ±24.4 vs 317.5 ±25.5)잠복기축단,P2(4.1 ±1.6 vs3.1 ±1.2)화P3(6.9±2.1 vs4.9 ±1.8)파폭승고,Cc(4.4±2.4 vs3.1±2.0)화Rc(31.0±10.5 vs 24.1 ±11.2)증가,Re(18.4±8.9 vs 24.8±10.8)、Rpe(5.7±2.7 vs 8.2±4.3)화nRpe(12.2±6.5 vs 16.6±7.8)감소,위자격조적P3잠복기축단(299.5 ±27.3 vs320.3 ±29.4)、P3파폭승고(6.0±2.2 vs 4.8±1.9),Cc증가(28.7 ±9.6 vs 23.2±10.7),Re(20.4±8.1 vs25.1±9.7)화nRpe(13.1 ±6.2 vs 16.3 ±7.0)감소,차차이균유통계학의의(P＜0.05).치료4주후,rTMS조P2、N2잠복기화P3파폭급Cc、Rc、Re、Rpe、nRpe적개선여위자격조상비,조간차이균유통계학의의(P＜0.01).결론 rTMS(10 Hz)연합리배동치료가이개선정신분렬증환자적인지공능화강저약물적사용제량.
    Objective To investigate the influence of repetitive transcranial magnetic stimulation (rTMS) on the cognitive function of patients with schizophrenia.Methods Sixty-eight patients diagnosed as schizophrenic according to the 4th edition of the Diagnostic and Statistical Manu al of Mental Disorders were randomly assigned to either a real rTMS group (n =33) or a sham rTMS group (n =35).Both groups were given risperidone for 4 weeks,in addition to real or sham rTMS of the left dorsolateral prefrontal cortex at 10 Hz.The psychiatric symptoms of both groups were assessed using a Positive and Negative Syndrome scale (PANSS) before and after the 4 weeks of treatment.At the outset and at weeks 2 and 4 their cognition was evaluated using event-related potential P300 and the Wisconsin card sorting test (WCST).Results After 4 weeks of treatment the average negative symptoms score was significantly lower in rTMS group than in the sham group.The total score on the PANSS and the score of each factor were all significantly lower than before treatment in both groups.Both the average dose and the maximum dose of risperidone in the rTMS group were significantly higher than those in the sham group.Compared with before treatment,there were no significant differences in latency,P300 amplitude,completed categories (Cc),responses correct (Rc),response errors (Re),perseverative errors (Rpe) or non-perseverative errors (nRpe) in either group after 2 weeks of treatment.After 4 weeks,however,significantly shortened latency of P2,N2 and P3,significantly heightened amplitude of P2 and P3,significantly increased Cc and Rc,and significantly decrcased Re,Rpe and nRpe were all observed in the rTMS group.In the sham group,significantly shortened P3 latency,significantly heightened P3 amplitude,significantly increased Cc,and significantly decreased Re and nRp were observed.The rTMS group showed significantly better improvement in P2 and N2 latency,more improved P3 amplitude,and better Cc,Rc,Re,Rpe and nRpe results than the sham group after 4 weeks of treatment.Conclusion 10 Hz rTMS may have a therapeutic effect on the cognitive dysfunctions of schizophrenia with a treatment duration of more than 2 weeks.It can reduce the dosage of antipsychotic drugs required.
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