重复经颅磁刺激对慢性精神分裂症患者认知功能和血清脑源性神经营养因子水平的影响研究

发布时间：2018-03-19 23:10

本文选题：精神分裂症　切入点：经颅磁刺激　出处：《中国全科医学》2017年25期 　论文类型：期刊论文

【摘要】：目的探讨重复经颅磁刺激(r TMS)对精神分裂症患者认知功能和血清脑源性神经营养因子(s BDNF)水平的影响。方法选取2014年2月—2016年6月在南京医科大学附属无锡精神卫生中心住院治疗的慢性精神分裂症患者90例,采用随机数字表法分为A、B、C组,每组30例。r TMS治疗分2个阶段:A组患者第1阶段刺激频率为5 Hz,治疗10次后休息1周进入第2阶段,更换刺激频率为10 Hz;B组患者第1阶段刺激频率为10 Hz,治疗10次后休息1周进入第2阶段,更换刺激频率为5 Hz;C组患者进行假刺激。分别于治疗前1天、治疗20次后当天或第2天,采用阳性与阴性症状量表(PANSS)评价患者精神症状严重程度,采用华文认知能力量表(CCAS)评价患者认知功能;分别于治疗前1天、治疗20次后第2天,检测患者s BDNF水平。结果治疗前3组患者PANSS得分、CCAS得分、s BDNF水平比较,差异均无统计学意义(P0.05)。治疗后3组患者PANSS总分及阴性分量表得分比较,差异有统计学意义(P0.05);CCAS中数字广度、汉词配对、图符配对分测验得分,学习能力维度得分,言语智商、总智商得分比较,差异有统计学意义(P0.05);s BDNF水平比较,差异有统计学意义(P0.05)。其中,治疗后A、B组患者PANSS总分及阴性分量表得分低于C组;CCAS中数字广度、汉词配对、图符配对分测验得分,学习能力维度得分,言语智商及总智商得分高于C组;s BDNF水平高于C组;差异有统计学意义(P0.05)。Pearson相关分析结果显示,患者治疗前后PANSS阳性分量表得分差值与治疗前后CCAS中推理能力维度得分差值呈负相关(P0.05),治疗前后PANSS总分及阴性分量表得分差值治疗前后与CCAS中工作记忆、学习能力、推理能力、空间计算、加工速度维度得分及言语智商、操作智商、总智商得分差值呈负相关(P0.05);患者治疗前后s BDNF水平差值与治疗前后CCAS中工作记忆、学习能力、推理能力、空间计算、加工速度维度得分及言语智商、操作智商、总智商得分差值呈正相关(P0.05)。3组患者治疗过程中不良反应发生率比较,差异无统计学意义(P0.05)。结论先5 Hz后10 Hz模式与先10 Hz后5 Hz模式r TMS均能改善慢性精神分裂症患者的认知功能,慢性精神分裂症患者认知功能的改善可能与阴性症状改善有关,提高s BDNF水平可能是r TMS改善精神分裂症患者认知功能的机制之一。
[Abstract]:Objective to investigate the effects of repetitive transcranial magnetic stimulation (TMS) on cognitive function and serum level of brain-derived neurotrophic factor (BDNF) in patients with schizophrenia. Methods Wuxi Spirit affiliated to Nanjing Medical University from February 2014 to June 2016 was selected. 90 patients with chronic schizophrenia who were hospitalized at the health center, The first stage stimulation frequency of the patients in group A was 5 Hz after 10 times of treatment. After 10 times of treatment, the first week of rest entered the second stage, and 30 cases in each group were divided into 2 stages: the first stage of stimulation frequency was 5 Hz, and the rest was 1 week after 10 times of treatment. The first stage stimulation frequency of the patients in group B was 10 Hz. After 10 times of treatment, the patients in group B took a rest for one week to enter the second stage. The patients in group C were given pseudostimuli after 10 times of treatment, and the patients in group C were given pseudostimuli one day before treatment. Positive and negative symptom scale (PANSS) was used to evaluate the severity of mental symptoms, and Chinese cognitive ability scale (CCAS) was used to evaluate the cognitive function of the patients, one day before treatment and two days after 20 times of treatment. Results before treatment, there was no significant difference in PANSS score and BDNF between the three groups. After the treatment, the total PANSS score and the negative subscale scores of the three groups were compared, and the difference was statistically significant. The scores of Chinese word pairing, map symbol pairing subtest, learning ability dimension score, speech intelligence quotient and total intelligence quotient were compared. The difference was statistically significant (P 0.05) and the difference was statistically significant (P 0.05). After treatment, the scores of total score and negative score of PANSS in group A B were lower than those in group C, such as digit span, Chinese word pairing, map match subtest, learning ability dimension, speech intelligence quotient and total intelligence quotient, which were higher than those in C group and C group. The difference was statistically significant (P 0.05). Pearson correlation analysis showed that, There was a negative correlation between the difference of PANSS positive score before and after treatment and the dimension difference of reasoning ability in CCAS before and after treatment (P 0.05). Before and after treatment, the total score of PANSS and the score difference of negative subscale of PANSS were different from those of CCAS in working memory, learning ability and reasoning ability before and after treatment. Spatial calculation, processing speed dimension score and speech intelligence quotient, operating intelligence quotient, total intelligence quotient difference were negatively correlated (P 0.05). The difference of s BDNF level before and after treatment was correlated with working memory, learning ability, reasoning ability, spatial calculation in CCAS before and after treatment. The scores of processing speed dimension, verbal intelligence quotient, operating intelligence quotient, total intelligence quotient difference were positively correlated with the incidence of adverse reactions in the treatment of P0.05C.3 group. There was no significant difference (P 0.05). Conclusion the improvement of cognitive function in patients with chronic schizophrenia may be related to the improvement of negative symptoms. Conclusion the first 5 Hz and 10 Hz and 5 Hz r TMS modes can improve the cognitive function of the patients with chronic schizophrenia, and the improvement of the cognitive function of the patients with chronic schizophrenia may be related to the improvement of the negative symptoms. Increasing the level of s BDNF may be one of the mechanisms of r TMS to improve cognitive function in schizophrenic patients.
【作者单位】：南京医科大学附属无锡精神卫生中心老年精神科;南京医科大学附属无锡精神卫生中心中心实验室;南京医科大学附属无锡精神卫生中心心理测量室;
【基金】：无锡市医院管理中心医学科研项目(YGZXQ1307) 南京医科大学科技发展面上基金项目(2013NJMU206)
【分类号】：R749.3

【相似文献】