摘要
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.
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 re
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2015年第3期219-223,共5页
Chinese Journal of Physical Medicine and Rehabilitation
基金
全军医学科研计划（CWS12J071）
