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

摘要

目的 探讨重复经颅磁刺激(rTMS)对精神分裂症患者认知功能和血清脑源性神经营养因子(sBDNF)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.rTMS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sBDNF水平.结果 治疗前3组患者PANSS得分、CCAS得分、sBDNF水平比较,差异均无统计学意义(P＞0.05).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(P＜0.05);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(P＜0.05);sBDNF水平比较,差异有统计学意义(P＜0.05).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;sBDNF水平高于C组;差异有统计学意义(P＜0.05).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(P＜0.05),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(P＜0.05);患者治疗前后sBDNF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(P ＜0.05).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(P＞0.05).结论 先5 Hz后10 Hz模式与先10 IL后5 Hz模式rTMS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sBDNF水平可能是rTMS改善精神分裂症患者认知功能的机制之一.%Objective To evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) with 5 Hz or 10 Hz on the cognitive function and serum brain-derived neurotrophic factor (sBDNF) levels in chronic schizophrenia.Methods According to the random number table,90 patients with chronic schizophrenia receiving inpatient treatment in Wuxi Mental Health Center Affiliated to Nanjing Medical University from February 2014 to June 2016 were equally divided into three groups:group A,group B and group C.The rTMS treatment for all the groups consists of two stages.For group A,in the first stage,they received 10 times of rTMS treatment with a frequency of 5 Hz,after that,they received 10 times of rTMS treatment with a frequency of 10 Hz after one-week break.For group B,they first received 10 times of rTMS treatment with a frequency of 10 Hz,and after one week of break,they received 10 times of rTMS treatment with a frequency of 5 Hz.For group C,they received 10 times of sham rTMS treatment with a frequency of 5 Hz,and 10 times of sham rTMS treatment with a frequency of 10 Hz subsequently after a one-week interval.The severity of mental illness was assessed by Positive and Negative Syndrome Scale (PANSS) and cognitive function was assessed by the Chinese Cognitive Ability Scale (CCAS) on the preceding day of rTMS treatment,and on the day completing the rTMS treatment or first day after the rTMS treatment,respcctively.sBDNF was measured on the preceding day of rTMS treatment,and on the first day after rTMS treatment,respectively.Results Before rTMS treatment,three groups presented similar total scores of PANSS and CCAS and the scores of each subscale of the two and sBDNF levels (P ＞ 0.05).After treatment,the total scores of PANSS and scores of Negative Scale,the total scores of CCAS and scores of the digit span,Chinese word matching,picture and word matching quiz,scores of learning ability dimension,verbal IQ and the overall scores of IQ and sBDNF levels differed significantly between all the groups (P ＜ 0.05),in particular,group C had higher total scores of PANSS and scores of Negative Scale,lower scores of digit span,Chinese word matching,picture and word matching quiz,learning ability dimension,verbal IQ and lower total scores of IQ and lower sBDNF levels than the other two groups (P ＜ 0.05).The results of Pearson correlation analysis showed,the treatment-derived difference in Positive Scale scores was negatively correlated with that of CCAS reasoning ability dimension scores (P ＜ 0.05);the treatment-derived difference in total scores of PANSS as well as in Negative Scale scores had negative correlations with that in scores of CCAS working memory,learning ability,reasoning ability,spatial computation,processing speed dimensions,and verbal IQ and operation IQ and total scores of IQ (P ＜ 0.05);the treatment-derived difference in sBDNF levels was positively correlated with that in scores of CCAS working memory,learning ability,reasoning ability,spatial computation,processing speed dimensions,and verbal IQ and operation IQ (P ＜ 0.05).The three groups demonstrated similar incidence of adverse reactions during the treatment (P ＞0.05).Conclusion Both the patterns of rTMS treatment used in groups A and B can improve the cognitive function in patients w ith chronic schizophrenia,which may be achieved by improving the negative symptoms and increasing the sBDNF levels.