不同脑部重复经颅磁刺激对精神分裂症患者认知功能的影响

摘要

Objective:To investigate the effect of different region repetitive transcranial magnetic stimula-tion(rTMS)with theta burst stimulation(TBS)on cognitive function of schizophrenia patients. Method:Ninty-six patients with schizophrenia were randomly assigned to 4 groups:left frontal lobe group,bilateral frontal lobe group,left temporal lobe group and sham stimulation group(each 24 cases). All patients were treated by rTMS with TBS,of which appropriate stimulus location was selected according to the grouping categories. The cognitive function was evaluated using the Wisconsin card sorting test-64(WCST-64),paced auditory serial addition test (PASAT)and Hopkins verbal learning test-revised(HVLT-R)at pre-and post-treatment. Results:Totally 92 patients finished the research. There were no significant difference on the indexs of WCST-64,HVLT-R and scores of PASAT at pre treatment among the 4 groups. The indexs scores of PASAT and HVLT-R were remarkable higher than these in other three groups besides sham stimulation group in pre-treatment after rTMS(all P <0. 05);the in-dexs scores of WCST-64 were remarkable lower than those in other three groups besides sham stimulation group in pre-treatment(P < 0. 05 or P < 0. 01),while were more significantly changes in left frontal lobe group and bi-lateral frontal lobe group(P < 0. 05 or P < 0. 01). There were no significant difference on the indexs scores of PASAT,HVLT-R,WCST-64 between left frontal lobe group and bilateral frontal lobe group. Conclusion:The regions of left frontal lobe,bilateral frontal lobe and left temporal lobe are stimulated by rTMS with TBS are ef-fective for cognitive impairment. The better effect is stimulating left frontal lobe and bilateral frontal lobe.%目的：初步探讨不同部位θ短阵快速脉冲（TBS）重复经颅磁刺激（rTMS）对精神分裂症患者认知功能的影响。方法：96例精神分裂症患者随机分为左侧额叶组、双侧额叶组、左侧颞叶组及假刺激组，每组各24例。在维持原有抗精神病药种类及剂量不变的基础上采用 TBS 模式进行相应部位 rT-MS，每周5次，4周为1疗程。治疗前后应用威斯康星卡片分类测验-64（WCST-64）、定步调听觉连续加法测验（PASAT）、霍普金斯词汇学习测验-修订版（HVLT-R）对患者认知功能进行评定。结果：92例患者完成疗程；治疗前各组 HVLT-R、WCST-64及 PASAT 评分差异无统计学意义；治疗后，除假刺激组外，其余3组 PASAT、HVLT-R 评分较治疗前明显升高（P 均<0.05）；WCST-64的持续错误数和持续反应数均明显下降（P <0.05，P <0.01），其中左侧额叶组及双侧额叶组 PASAT、HVLT-R 评分较左侧颞叶组明显升高（P <0.05，P <0.01），WCST-64持续错误数和持续反应数较左侧颞叶组明显下降（P <0.05， P <0.01），左侧额叶组和双侧额叶组间 HVLT-R、WCST-64及 PASAT 评分差异无统计学意义。结论：TBS 模式的 rTMS 刺激左侧额叶、双侧额叶及左侧颞叶对精神分裂症患者认知功能均有明显改善，刺激左侧额叶及双侧额叶的改善作用更佳。