摘要
目的探讨神经导航的10 Hz重复经颅磁刺激(rTMS)治疗复员退伍慢性精神分裂症的临床症状及认知功能的影响。方法选取56例慢性精神分裂症患者,随机分为10 Hz的rTMS治疗组(治疗组)和重复经颅磁假刺激组(假刺激组)各28例,分别于治疗前及治疗后第2、4、6、8周末,采用阳性与阴性症状量表(PANSS)评估精神病理状况,用可重复的神经心理状态评估量表(RBANS)评估认知功能。结果RBANS总分及语言、注意子测验分与年龄、总病程均呈负相关(P<0.05),RBANS总分及视觉空间/结构、注意子测验分与受教育年限均呈正相关(P<0.05),RBANS总分及视觉空间/结构、语言、注意、延迟记忆子测验分与PANSS阴性量表分、负性因子分均呈负相关(P<0.05),RBANS注意子测验分与PANSS抑郁/焦虑呈负相关(P<0.05)。进一步多元线性回归分析显示,受教育年限是RBANS总分及视觉空间/结构、注意影响因素(P<0.05)。经过8周的rTMS及假刺激治疗后,以5个时间点(治疗前、治疗后第2、4、6、8周末)作为效应内重复测量,PANSS总分及各分量表分、RBANS总分及各子测验分均有时间效应(P<0.05)。结论10 Hz的rTMS对复员退伍慢性精神分裂症的临床症状及认知功能障碍未显现出疗效,可能研究对象年老、病程长,严重的阴性症状,尤其是严重与社会脱节和滞后的文化层次及结构是影响疗效的因素。
Objective To explore the effect of 10 Hz repetitive Transcranial Magnetic Stimulation(rTMS)on clinical symptoms and cognitive function in patients with chronic schizophrenia after demobilization.Methods A total of 56 patients with chronic schizophrenia were selected and randomly divided into treatment group(28 cases)treated with 10 Hz rTMS and sham stimulation group(28 cases)treated with sham stimulation.They were all assessed with Positive and Negative Syndrome Scale(PANSS)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)before treatment and at the ends of the 2nd,4th,6th and 8th weeks after treatment.Results The total score and factor scores of language and attention of RBANS were negatively correlated with age and total duration of disease(P<0.05).The total score and factor scores of visual space/structure and attention of RBANS were positively correlated with education level(P<0.05).The total score and factor scores of visual space/structure,language,attention and delayed memory of RBANS showed significant negative correlations with factor scores of negative scale and negative factor of PANSS(P<0.05).The factor score of attention of RBANS was negatively correlated with factor score of depression/anxiety of PANSS(P<0.05).Multiple linear regression analysis showed that education level was an influence factor for the total score and factor scores of visual space/structure and attention of RBANS(P<0.05).After 8 weeks of rTMS and sham stimulation treatment,5 time points(before treatment and at the ends of the 2nd,4th,6th and 8th weeks after treatment)were used as intra-effect repeated measurements,and there existed significant time effect in the total scores and all factor scores of PANSS and RBANS(P<0.05).Conclusion 10 Hz rTMS has no significant effect on the clinical symptoms and cognitive dysfunction in patients with chronic schizophrenia after demobilization.It is possible that the old age,long course of disease,severe negative symptoms,especially serious social disconnection and lagging cultural hierarchy and structure are important factors affecting the efficacy.
出处
《精神医学杂志》
2021年第1期10-15,共6页
Journal of Psychiatry
基金
河北省医学科学研究重点课题计划(编号:20150593)。
