摘要
目的:分析高频重复经颅磁刺激(HF-rTMS)联合记忆认知训练对脑卒中后认知功能障碍(PSCI)患者记忆、认知的影响,并观察患者CT灌注成像(CTP)的变化,进一步分析CT灌注参数与MoCA评分、MMSE评分的相关性。方法:将PSCI患者170例随机分为观察组与对照组,各85例,对照组在常规康复训练的基础上进行记忆认知训练联合假HF-rTMS干预,观察组在常规康复训练的基础上进行记忆认知训练联合真HF-rTMS干预。治疗前、治疗6周后,观察2组CT灌注参数[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)]、事件相关电位P300(ERP-P300)、记忆功能[Stroop任务测试、Rivermead行为记忆测试-Ⅱ(RBMT-Ⅱ)]、认知功能[蒙特利尔认知评估量表(MoCA)、简易智力状态检查(MMSE)量表],并分析观察组治疗后CT灌注参数与MoCA评分、MMSE评分的相关性。结果:治疗后,2组CBF及CBV均较治疗前增加,MTT及TTP均较治疗前缩短(P<0.05,0.01),观察组上述参数较对照组改善更为显著(P<0.05);治疗后,2组ERP-P300较治疗前潜伏期降低,波幅增高(P<0.05,0.01),观察组治疗后ERP-P300潜伏期低于对照组,波幅高于对照组(P<0.05,0.01);治疗后,2组Stroop任务测试正确率、RBMT-Ⅱ评分均有所提高,Stroop任务测试用时相对缩短(P<0.05,0.01),观察组治疗后Stroop任务测试正确率高于对照组,用时较对照组短,RBMT-Ⅱ评分高于对照组(P<0.01);治疗后,2组MoCA评分、MMSE评分均较治疗前增高(P<0.01),观察组治疗后MoCA评分、MMSE评分均高于对照组(P<0.05)。CTP参数中CBF、CBV与MoCA评分、MMSE评分存在正相关(r=0.176、0.170、0.470、0.395,P<0.05),MTT与MoCA评分、MMSE评分呈负相关(r=-0.192、-0.235,P<0.05);CTP参数中TTP与MoCA评分、MMSE评分无明显相关性。结论:HF-rTMS联合记忆认知训练可改善PSCI患者的认知与记忆功能。CTP结果显示,该疗法可增加脑血流量及脑血容量,缩短MTT、TTP,优化脑部血流灌注情况,且脑部血流灌注情况与患者认知功能密切相关,HF-rTMS联合记忆认知训练可能通过改善脑灌注来提升PSCI患者的认知功能。
Objective:To evaluate the therapeutic effects of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)combined with memory cognitive training on post-stroke cognitive impairment(PSCI),and investigate cerebral perfusion changes using CT perfusion imaging(CTP)and the correlation between CT perfusion parameters and MoCA score and MMSE score.Methods:In this randomized controlled trial,170 PSCI patients were allocated to either an active intervention group(real HF-rTMS+cognitive training,n=85)or a control group(sham HF-rTMS+cognitive training,n=85).Outcome measures included CTP parameters(cerebral blood flow[CBF],blood volume[CBV],mean transit time[MTT],peak time[TTP]),ERP-P300 components,and standardized neuropsychological assessments(Stroop test,RBMT-II,MoCA,MMSE)at baseline and 6-week follow-up.Correlation analyses assessed relationships between hemodynamic parameters and cognitive outcomes.Results:After treatment,CBF and CBV in the two groups were increased when compared with those before treatment,and MTT and TTP were shortened when compared with those before treatment(P<0.05,0.01),and the above parameters in the observation group were improved more significantly than those in the control group(P<0.05).After treatme-nt,the latency of ERP-P300 in the two groups was decreased when compared with that before treatment,and the amplitude was increased(P<0.05,0.01).The latency of ERP-P300 in the observation group was lower than that in the control group,and the amplitude was higher than that in the control group(P<0.05,0.01).After treatment,the Stroop task test accuracy and RBMT-II score of the two groups were improved,and the Stroop task test time was shortened(P<0.01).After treatment,the Stroop task test accuracy was higher,the time was shorter,and the RBMT-II score was greater in the observation group than those in the control group(P<0.01).After treatment,the MoCA score and MMSE score in the two groups were increased when compared with those before treatment(P<0.01),and the MoCA score and MMSE score in the observation group were higher than those in the control group(P<0.01).CBF and CBV in CTP parameters were positively correlated with MoCA score and MMSE score(r=0.176,0.170,0.470,0.395,P<0.05),and MTT was negatively correlated with MoCA score and MMSE score(r=-0.192,-0.235,P<0.05).There was no significant correlation between TTP in CTP parameters and MoCA score and MMSE score.Conclusion:The HF-rTMS combined with cognitive training protocol significantly enhances cognitive recovery in PSCI patients,potentially mediated through optimized cerebral perfusion.CTP parameters demonstrate predictive value for cognitive outcomes,with CBF/CBV and MTT serving as potential neuroimaging biomarkers.
作者
杨保元
常士峰
王建晖
Yang Baoyuan;Chang Shifeng;Wang Jianhui(Department of Rehabilitation Medicine,Nanshi Hospital of Nanyang,Nanyang,Henan 473000,China)
出处
《中国康复》
2025年第6期338-343,共6页
Chinese Journal of Rehabilitation
基金
2022年南阳南石医院科研立项项目(KJGG116)。
关键词
脑卒中后认知功能障碍
高频重复经颅刺激
记忆认知康复训练
CT灌注成像
记忆
认知功能
cognitive dysfunction after stroke
high frequency repetitive transcranial stimulation
memory cognitive rehabilitation training
CT perfusion imaging
memory
cognitive function
