低频重复经颅磁刺激对难治性精神分裂症的增效作用  

Study of synergistic effect of 1 Hz repetitive transcranial magnetic stimulation on medication-resistant schizophrenia

作　　者：王雪[1] 罗炯[1] 李晓虹[1] 任艳萍[1] 

机构地区：[1]首都医科大学附属北京安定医院抑郁症治疗中心,北京100088

出　　处：《四川精神卫生》2016年第1期41-45,共5页Sichuan Mental Health

基　　金：首都临床特色应用研究(Z131107002213095);北京市医院管理局重点医学专业发展计划-精神病学专业(ZYLX201403)

摘　　要：目的评价低频重复经颅磁刺激(r TMS)对难治性精神分裂症的疗效和认知功能的影响及其安全性。方法将52例幻听症状突出的难治性精神分裂症患者随机分为真刺激组和伪刺激组,刺激频率为1Hz,部位为背外侧前额叶皮质。在基线期、2周(治疗10次)、6周(治疗20次)和治疗结束后1个月采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、临床总体印象量表(CGIS)评价精神症状,采用可反复测查的成套神经心理状态评估工具(RBANS)评价认知功能,采用副反应量表(TESS)评定不良反应。结果 r TMS治疗10次、20次及随访1个月时,真刺激组和伪刺激组相比,PANSS幻觉、CGI评分、AHRS频率及RBANS总评分比较差异均有统计学意义(P<0.05或0.01);r TMS治疗20次及随访1个月时,AHRS总评分、影响、痛苦、RBANS视觉广度、言语功能及注意力评分差异有统计学意义(P<0.05或0.01);随访1个月时,PANSS阳性症状、一般病理症状评分、RBANS即刻记忆评分差异有统计学意义(P<0.05或0.01)。r TMS治疗后未发现明显不良反应。结论低频r TMS可改善精神分裂症的幻听、阳性症状和认知功能且安全性好。Objective To evaluate the efficacy and safety of 1Hz repetitive transcranial magnetic stimulation( r TMS) on auditory hallucination and cognitive impairment of schizophrenia. Methods Fifty-two patients who had medication-resistant auditory hallucination were randomized to either active r TMS applied to the dorsolateral prefrontal cortex( n = 26) or sham r TMS( n = 26). The outcome measures included Positive and Negative Syndrome Scale( PANSS),Auditory Hallucinations Rating Scale( AHRS),Clinical Global Impression Scale( CGIS),Repeatable Battery for the Assessment of Neuropsychological Status( RBANS) and Treatment Emergent Symptom Scale( TESS) at baseline,treatment for 2 weeks,6 weeks and 1-month follow-up. Results The auditory hallucinations of PANSS,the CGI score,the frequency of AHRS and the total score of RBANS were significantly improved in the real r TMS group than that in the sham r TMS group after treatments of 10 times,20 times and 1-month follow-up( P < 0. 05 or 0. 01). Compared with the sham r TMS group,the real r TMS group revealed significant improvements in the influence,pain and total score of AHRS as well as in the visual span,verbal function and attention of RBANS after treatment of 20 times and 1-month follow-up( P < 0. 05 or0. 01). The immediate memory of RBANS,positive syndromes and general pathological syndromes of PANSS were significantly improved in the real r TMS group than that in the sham r TMS group at 1-month follow-up assessment( P < 0. 05 or 0. 01). There was no significant difference in adverse reaction after treatment. Conclusion It suggests that 1Hz repetitive transcranial magnetic stimulation is a safe approach showing efficacy on auditory hallucination,positive symptoms and cognitive functions in schizophrenic patients.

关 键 词：重复经颅磁刺激 精神分裂症 幻听 认知功能 双盲 随机对照研究 

分 类 号：R749.3[医药卫生—神经病学与精神病学]