重复经颅磁刺激联合奥氮平治疗精神分裂症伴幻听患者的疗效及其机制  

Clinical efficacy and mechanism of repeat transcranial magnetic stimulation combined with olanzapine in schizophrenia patients with auditory hallucinations

作　　者：孙玉涛[1] 卢秀春 李坤玉 沈振明[1] 赵安全[3] 元艳平 SUN Yutao;LU Xiuchun;LI Kunyu;SHEN Zhenming;ZHAO Anquan;YUAN Yanping(Department of Psychology,Tangshan No.5 Hospital,Tangshan Hebei 063000;Department of Critical Psychiatry,Tangshan No.5 Hospital,Tangshan Hebei 063000;Department of Traditional Chinese Medicine Psychiatry,Tangshan No.5 Hospital,Tangshan Hebei 063000;Department of Psychosomatic Medicine,Tangshan No.5 Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市第五医院心理科,河北唐山063000 [2]唐山市第五医院重症精神科,河北唐山063000 [3]唐山市第五医院中医精神科,河北唐山063000 [4]唐山市第五医院身心医学科,河北唐山063000

出　　处：《临床与病理杂志》2021年第12期2870-2876,共7页Journal of Clinical and Pathological Research

基　　金：河北省医学科学研究课题(20201466)。

摘　　要：目的:探究重复经颅磁刺激(repeat transcranial magnetic stimulation,r TMS)联合奥氮平治疗精神分裂症伴幻听患者的疗效,并探讨其作用机制。方法:选取2017年6月至2020年6月在唐山市第五医院接受r TMS治疗的84例精神分裂症伴幻听患者,按是否进行r TMS将患者分为对照组(45例)与观察组(39例)。对照组采用奥氮平治疗,观察组采用奥氮平联合r TMS进行治疗。观察两组治疗后临床疗效;对比治疗前后阳性与阴性症状量表(Positive and Negative Symptom Scale,PANSS)评分、幻听量表(Auditory Hallucination Rating Scale,AHRS)评分、脑部神经递质[多巴胺(dopamine,DA)、5-羟色胺(5-hydroxytry ptamine,5-HT)、γ-氨基丁酸(γ-A minobutyricacid,GABA)]水平及血清生化指标[同型半胱氨酸(homocysteine,Hcy)、脑源性神经细胞营养因子(brain derived neurotrophic factor,BDNF)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF-α)]水平。结果:观察组临床总有效率为84.62%,高于对照组的57.78%(P<0.05);治疗后,观察组PANSS和AHRS评分低于对照组(P<0.05),观察组脑部DA、5-HT、GABA水平均高于对照组(P<0.05),观察组Hcy、IL-6、TNF-α水平低于对照组(P<0.05),BDNF水平高于对照组(P<0.05);观察组不良反应总发生率为20.51%,对照组为22.22%,两组比较差异无统计学意义(P>0.05)。结论:rTMS联合奥氮平治疗精神分裂症伴幻听患者具有较好的临床疗效,可改善患者精神症状及幻听症状,这可能与提高脑部神经递质水平,缓解炎症反应以及改善血清BDNF水平有关。Objective:To explore the efficacy of repetitive transcranial magnetic stimulation(r TMS) combined with olanzapine in the treatment of schizophrenia patients with auditory hallucination,and to explore its mechanism.Methods:A total of 84 schizophrenic patients with auditory hallucination who were treated in our hospital from June 2017 to June 2020 were selected and divided into a control group(45 cases) and an observation group(39 cases) according to whether r TMS was performed.The control group was treated with olanzapine,and the observation group was treated with olanzapine combined with r TMS.The clinical efficacy of the two groups were observed;the Positive and Negative Symptom Scale(PANSS) score,Auditory Hallucination Scale(AHRS) score,brain neurotransmitters [dopamine(DA),5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA)] and serum biochemical indexes [homocysteine(Hcy),brain-derived neurotrophic factor(BDNF),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)] were compared before and after treatment between the 2 groups.Results:The total effective rate of the observation group was 84.62%,which was higher than 57.78% of the control group(P<0.05).After the treatment,the PANSS and AHRS scores of the observation group were lower than those of the control group(P<0.05).After treatment,the levels of DA,5-HT and GABA in the observation group were higher than those in the control group(P<0.05),the levels of Hcy,IL-6 and TNF-α in the observation group were significantly lower than those in the control group,and the level of BDNF was higher than that of control group(P<0.05).The total incidence of adverse reactions was 20.51% in the observation group and 22.22% in the control group,and there was no significant difference between the 2 groups(P>0.05).Conclusion:r TMS combined with olanzapine has high clinical efficacy in the treatment of schizophrenia with auditory hallucination,which can improve the mental symptoms and auditory hallucination symptoms.This may be related to the improvement of brain neurotransmitt

关 键 词：精神分裂症 幻听 重复经颅磁刺激 奥氮平 神经递质 

分 类 号：R749.3[医药卫生—神经病学与精神病学]