经颅直流电刺激联合重复经颅磁刺激治疗脑卒中后认知障碍的疗效  

Effect of transcranial direct current stimulation combined with repeated transcranial magnetic stimulation on post-stroke cognitive impairment

作　　者：罗雅丽 陈劲松 白洁 陈莎莎 刘双 LUO Yali;CHEN Jinsong;BAI Jie;CHEN Shasha;LIU Shuang(Mianyang Hospital Affiliated to Medical College of University of Electronic Science and Technology of China·Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院,四川绵阳621000

出　　处：《中国实用神经疾病杂志》2022年第10期1203-1209,共7页Chinese Journal of Practical Nervous Diseases

基　　金：四川省医学科研课题计划(编号:S19068);四川省卫生健康委员会科研课题(编号:20PJ261);康复医学四川省重点实验室开放课题(编号:KFYXSZDSYS-06)。

摘　　要：目的观察经颅直流电刺激(tDCS)联合重复经颅磁刺激(rTMS)治疗脑卒中后认知障碍(PSCI)的疗效。方法纳入2020-07—2022-02电子科技大学医学院附属绵阳医院住院的PSCI患者120例,随机分为rTMS组、tDCS组、联用1组和联用2组。rTMS组采用r TMS治疗,tDCS组采用tDCS治疗,联用1组采用先rTMS后tDCS治疗,联用2组采用先tDCS后r TMS治疗,4组均治疗8周。治疗前后观察蒙特利尔认知评估量表(MoCA)、连线测验(TMT)、Stroop色词试验评分,磁共振弥散张量成像(DTI),实验室指标(hs-CRP、BDNF、SOD)。结果量表测试方面,治疗后联用2组TMT时长低于其余3组(38.03±3.49比42.96±3.70、43.11±3.58、40.72±4.46)(P<0.05),Stroop色词试验高于其余3组(56.26±4.64比54.29±4.36、52.85±3.69、55.39±4.59)(P<0.05),MoCA评分高于rTMS组和tDCS组(23.05±4.02比21.33±2.64、19.75±2.27),与联用1组比较无统计学差异(P>0.05)。DTI方面,治疗后联用2组在胼胝体压部、矢状层(右侧)、上纵束(双侧)、扣带束(双侧)的FA值高于其余3组(P<0.05),在矢状层(左侧)、下额枕束(双侧)的FA值高于tDCS组,在胼胝体膝部与其他3组比较无统计学差异(P>0.05),且联用2组MoCA评分、Stroop色词试验个数的提高与胼胝体压部、左侧上纵束、双侧扣带束FA值的上升呈正相关(P<0.05),而TMT总时长的减少与胼胝体压部、双侧上纵束、双侧扣带束FA值的上升呈负相关(P<0.05)。实验室指标方面,联用2组BDNF、SOD水平高于其余3组(P<0.05),hs-CRP水平低于rTMS组和tDCS组(P<0.05),与联用1组比较无统计学差异(P>0.05)。结论在PSCI治疗上,单独采用r TMS优于单独采用tDCS,先采用tDCS后采用rTMS具有较好的效果,优于单独使用tDCS或rTMS以及先使用rTMS后使用t DCS。Objective To observe the efficacy of transcranial direct current stimulation(tDCS)combined with repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke cognitive impairment(PSCI).Methods Totally 120 patients with PSCI in the Inpatient Department of Mianyang Hospital Affiliated to Medical College of University of Electronic Science and Technology of China from July 2020 to February 2022were randomly divided into rTMS group,tDCS group,combined group 1 and combined group 2.rTMS group was treated with rTMS,tDCS group was treated with tDCS,combined group 1 was treated with rTMS before tDCS,and combined group 2 was treated with tDCS before rTMS.All groups were treated for 8 weeks.MoCA scores,connection test(TMT),Stroop color word test,magnetic resonance diffusion tensor imaging(DTI)and laboratory indexes(hs-CRP,BDNF,SOD)were observed before and after treatment.Results In terms of scale test,after treatment,the duration of TMT in the combined group 2 was lower than that in the other three groups(38.03±3.49 vs 42.96±3.70,43.11±3.58,40.72±4.46)(P<0.05),and the Stroop color word test was higher than that in the other three groups(56.26±4.64 vs 54.29±4.36,52.85±3.69,55.39±4.59)(P<0.05),and the MoCA score was higher than that in the rTMS group and tDCS group(23.05±4.02 vs 21.33±2.64,19.75±2.27),and there was no difference between the combined group 2(P>0.05).In terms of DTI,after treatment,the FA values of the combined group 2 in the pressing part of the corpus callosum,sagittal layer(right),upper longitudinal tract(bilateral)and cingulate tract(bilateral)were higher than those of the other three groups(P<0.05),and in the sagittal layer(left)and lower fronto occipital tract(bilateral)were higher than those of the tDCS group,and there was no difference in the knee of the corpus callosum and other three groups(P>0.05).The increase of MoCA score and Stroop color word test in the combined group 2 was positively correlated with the increase of FA values of the pressing part of corpus callosum,

关 键 词：脑卒中 认知障碍 经颅直流电刺激 重复经颅磁刺激 磁共振弥散张量成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]