重复经颅磁刺激对急性脑梗死患者脑内神经递质及神经与认知功能的影响  

Effects of repetitive transcranial magnetic stimulation on neurotransmitters,neurological and cognitive function in patients with acute cerebral infarction

作　　者：涂鄂文[1] 王照[1] 宁敏 石晴 林虎 方芳 TU Ewen;WANG Zhao;NING Min;SHI Qing;LIN Hu;FANG Fang(Dept.of Neurology,Brain Hospital of Hunan Province,Changsha 410007,Hunan,China)

机构地区：[1]湖南省脑科医院神经内科,湖南长沙410007

出　　处：《武汉大学学报（医学版）》2024年第1期84-89,共6页Medical Journal of Wuhan University

基　　金：湖南省医药卫生科研计划课题项目(编号:B2014-101)。

摘　　要：目的:探讨急性脑梗死后脑内神经递质的变化特点及重复经颅磁刺激(rTMS)治疗对神经递质、神经功能和认知功能的影响。方法:选择2017年1月至2019年1月收治的200例急性脑梗死伴认知功能障碍患者,采用随机数字表法分为对照组及rTMS组各100例,对照组采用抗血小板、调脂等常规治疗,rTMS组在常规治疗的基础上加用rTMS治疗,分别于入院时及发病后第3、14、28天采用NIHSS评分评估神经功能缺损情况,采用脑涨落图检测谷氨酸(Glu)、γ-氨基丁酸(GABA)、多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)和乙酰胆碱(Ach)6种神经递质功率;入院时及发病后第14、28天采用蒙特利尔认知评估量表(MoCA)和简明精神状态检查表(MMSE)评估认知功能。结果:急性脑梗死后脑内神经递质失衡,具体特点表现为发病后前3 d,6种神经递质功率呈上升趋势,第3天达到峰值,此后至第14、28天呈持续回落趋势;第14天,rTMS组Glu、DA、5-HT、NE功率和NIHSS评分均低于对照组,GABA功率和MMSE评分高于对照组;第28天,Glu、DA、5-HT、NE、Ach功率和NIHSS评分均低于对照组,GABA功率、MoCA评分和MMSE评分均高于对照组。结论:急性脑梗死后脑内神经递质失衡,rTMS治疗可有效改善神经递质失衡情况,减轻神经功能损伤和改善认知功能。Objective:To investigate the changes of neurotransmitters in the brain after acute cerebral infarc-tion and the effects of repeated transcranial magnetic stimulation(rTMS)on neurotransmitters,neuro-logical function,and cognitive function.Methods:A total of 200 patients with acute cerebral infarction and cognitive impairment admitted from January 2017 to January 2019 were randomly divided into the control group and rTMS group,with 100 patients in each group.The control group received conven-tional treatment such as antiplatelet therapy and lipid regulation,and the rTMS group was treated with rTMS in addition to conventional treatment.NIHSS were used to evaluate the neurological deficit at admission and on the 3rd,14th,and 28th days after onset.The power of six neurotransmitters includ-ing glutamate(Glu),gamma-aminobutyric acid(GABA),dopamine(DA),5-hydroxytryptophan(5-HT),norepinephrine(NE),and acetylcholine(Ach)were measured by encephalofluctuograph.Cog-nitive function was assessed by the Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)at admission and on the 14th and 28th days after onset.Results:After acute ce-rebral infarction,there was a neurotransmitter imbalance in the brain.The specific characteristics were as follows:the power of six neurotransmitters showed an upward trend in the first three days after the onset and reached the peak on the third day,then showed a continuous downward trend on the 14th and 28th days;on the 14th day,the scores of Glu,DA,5-HT,and NE power,and NIHSS in the rTMS group were lower than those in the control group,the scores of GABA power and MMSE were higher than those in the control group;On the 28th day,the scores of Glu,DA,5-HT,NE,ACh power and NIHSS were lower than those in the control group,the scores of GABA power,MoCA and MMSE were higher than those in the control group.Conclusion:There was a neurotransmitter imbalance in the brain after acute cerebral infarction,and rTMS treatment can effectively improve the neurotrans-mitter imbalance,relieve neu

关 键 词：急性脑梗死 重复经颅磁刺激 神经递质 认知功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]