高频重复经颅磁刺激联合有氧运动训练对轻中度帕金森病患者运动障碍的影响  

Effect of high-frequency rTMS combined with aerobic exercise training on motor disorder of patients with mild to moderate PD

作　　者：曹文慧 林戈威 徐颖 杨晓帆 Cao Wenhui;Lin Gewei;Xu Ying;Yang Xiaofan(Department of Rehabilitation Medicine,Red Flag Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157000,Heilongjiang Province,China)

机构地区：[1]牡丹江医科大学附属红旗医院康复医学科,157000

出　　处：《中华老年心脑血管病杂志》2024年第11期1338-1342,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：黑龙江省卫生健康委科研课题(20232020010252);黑龙江省省属高等学校基本科研业务费科研项目(2021-KYYWF-0498);牡丹江市应用技术研究与开发计划项目(HT2022NS072)。

摘　　要：目的 探讨高频重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)联合有氧运动训练对轻中度帕金森病(Parkinson's disease, PD)患者运动功能、步态和日常生活能力的影响。方法 选取2021年3月至2023年1月于牡丹江医科大学附属红旗医院康复医学科住院的PD患者54例,随机分为联合治疗组27例和常规治疗组27例。常规治疗组有氧运动训练2周,联合治疗组在此基础上给予双侧初级运动皮质高频(10 Hz)rTMS。比较2组治疗前(T0期)、治疗后1 h(T1期)和治疗后第4周(T2期)统一帕金森病评定量表第三部分(unified Parkinson's diseaserating scale-Ⅲ,UPDRS-Ⅲ)运动评分、步态参数(步速、步幅、步频)和日常生活能力量表(activity of daily living scale, ADL)评分的差异。结果 联合治疗组T1期和T2期UPDRS-Ⅲ评分明显低于常规治疗组[(23.30±3.36)分vs(26.22±4.04)分,(24.04±3.45)分vs(27.19±3.41)分,P<0.01],联合治疗组T1期和T2期步速、步幅明显高于常规治疗组(P<0.05,P<0.01)。联合治疗组T1期、T2期UPDRS-Ⅲ、ADL评分明显低于T0期,步速、步幅明显高于T0期(P<0.05);T1期ADL评分明显低于T2期(P<0.05);常规治疗组T1期UPDRS-Ⅲ评分、ADL评分明显低于T0期和T2期,步速、步幅明显高于T0期和T2期(P<0.05)。联合治疗组与常规治疗组不同时间点步频比较,差异无统计学意义(P>0.05)。结论 双侧M1区高频rTMS联合有氧运动训练改善轻中度PD患者运动症状和步态(步速、步幅)优于单一有氧运动训练,并且作用效果可持续至治疗后4周。Objective To investigate the effects of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with aerobic exercise training on motor function,walking ability and activity of daily living(ADL)in patients with mild to moderate Parkinson's disease(PD).Methods A total of 54 PD patients admitted in our department from March 2021 to January 2023 were recruited and randomly divided into conventional treatment group(n=27,aerobic exercise training for 2 weeks)and combination treatment group[n=27,aerobic exercise training plus high-frequency(10 Hz)rTMS in the bilateral primary motor cortex].Unified Parkinson's Disease Rating Scale-Ⅲand ADL scale were applied in two groups before treatment(T0)and 1 h(T1)and 4 weeks(T2)after 2 weeks of treatment to compare the differences in motor score,gait parameters(pace,stride length and stride frequency)and ADL score between them.Results At T1 and T2,the combination treatment group obtained significantly lower UPDRS-Ⅲscore(23.30±3.36 vs 26.22±4.04,24.04±3.45 vs 27.19±3.41,P<0.01),but higher gait speed and longer stride length when compared with the conventional treatment group(P<0.05,P<0.01).In the combination treatment group,the UPDRS-Ⅲand ADL scores at T1 and T2 were decreased,stride speed and stride amplitude were increased when compared with the levels at T0(P<0.05),and the ADL score was decreased at T1 than T2(P<0.05).In the conventional treatment group,the UPDRS-Ⅲand ADL scores at T1 were decreased than those at T0 and T2,and the step speed and stride length were increased at T1 than T0 and T2(P<0.05).No statistical difference was found in step frequency between the two groups at different time points(P>0.05).Conclusion High-frequency rTMS in the M1 area bilaterally combined with aerobic exercise training is superior to aerobic exercise training alone in improving PD motor symptoms and gait parameters(gait speed,and stride length),and its efficacy can last up to 4 weeks after treatment.

关 键 词：帕金森病 经颅磁刺激 运动 运动障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学]