重复经颅磁刺激治疗对COPD认知功能障碍患者认知功能及低频振荡振幅的影响  

Effects of repetitive transcranial magnetic stimulation on cognitive function and amplitude of low frequency fluctuations in patients with cognitive dysfunction caused by COPD

作　　者：蒋育悦 黄旭晴[1] 陈玥铃 吴雨伦 王燕 王曦 王小川[2] JIANG Yuyue;HUANG Xuqing;CHEN Yueling;WU Yulun;WANG Yan;WANG Xi;WANG Xiaochuan(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;不详)

机构地区：[1]杭州师范大学附属医院呼吸与危重症医学科,310015 [2]杭州师范大学附属医院神经内科,310015 [3]杭州师范大学临床医学院

出　　处：《浙江医学》2024年第22期2373-2379,I0003,共8页Zhejiang Medical Journal

基　　金：杭州市农业与社会发展项目(20201203B182);杭州市卫生科技计划项目(A20220303)。

摘　　要：目的探讨重复经颅磁刺激(rTMS)治疗对慢性阻塞性肺疾病(COPD)患者认知功能及低频振荡振幅(ALFF)的影响。方法前瞻性选取2020年10月至2024年6月在杭州师范大学附属医院就诊的80例稳定期COPD患者为研究对象,采用随机数字表法分为rTMS组及对照组,每组各40例。对照组予常规治疗,rTMS组在常规治疗基础上辅以rTMS治疗。采用蒙特利尔认知评估量表(MoCA)和简易智力状态检查量表(MMSE)评估患者治疗前、治疗4周后的认知功能,ELISA法检测患者血清神经元特异性稀醇化酶(NSE)、中枢神经特异性蛋白(S-100β)、生长分化因子11(GDF-11)水平。比较两组患者治疗前后MoCA评分、MMSE评分和血清NSE、S-100β、GDF-11水平。采用Pearson相关分析治疗前所有患者MMSE评分、MoCA评分与血清NSE、S-100β、GDF-11水平的相关性。采集rTMS组患者治疗前后静息态功能磁共振成像数据,预处理后得到ALFF及分数低频振荡振幅(fALFF)图像,比较rTMS组患者治疗前后ALFF和fALFF值。结果治疗后,rTMS组患者MoCA总分、MoCA评分子评估项(视空间与执行功能、命名、延迟记忆、定向力)均高于对照组,且rTMS组MoCA总分、MoCA评分子评估项(视空间与执行功能、命名、注意力、延迟记忆、定向力)、MMSE评分均高于治疗前,差异均有统计学意义(均P<0.05)。治疗后,rTMS组患者血清NSE、S-100β水平均低于对照组和治疗前,GDF-11水平均高于对照组和治疗前,差异均有统计学意义(均P<0.05)。治疗前,所有患者MoCA总分、MMSE评分与血清NSE、S-100β水平均呈负相关,与血清GDF-11水平呈正相关(均P<0.05)。治疗后,rTMS组右梭状回、左额中回、左额上回、右额上回ALFF值均高于治疗前,左旁中央小叶、左楔前叶fALFF值均高于治疗前,差异均有统计学意义(均P<0.05)。结论rTMS治疗显著改善COPD患者的认知功能障碍,其机制可能与rTMS对特定脑区自发神经元活动的调控有关。Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)on cognitive function and amplitude of low frequency fluctuations(ALFF)in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 80 patients with stable COPD who visited the Affiliated Hospital of Hangzhou Normal University from October 2020 to June 2024 were prospectively selected as the research objects.They were divided into the rTMS group and the control group by the random number table method,with 40 cases in each group.The control group was given conventional treatment,and the rTMS group was supplemented with rTMS treatment on the basis of conventional treatment.The Montreal Cognitive Assessment(MoCA)and the Mini-Mental State Examination(MMSE)were used to evaluate the cognitive function of patients before and 4 weeks after treatment.The expression levels of serum neuron-specific enolase(NSE),S-100 calcium-binding protein beta(S-100β),and growth differentiation factor 11(GDF-11)in patients were detected by ELISA.The MoCA scores,MMSE scores,and the expression levels of serum NSE,S-100β,and GDF-11 in the two groups before and after treatment were compared.Pearson correlation analysis was used to analyze the correlations between the MMSE scores,MoCA scores and the serum NSE,S-100β,GDF-11 of all patients before treatment.The resting-state functional magnetic resonance imaging data of patients in the rTMS group were collected,and the ALFF and fractional amplitude of low frequency fluctuations(fALFF)images were obtained after preprocessing.The ALFF and fALFF values of patients in the rTMS group before and after treatment were compared.Results After treatment,the MoCA scores and the sub-items of MoCA score assessment(visuospatial and executive function,naming,delayed memory,orientation)in the rTMS group were higher than those in the control group,and the MoCA scores,the sub-items of MoCA score assessment(visuospatial and executive function,naming,attention,delayed memory,orientation),and the MMSE score

关 键 词：慢性阻塞性肺疾病 认知功能 经颅磁刺激 静息态功能磁共振成像 

分 类 号：R563.9[医药卫生—呼吸系统] R749.1[医药卫生—内科学]