重复经颅磁刺激对脑卒中患者认知功能障碍的影响

Effect of Repetitive Transcranial Magnetic Stimulation on Patients with Post-Stroke Cognitive Impairment

目的:观察重复经颅磁刺激(rTMS)对脑卒中患者认知功能的改善情况及对血清中神经营养因子和细胞因子水平变化的影响。方法:将脑卒中后认知功能障碍(PSCI)患者100例,采用SAS软件随机分为观察组51例和对照组49例,对照组接受常规治疗,观察组在常规治疗基础上加用rTMS治疗,每天1次,每周5次,共治疗8周。在治疗前后对2组进行认知功能评价,比较2组简易智力状态检查量表(MMSE)与蒙特利尔认知功能量表(MoCA)评分变化情况,并观察听觉词语学习测验(AVLT)、日常生活活动能力(ADL)指数评分。采用ELISA法观察2组治疗后血清中脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)和高敏C反应蛋白(hs-CRP)水平的变化。结果:治疗前2组MoCA中定向力(ORT)、视空间与执行功能(EF)、命名(NAM)、记忆力(MEM)、注意力(ATT)、语言(LANG)和抽象能力(ABS)的分值比较差异无统计学意义(P>0.05);治疗8周后2组ORT、EF、NAM、MEM、ATT、LANG和ABS较治疗前均有所提高,差异均有统计学意义(P<0.05, P<0.01),其中观察组MoCA分值显著优于对照组(P<0.05)。2组治疗前MMSE、AVLT123、AVLT5、AVLT再认、ADL评分差异无统计学意义(P>0.05),具有可比性;治疗后对照组MMSE、AVLT123、AVLT5、AVLT再认、ADL评分分别为(21.34±2.35)分、(9.15±3.36)个、(2.16±0.32)个、(15.24±2.62)个、(68.16±12.35)分,观察组分别为(25.21±3.45)分、(13.23±3.35)个、(2.24±1.62)个、(17.32±6.26)个、(74.43±15.34)分,2组均比治疗前有显著性提高,差异具有统计学意义(P<0.05,P<0.01),且观察组治疗后改善优于对照组,差异具有统计学意义(P<0.05)。2组治疗前血清BDNF、VEGF、IL-6和hs-CRP水平比较,差异无统计学意义(P>0.05);治疗后对照组血清BDNF、VEGF、IL-6和hs-CRP水平分别为(6.19±0.75)ng/mL、(113.25±11.35)pg/mL、(9.12±4.23)mmol/L、(3.74±1.47)mmol/L,观察组分别为(8.25±0.94)ng/mL、(172.36±18.35)pg/mL、(6.78±3.86)mmol/L、(2.25±1.25)mmol/L,2组治疗后血清BDNF、VEGF、IL-6和hs-CRP水平均较治疗前好转(P<0.05,P<0.01),且观察组较对照组改善明显,差异有统计学意义(P<0.05)。结论:rTMS通过提高认知功能障碍和脑内神经营养因子,降低炎症反应,可进一步改善脑卒中后认知功能。

Objective: To observe the improvement of cognitive function and the changes of serum nerve influencing factors and cytokines in patients with stroke treated with repetitive transcranial magnetic stimulation (rTMS). Methods: A total of 100 patients with post-stroke congitive impairment (PSCI) were randomly divided into observation group (n=51) and control group (n=49) by SAS software. The control group received routine treatment. On the basis of routine treatment, the observation group was treated with rTMS once a day, five times a week for eight weeks. Before and after treatment, the cognitive function scores of the two groups were compared, the changes of mini-mental state examination (MMSE) and Montreal cognitive function (MoCA) scores were compared, the activities of daily living (ADL) and auditory verbal learning test (AVLT) were observed. ELISA method was used to observe the changes of brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) in the two groups after treatment. Results: There were no significant differences in the scores of MoCA, including orientation (ORT), visual space and executive function (EF), naming (NAM), memory (MEM), attention (ATT), language (LANG) and abstract ability (ABS) before treatment between the two groups (P>0.05). After eight weeks of treatment, ORT, EF, NAM, MEM, ATT, LANG and ABS in the two groups were significantly higher than those before treatment (P<0.05, P<0.01). The MoCA score of the observation group was significantly better than that of the control group (P<0.05). There were no significant differences in MMSE, AVLT123, AVLT5, AVLT recognition, ADL scores between the two groups before treatment (P>0.05). After treatment, the MMSE, AVLT123, AVLT5, AVLT recognition and ADL scores of the control group were (21.34±2.35),(9.15±3.36),(2.16±0.32),(15.24±2.62),(68.16±12.35), and those of the observation group were (25.21±3.45),(13.23±3.35),(2.24±1.62),(17.32±6.26),(74.43±15.34), the differences between the two groups were significantly higher than those before treatment (P<0.05, P<0.01), and the improvement of the observation group was better than that of the control group after treatment (P<0.05). There were no significant differences in serum BDNF, VEGF, IL-6 and hs-CRP levels before treatment between the two groups (P>0.05). After treatment, the serum levels of BDNF, VEGF, IL-6 and hs-CRP in the control group were (6.19±0.75) ng/mL,(113.25±11.35) pg/mL,(9.12±4.23) mmol/L,(3.74±1.47) mmol/L, and the serum levels of BDNF, VEGF, IL-6 and hs-CRP in the observation group were (8.25±0.94) ng/mL,(172.36±18.35) pg/mL,(6.78±3.86) mmol/L,(2.25±1.25) mmol/L, the serum levels of BDNF, VEGF, IL-6 and hs-CRP in the two groups were better than those before treatment (P<0.05, P<0.01), and the improvement in the observation group was significantly higher than that in the control group (P<0.05). Conclusion: rTMS can furtherly improve PSCI by improving cognitive function.