低频重复经颅磁刺激对慢性精神分裂症患者血清催乳素水平的影响

A study about influence of slow repetitive transcranial magnetic stimulation on the level of serum prolactin in chronic schizophrenics

目的探讨低频重复经颅磁刺激(rTMS)治疗抗精神病药所致高催乳素血症的疗效及安全性。方法将61例利培酮所致高催乳素血症的住院军人慢性精神分裂症患者随机分为两组,在原有利培酮剂量稳定不变的基础上,分别予以10 d的1Hz低频rTMS刺激(31例)及假rTMS刺激(30例)。于刺激前、后对两组分别进行血清催乳素(PRL)测定及阳性和阴性症状量表(PANSS)、17项汉密尔顿抑郁量表(HAMD-17)评定,同时观察高催乳素血症临床症状的变化情况,并于1个月后对研究组的血清PRL水平进行复测。结果 (1)研究组rTMS刺激后PRL水平[(27.9±7.1)μg/L]较治疗前[(101.5±41.2)μg/L]下降,差异有统计学意义(P<0.01);对照组治疗后PRL水平[(111.4±44.5)μg/L]与治疗前[(106.6±41.9)μg/L]比较,差异无统计学意义(P>0.05);研究组疗效明显优于对照组(F=22.3,P<0.01);研究组治疗1个月后复测PRL[(96.7±38.3)μg/L],已恢复至治疗前水平(P>0.05)。(2)研究组男性乳房女性化消失(8/14),自发泌乳消失(11/17),月经恢复(4/7),对照组则均无改善。(3)与治疗前比较,治疗后研究组及对照组PANSS及HAMD-17评分变化均无统计学意义(均P>0.05)。两组不良反应均较轻,除头痛研究组多于对照组外,其余不良反应发生率两组相近。结论短期低频rTMS治疗可使慢性精神分裂症患者服用抗精神病药所致高催乳素血症的症状减轻,且安全性较好,但需进一步的rTMS维持治疗以巩固疗效。

Objective To explore the efficacy and tolerability of slow repetitive Transcranial Magnetic Stimulation （rTMS） in the treatment of hyperprolactinemia caused by antipsychotic. Methods A total of 61 chronic schizophrenic patients with hyperprolactinemia caused by risperidone were randomized into study group （31 cases） treated with active rTMS plus former dosage of risperidone and control group （31 cases） treated with sham rTMS plus former dosage of risperidone. The rTMS therapy lasted for 10 days with the frequency of 1Hz. Lvel of serum prolactin （PRL）, Positive and Negative Symptom Scale （PANSS） and 17 -item Hamilton Depression Rating Scale （HAMD- 17） were evaluated at the baseline and the end of the rTMS therapy. Changes of the clinical feasures of hyperprolactinemia in two groups were recorded. Level of PRL in study group was re - measured 1 month later after the rTMS therapy. Results （ 1 ） In study group, level of serum PRL after the rTMS therapy [ （27.9 ±7.1 ）μg/L] decreased significantly compared with the baseline [ （101.5 ±41.2）μg/L] （P 〈 0.01 ）. While there was no significant difference in control group before and after the sham rTMS therapy[ （ 106.6 ± 41.9）μg/L] vs. [ （ 111.4 ± 44.5 ） μg/L] （ P 〉 0.05 ）. The efficacy of study group was significantly superior to control group （ F = 22.3, P 〈 0.01 ）. However, level of PRL in study group rebounded to baseline level when re - measured at 1 month later （ P 〉 0.05 ）. （ 2 ） Improvements of feminine - like breast in males （8/14）, spontaneous lactation （11/17 ） and amenia （4/7） were observed in study group other than that in control group. （3） There were no significant differences in scores of PANSS and HAMD -17 in study group （P 〉 0.05 ） between the baseline and the endpoint, nor were in control group （ P 〉 0.05 ）. Side effects in the two groups were mild. The incidence of side effects was about the same between the two groups, except that the incidence rate of headache in study group was significantly higher than that in control group. reduce the hyperprolactinemia caused by antipsychotics with high safety, but rTMS maintenance therapy. Conclusion efficacy Short need to term low rTMS can be maintained with