θ短阵快速脉冲模式重复经颅磁刺激对精神分裂症患者执行功能疗效的研究

Effects of repetitive transcranial magnetic stimulation with theta burst stimulation paradigm on the execu-tive function of schizophrenia patients

目的：探讨θ短阵快速脉冲模式（Theta Burst Stimulation，TBS）的重复经颅磁刺激（ Repetitive Transcranial Magnetic Stimulate，rTMS）对精神分裂症患者执行功能的影响。方法将60例符合美国《精神障碍诊断与统计手册》第四版（ DSM-4）及国际疾病分类第10版（ICD-10）诊断标准的精神分裂症患者采用计算机随机分为TBS组（n＝30）、伪刺激组（n＝30），均实施4周干预20次。在干预前、后均予以威斯康星卡片测验（Wisconsin Card Sorting Test，WCST）及Go／NoGo范式的事件相关电位（Event-related potential，ERPs ）对所有受试者的执行功能予以评定，对各项结果进行组间及干预前后比较。结果与干预前相比， TBS组经过4周干预后WSCT的选择错误率[（59．8±14．7）％]、持续性错误数（55．3±18．0）及持续性错误的百分数[（71．3±12．6）％]降低，概念化水平百分数[（53．3±17．0）％]升高（均P＜0．05），No-Go任务下的各电极位点P3波幅升高（P＜0．01或＜0．05）；而伪刺激组干预前后的WSCT各项目评分及No-Go任务下的各电极位点P3波幅均无变化（均P＞0．05）；干预后两组间各评估指标比较，差异有统计学意义（P＞0．05）。结论 TBS模式的rTMS能够改善精神分裂症患者的执行功能。

Objective To evaluate the effect of theta burst stimulation（ TBS） paradigm of repetitive tran-scranial magnetic stimulation （ rTMS ） on the treatment of schizophrenia through assessing executive function. Methods 60 patients met with DSM-4 and ICD-10 for schizophrenia disorders criteria were enrolled in this study. The group was divided into theta burst stimulation group（research group, n=30） and sham intervention group （ control group, n=30） . The research group and control group were assessed with the Wisconsin card sorting test （WCST） and the go/no-go task by event-related potential（ERPs） before and after 4 weeks treatment. Each test results of all groups before and after treatment were compared with each other respectively. Results Regarding the WCST test,compared with the baseline,the post-rTMS state of the TBS group showed a decrease in the error selec-tion percentage（（59.8±14.7）%）,the preservative error number（55.3±18.0） and the preservative error percentage （71.3±12.6）%,but the percentage of conceptual level（71.3±12.6）% increased in the TBS group（P〈0.05）. Re-garding the go/no-go task by ERPs,compared with the baseline,the post-rTMS statet of the TBS group showed an increase in the no-go P3 amplitude（P〈0.05 or 0.01） . After intervention,the score of WCST test and the no-go P3 amplitude were significant differences in TBS group compared with same rTMS group（P〉0.05）.Conclusions The-ta burst stimulation paradigm of rTMS can improve the executive function in schizophrenic patients.