重复经颅磁刺激对精神分裂症难治性阴性症状及脑源性神经营养因子的影响

Effects of repetitive transcranial magnetic stimulation on schizophrenia with refractory negative symptoms and brain-derived neurotrophic factor

目的探讨不同部位重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)对精神分裂症难治性阴性症状及血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)的作用特点。方法纳入伴有难治性阴性症状的精神分裂症患者80例,随机分为研究组和对照组,每组各40例,均在维持原药物治疗种类和剂量基础上接受4周10 Hz r TMS治疗,研究组刺激部位为左侧前额叶背外侧皮质(dorsolateral prefrontal cortex,DLPFC),对照组为右侧DLPFC。治疗前、治疗4周末分别进行阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评估和BDNF水平测定。结果治疗前后比较,研究组[(71.2±13.8)vs.(63.3±11.4)]、对照组[(70.3±13.4)vs.(63.7±12.2)]的PANSS总分均降低(P<0.05),研究组阴性症状分降低[(22.8±6.6)vs.(18.4±5.9)],且研究组阴性症状分变化值比对照组更大[(4.4±1.9)vs.(2.9±1.2)],差异具有统计学意义(P<0.01)。与治疗前比较,治疗后研究组[(6.78±2.16)vs.(8.74±2.76)]和对照组[(6.83±2.32)vs.(8.66±2.70)]BDNF水平均升高(P<0.01),但两组变化值无统计学差异(P>0.05)。结论联合抗精神病药物,10Hz r TMS作用于精神分裂症患者左侧DLPFC可以改善难治性阴性症状,作用于左侧或右侧DLPFC均能增加血清BDNF水平。

Objective To compare with the effect of high-frequency repetitive transcranial magnetic stimulation （rTMS） between the left and the right prefrontal on refractory negative symptoms and serum brain-derived neurotrophic factor （BDNF）. Methods 80 hospitalized schizophrenics with refractory negative symptoms were divided into study group （n=40） and control group （n=40） randomly. Both groups were received 4-week treatment of 10 Hz rTMS. The stimulus lo？cation of the study group was the left prefrontal, and the control group was the right prefrontal. The type and dose of anti？psychotics remained unchanged during the treatment. The evaluation of positive and negative symptom scale （PANSS） and the measurement of BDNF concentration before treatment and after 4 weeks treatment was analyzed. Results Com？pared with before treatment, the total score of PANSS after treatment significantly decreased （P〈0.05） both in the study group [（71.2±13.8） vs. （63.3±11.4）] and the control group [（70.3±13.4） vs. （63.7±12.2）]. The score of negative symptoms in the study group decreased [（22.8±6.6） vs. （18.4±5.9）, P〈0.01]. The BDNF concentration increased in the study group ]（6.78±2.16） vs. （8.74±2.76）] and the control group [（6.83±2.32） vs. （8.66±2.70）]. Conclusion 10Hz rTMS on the left prefrontal combined with drugs are helpful to improve the refractory negative symptom of the patients with schizophrenia. Stimulation on both left and right prefrontal lobe could increase serum BDNF concentration.