重复经颅磁刺激对酒依赖患者记忆功能及海马代谢的影响

The effect of repetitive trascranial magnetic stimulation on memory function and hippocampus metabolism in patients with alcohol dependence

目的探讨重复经颅磁刺激（rTMS）对酒依赖患者戒断期记忆功能的影响及与海马代谢物水平变化的关系。方法将38例男性戒断期酒依赖患者按随机数字表分为rTMS组和伪rTMS组，rTMs组给予1Hz刺激4周，刺激部位为右侧背外侧前额叶皮质（DLPFC）；伪rTMS组给予无效刺激。治疗前后分别评估言语记忆、视觉记忆，并采用氢质子磁共振波谱（1H—MRs）检测双侧海马部位代谢物N-乙酰基天f1冬氨酸（NAA）、胆碱化合物（Cho）和肌酸复合物（Cr）。结果（1）rTMS组治疗后言语记忆和视觉记忆评分较治疗前提高（P〈0．05），而伪rTMS组治疗后记忆评分较治疗前差异无统计学意义（P〉0．05）。治疗后，rTMS组仅视觉记忆评分优于伪rTMS组，差异有统计学意义（P〈0．01），而言语记忆未见明显改善（P〉0．05）。（2）rTMS组治疗后双侧海马NAA／Cr、Cho／Cr较治疗前升高（P〈0．01），而伪rTMS组治疗前后双侧海马NAA／Cr、Cho／Cr的差异无统计学意义（P〉0．05）。治疗后，rTMS组双侧海马NAA／Cr、Cho／Cr高于伪rTMS组，差异有统计学意义（P〈0．01）。（3）左侧海马NAA／Cr、右侧海马Cho／Cr治疗后与治疗前的差值分别与言语记忆、视觉记忆评分呈正相关（P〈0．01）。结论rTMS可以改善戒断期酒依赖患者的记忆功能，其可能机制与升高海马NAA／Cr和Cho／Cr有关。

Objective To explore the effect of repetitive trascranial magnetic stimulation on the memory function and the changes of hippocampus metabolism in detoxified alcohol dependent patients. Methods Totals of 38 detoxified alcohol dependent patients were randomly divided into two groups： rT- MS group with 1Hz, over right dorsolateral prefrontal cortex （DLPFC） for 4 weeks, and sham rTMS group with no effective simulation. All subjects were assessed by Hopkins Verbal Learning Test--Revised and Brief Visuospatial Memory Test--Revised to evaluate their verbal and visual memory function, and proton magnetic resonance spectroscopy（1 H- MRS） to test the level of N--acetyl aspartic acid （NAA）, choline compounds （Cho）, creatine compounds （Cr） of bilateral hippocampus. Results （1）The verbal memory and visual memory scores of rTMS group were significantly increased after treatment （P 0.05）, while there was no significant difference on memory scores in sham rTMS group before and after treatment （P 〈0.05）. After treatment, only visual memory score in rTMS group was significantly high- er than that of the sham rTMS group （P 〈 0.01）, and there was no significant difference on verbal mem- ory （P 〉 0. 05）. （2）Compared with pre--treatment, NAA/Cr and Cho/Cr of bilateral hippocampus in rTMS group was significantly increased after treatment （P 〈 0.01）, while there was no significant difference in sham rTMS group （P〈 0.05）. After treatment, NAA/Cr and Cho/Cr of bilateral hippocampus was significantly higher in rTMS group than that of the sham rTMS group （P 〈 0.01）. （3）The difference in NAA/Cr of left hippocampus and Cho/Cr of right hippocampus between before and after treatment were positively correlated with verbal and visual memory respectively （P 〈 0.01）. Conclusions rTMS can improve the memory function in detoxified alcohol dependent patients, which may be related to the increased level of NAA/Cr and Cho/Cr of hippocampus.