重复经颅磁刺激对非痴呆型血管性认知功能障碍患者的治疗效果

Clinical Effect of Repetitive Transcranial Magnetic Stimulation （rTMS） on Cognitive Function in Patients with Non Dementia Vascular Cognitive Impairment

【目的】探讨重复经颅磁刺激（rTMS）对非痴呆型血管性认知功能障碍患者的治疗效果。【方法】选取2012年1月至2015年1月于本院就诊的90例非痴呆型血管性认知功能障碍患者作为研究对象，按照随机数表法（2：1），将其中的60例患者作为观察组，观察组患者采取rTMS的治疗方法，按照磁刺激量的大小将观察组患者随机分为0．5Hz rTMS组、5Hz rTMS组各30例；另外30例患者作为对照组不给予rTMS治疗。采用简易智能精神状态量表（MMSE）、蒙特利尔认知评估量表（MoCA）、汉密顿抑郁量表（HAMD）评定患者认知功能评分，比较治疗前后患者认知功能的变化。【结果10．5、5Hz rTMS组治疗后MMSE、MoCA、HAMD量表评分显著高于治疗前，差异具有统计学意义（P〈0．05）；对照组治疗后MMSE、MoCA、HAMD量表评分与治疗前比较，差异不具有统计学意义（P〉0．05）。三组患者的潜伏期以及波幅差异具有统计学意义（P〈0.05）；观察组治疗前Hanchinski缺血指数量表评分显著低于治疗后，差异具有统计学意义（P〈0．05）；经过治疗后三组患者的ET-1和VEGF的含量显著的增加，并且随着磁刺激的加大内皮素-1（ET-1）和血管内皮生长因子（VEGF）的含量也逐渐的增加（P〈0．05）。【结论】rTMS可以显著地改善非痴呆型血管性认知功能障碍患者的诱导电位P300和神经心理学状况。

[Objective]To investigate the effect of repetitive transcranial magnetic stimulation （rTMS） on cognitive function in patients with non dementia vascular cognitive impairment. [Methods] Ninety patients with non dementia vascular cognitive impairment in our hospital from January 2012 to January 2015 were se- lected as the research objects. According to the random number table method （2：1）, 60 cases of the patients were treated as the observation group. Patients of the observation group were treated with rTMS . The obser- vation group was further randomly divided into 0.5 rTMS Hz group and 5 rTMS Hz group in terms of the magnitude of the magnetic stimulation, 30 cases in each. The other 30 patients as the control group did not receive any rTMS treatment. The mini mental state examination （MMSE）, the Montreal Cognitive Assessment Scale （MoCA） and the Hamilton Depression Rating Scale （HAMD） were used to compare the changes before and after treatment. [Results]After treatment, MoCA, MMSE and HAMD scores of 0.5, 5 Hz rTMS groups were significantly higher than those before treatment, the difference was statistically significant （ P 〈0.05）; After treatment, MMSE, MoCA and HAMD scale scores in the control group were not statistically significant （ P〉0.05）. The latency and amplitude differences of the three groups were statistically significant （ P〈 0.05）; Hanchinski ischemia index score in the observation group was significantly lower than that before treatment, the difference was statistically significant （ P 〈0.05）; After treatment, the content of ET-1 and VEGF in the three groups was significantly increased. With the increase of magnetic stimulation, the content of endo- thelin -1 （ET-1） and vascular endothelial growth factor （VEGF） increased gradually （ P〈0.05）.[Conclusion] rTMS can significantly improve the induced potential P300 and neuropsychological status in patients with non dementia vascular cognitive impairment.