高频重复经颅磁刺激对精神分裂症阴性症状及认知功能疗效的性别差异

Gender differences in negative symptoms and cognition of schizophrenia after high-frequency repetitive transcranial magnetic stimulation

目的观察高频重复经颅磁刺激（rTMS）对精神分裂症患者阴性症状及认知功能疗效的性别差异。方法选取62例精神分裂症患者按照随机数字表法分为真刺激组和伪刺激组，刺激部位为左前额叶背外侧皮质区（DLPFC），刺激参数为高频10Hz，治疗4周，伪刺激组使用无实际刺激作用的专用线圈。应用阳性与阴性症状评估量表（PANSS）评价患者的精神症状，精神分裂症简明认知功能成套测评量表（BACS）评价患者的认知功能。结果经过4周干预，真刺激组治疗后患者的阴性症状改善更明显，且具有性别差异，女性经治疗后阴性症状改善更明显（P〈0．05）。认知量表评估结果显示，真刺激组治疗后在言语流畅性、符号编码、数字序列、代币运动、语言记忆、伦敦塔及字词流畅性中得分较伪刺激组高，且差异有统计学意义（P〈0．05），但无性别差异（P〉0．05）。结论经rTMS治疗能改善患者的阴性症状及认知功能，在改善阴性症状方面具有性别差异，女性效果更好。

Objective To evaluate the gender differences in negative symptoms and cognition of schizophrenia after high-frequency repetitive transcranial magnetic stimulation （rTMS）. Methods A total of 62 patients with chronic schizophrenia were assigned into sham rTMS group and rTMS group by random number table method. Patients in the rTMS group were stimulated with 10 Hz in the left dorsolateral prefrontal cortex （DLPFC） for four weeks, while a special coil without actual stimulation were applied to the patients in the sham rTMS group. Positive and Negative Symptom Scale （PANSS） was used to assess patients＇ psychotic symptoms. Brief Assessment of Cognitive in Schizophrenia （BACS） was applied to evaluate patients＇ cognitive function. Results After 4-week intervention, the negative symptoms of the rTMS was significantly improved after the treatment with gender differences, thus the improvement was more evident in female after treatment （P 〈 0.05）. The result of BACS indicated that the scores of word fluency, symbol coding, digital sequencing, token motor task, verbal memory, tower of London and category fluency in the rTMS group were all higher than those of the sham rTMS group with statistical differences （P 〈 0.05）, but without gender difference （P 〉 0.05）. Conclusions Application of active 10 Hz rTMS to the DLPFC can improve the negative symptoms and cognition in patients with schizophrenia. There is a gender difference in improving negative symptoms, and it shows better effect in female.