不同频率重复经颅磁刺激对精神分裂症患者性激素水平及认知功能的影响

Effects of transcranial magnetic stimulation with different frequencies on sex hormone level and cognitive function in patients with schizophrenia

目的探讨不同频率重复经颅磁刺激对精神分裂症患者血清泌乳素(PRL)水平及认知功能的影响,为临床精神分裂症的治疗提供依据。方法选取2017年11月—2019年9月在温州医科大学附属康宁医院就诊的精神分裂症患者200例作为实验组,并根据随机数字表法分为A组和B组,每组100例。A组给予低频重复经颅磁刺激,B组给予高频重复经颅磁刺激。选取同期健康体检者100例作为对照组。采用放射免疫法测定PRL水平;采用阳性和阴性症状量表(PANSS)评估精神症状;采用重复性成套神经心理状态量表(RBANS)评估认知功能。结果与对照组比较,实验组血清PRL水平和PANSS阳性症状分、阴性症状分及总分较高(P<0.05);而RBANS评分较低(P<0.05)。精神分裂症患者血清PRL水平与RBANS评分呈正相关(r=0.514,P=0.000);而与PANSS阳性症状分、阴性症状分及总分呈负相关(r=-0.462、-0.501和-0.487,均P=0.000)。与A组比较,B组治疗前后血清PRL、PANSS及PANSS阴性症状分的差值较高;而PANSS阳性症状分的差值较低(P<0.05)。结论高频重复经颅磁刺激治疗精神分裂症降低血清PRL水平,改善RBANS评分和PANSS阴性症状分的效果优于低频重复经颅磁刺激;但改善PANSS阳性症状分的效果不如低频重复经颅磁刺激。

Objective To investigate the effects of repeated transcranial magnetic stimulation on serum prolactin(PRL)level and cognitive function in patients with schizophrenia in order to provide evidence for the treatment of clinical schizophrenia.Methods Totally 200 cases of schizophrenia in Kangning Hospital,Wenzhou Medical University were selected as schizophrenia group(test group),and were divided into A group and B group accorded to random number method,100 cases in each group.Patients in A group were given low frequency repetitive transcranial magnetic stimulation.Patients in B group were given high frequency repetitive transcranial magnetic stimulation.At the same time,100 healthy subjects were selected as control group.The PRL level was determined by radioimmunoassay.Psychiatric symptoms were assessed using the Positive and Negative Symptoms Scale(PANSS).Cognitive functions were assessed using a repetitive set of neuropsychological status tests(RBANS).Results Compared with control group,serum PRL levels in test group were increased(P<0.05),RBANS scores were decreased(P<0.05),PANSS positive symptoms scores,negative symptom scores and total scores were increased(P<0.05).Serum PRL levels in patients with schizophrenia were positively correlated with RBANS scores(r=0.514,P=0.000),and negatively correlated with PANSS positive symptoms,negative symptom scores and total scores(r=-0.462,-0.501 and 0.487,all P=0.000).Compared with group A,the difference of serum PRL level,the difference of PANSS score and the difference of PANSS negative symptoms before and after treatment in group B were increased(P<0.05),and the difference of PANSS positive symptoms in group B was decreased(P<0.05).Conclusions Compared with low-frequency repetitive transcranial magnetic stimulation,the effect of high-frequency repetitive transcranial magnetic stimulation for schizophrenia reduces serum PRL levels,improves RBANS scores and PANSS-negative symptom scores more significantly,but the improvements of PANSS-positive symptom scores were not as effective as low-frequency repeats.