超低频重复经颅磁刺激对老年缺血性脑卒中病人吞咽功能及血清神经元特异性烯醇酶的影响

Effect of ultralow-frequency rTMS on swallowing function and serum NSE in elderly patients with ischemic stroke

目的探讨超低频重复经颅磁刺激(rTMS)对老年缺血性脑卒中吞咽功能障碍病人吞咽功能及血清神经元特异性烯醇酶(NSE)的影响。方法选取川北医学院附属医院2017年3月至2018年3月收治的老年缺血性脑卒中吞咽障碍病人,将符合入组条件的60例病人按照随机数字表法分为rTMS组(30例)和对照组(30例),两组病人均进行常规药物治疗和吞咽训练,rTMS组病人在此基础上于病侧脑部初级运动皮质区(M1区)进行超低频(10 m Hz)重复经颅磁刺激,每天1次,连续2周共计14次刺激。分别于治疗前、后采用:洼田饮水试验、藤岛一郎吞咽障碍评分评估吞咽功能;行血清神经元特异性烯醇酶(NSE)测定。结果与对照组比较,rTMS组洼田饮水实验等级及NSE含量均明显降低(24.40±6.27)μg/mL,藤岛一郎吞咽障碍评分[M(P25,P75)]显著提高7.5(7,8)(均P<0.05);rTMS组治疗前、后NSE值与吞咽功能评分均呈负相关。结论超低频重复经颅磁刺激可以明显改善老年缺血性脑卒中吞咽障碍病人的吞咽功能,并降低血清NSE水平,其中降低NSE水平可能是其作用机制之一。

Objective To investigate the effect of ultralow-frequency repetitive transcranial magnetic stimulation(rTMS)on swallowing function and serum NSE in elderly patients with dysphagia after ischemic stroke.Methods The elderly patients with dysphagia after ischemic stroke admitted in Affiliated Hospital of North Sichuan Medical College from March 2017 to March 2018,60 patients who met the enrollment conditions were divided into the rTMS group(30 cases)and control group(30 cases).Both groups received routine drug treatment and swallowing training.On this basis,patients in the rTMS group received utralow-frequency(10 mHz)rTMS treatment,which were carried out on the primary motor cortex of the injured side once a day for two weeks.Serum levels of NSE and swallowing function which was evaluated by Watian drinking water test and Fujima Ichiro dysphagia score were measured before and after treatment.Results After rTMS treatment,the results of Watian drinking water test and serum levels of NSE were lower in rTMS group(24.40±6.27)compared with control group(P<0.05).Whereas,fujima Ichiro dysphagia score in r TMS group 7.5(7,8)was higher than that of control group(P<0.05).Furthermore,serum level of NSE was negatively correlated with swallowing function score before and after rTMS treatment.Conclusion Ultralow-frequency repetitive transcranial magnetic stimulation significantly improves swallowing function in elderly patients with dysphagia after ischemic stroke,the underline mechanism may be related with decreasing serum levels of NSE.