重复经颅磁刺激联合多奈哌齐对阿尔茨海默病患者的临床疗效观察

Clinical efficacy of repetitive transcranial magnetic stimulation combined with donepezil in Alzheimer’s disease

目的探讨重复经颅磁刺激联合多奈哌齐对阿尔茨海默病患者症状评分、炎症因子及CysC、Hcy的影响。方法轻中度阿尔茨海默病患者77例按照入院先后顺序分为对照组(39例)和观察组(38例),均用多奈哌齐治疗,观察组另加用重复经颅磁刺激(rTMS)治疗。观察2组患者临床疗效,比较2组治疗前后临床症状相关评分、炎症因子(TNF-ɑ、IL-6、CRP)、胱抑素C(CysC)及同型半胱氨酸(Hcy)的变化情况。结果治疗后,对照组临床总有效率(66.67%)低于观察组(84.62%),差异有统计学意义(χ^2=4.374,P=0.036)。治疗前,2组患者MoCA、MMSE、BEHAVE-AD症状评分及炎症因子、CysC、Hcy差异均无统计学意义(P>0.05);治疗后,2组临床症状相关评分、炎症因子及CysC、Hcy水平均改善,且观察组优于对照组,差异均有统计学意义(P<0.05)。结论rTMS联合多奈哌齐可有效提升阿尔茨海默病患者的临床疗效,降低其炎症反应,改善机体CysC、Hcy水平。

Objective To investigate the effects of the repetitive transcranial magnetic stimulation(rTMS)combining with donepezil on symptom scores,inflammatory factors,Cystatin C(CysC)and homocysteine(HCY)in patients with Alzheimer’s disease.Methods According to the order of admission,seventy-seven patients with mild to moderate Alzheimer’s disease were divided into the control group(n=39)and the observation group(n=38),all of them were treated with donepezil.rTMS was given additionally in the observation group.The clinical efficacy,changes in clinical symptom-related scores,inflammatory factors(TNF-ɑ,IL-6,CRP),CysC and HCY were compared between the two groups before and after the treatment.Results After the treatment,the total clinical effective rate was lower(66.67%)in the control group than in the observation group(84.62%),and the difference was statistically significant(2=4.374,P=0.036).Before treatment,there was no significant difference in the symptom scores of MoCA,MMSE,BEHAVE-AD,inflammatory factors,CysC and HCY between the two groups,but after treatment,an improvement in the clinical symptom-related scores,inflammatory factors and levels of CysC and HCY was found in both groups.Meanwhile,the observation group showed a better improvement in the observation group comparing with the control group,and the difference was statistically significant(P<0.05).Conclusions rTMS combining with donepezil can effectively improve clinical efficacy,reduce inflammatory response as well as improve the levels of CysC and HCY in patients with Alzheimer’s disease.