电刺激小脑顶核对缺血性脑白质病病人认知及执行功能的影响

Effect of fastigial nucleus electrical stimulation on cognition and executive function in patients with ischemic leukoencephalopathy

目的探讨电刺激小脑顶核(FNS)对缺血性脑白质病(WMIL)病人认知功能及执行功能的影响。方法选取核工业四一六医院2018年2月至2019年2月66例WMIL病人,随机数字表法分为基础组和研究组,均给予降低颅压、平衡体内水电解质、服用降脂降压、脑蛋白水解物类脑保护剂等常规治疗,研究组另施予FNS 1日1次,持续电刺激治疗。均持续治疗3个月。分别对比两组病人治疗前后简易精神状态量表(MMSE)、蒙特利尔认识评量表(MoCA)、斯特鲁色词测试C部分(SCETC)、画钟测验(CDT)以及执行功能相关脑区白质部分各向异性分数(FA)值测算。结果治疗前两组病人MMSE和MoCA评分、SCWT-C和CDT测验结果以及FA值均差异无统计学意义(P>0.05),治疗后3个月研究组MMSE和MoCA评分均有所增加,SCWT-C正确率提高,耗费时间缩短以及CDT评分增加,脑部各区FA均有不同程度增加,研究组上述指标本组内比较均差异有统计学意义(P<0.05),而基础组上述指标本组内比较均差异无统计学意义(P>0.05),治疗后3个月研究组病人MMSE评分[(17.86±2.79)分]、MoCA评分[(18.52±3.86)分]、SCWT-C测验结果[正确率(66.92±5.29)%]、CDT测验结果[(2.89±0.26)分]以及FA值均高于基础组[MMSE(14.58±3.52)分、MoCA(14.81±4.37)分、SCWT-C正确率(49.42±6.35)%、CDT(1.99±0.41)分],两组间比较均差异有统计学意义(P<0.05)。结论FNS疗法能够提高WMIL病人的认知功能和执行功能,近期疗效确切。

Objective To explore the effect of fastigial nucleus stimulation(FNS)on cognitive and executive functions in patients with white matter ischemic lesions(WMIL).Methods Sixty-six patients with WMIL in Nuclear Industry 416 Hospital from February 2018 to February 2019 were selected and assigned into the basic group and the study group by the random digital table method-All patients were given conventional treatment such as reducing intracranial pressure,balancing water and electrolyte in the body,taking lipid-lowering and antihypertensive drugs,brain protein hydrolysate brain protective agents and so on,and the study group was additional-1 y given FNS once a day for continuous electrical stimulation.The treatment lasted for 3 months.Mini-mental state examination Scale(MMSE),Montreal Cognitive Assessment Scale(MoCA),Stroop Color-Word Test C(SCET-C),Clock Drawing Test(CDT)and Fractional Anisotropy(FA)in executive function-related brain areas were compared before and after treatment.Results There were no significant differences in MMSE and MoCA scores,SCWT-C and CDT test results and FA values between the two groups before treatment(P>0.05).Three months after treatment,the MMSE and MOCA scores of the study group were increased,the SCWT-C accuracy rate was increased,the time-consuming was shortened,the CDT score was increased,and the FA of each brain area was increased in varying degrees,with statistically significant differences(P<0.05).There was no significant difference in the basic group(P>0.05).Three months after treatment,the MMSE scores[(17.86±2.79)points],MOCA scores[(18.52±3.86)points],SCWT-C accuracy rate results[correct rate(66.92±5.29)%],CDT test results[(2.89±0.26)points]and FA values of the study group were higher than those of the basic group[MMSE(14.58±3.52)points,MOCA(14.81±4.37)points,SCWT-C correct rate(49.42±6.35)%,CDT(1.99±0.41)points],with statistically significant differences(P<0.05).Conclusion FNS therapy can improve the cognitive and executive functions of WMIL patients,and the short-term effect is definite.