不同刺激参数重复经颅磁刺激治疗孤独症谱系障碍的疗效对比研究

Comparative study of repetitive transcranial magnetic stimulation with different stimulation parameters in the treatment of autism spectrum disorders

目的探讨应用不同频率的重复经颅磁刺激(rTMS)干预对孤独症谱系障碍(ASD)儿童临床疗效的影响.方法选取82例符合美国精神障碍诊断与统计手册第5版(DSM-5)诊断标准的汉族ASD儿童,平均年龄(6.83±2.63)岁,随机分为研究组(n=41)和对照组(n=41).研究组采取左侧高频+右侧低频刺激,对照组被试者接受双侧背外侧前额叶(DLPFC)低频刺激,两组刺激周期为每周5次,共刺激8周.分别在rTMS干预前、干预1个疗程、干预2个疗程后进行儿童孤独症评定量表(CARS)、重复行为问卷-第2版(RBQ-2)、长处和困难问卷(家长版)(SDQ)和简式感觉剖析量表(SSP)评定.结果79例儿童完成了全部试验.两组干预前的基线资料差异无统计学意义;重复测量方差分析结果显示:CARS评分方面,组别主效应不显著[F(1,76)=3.651,P=0.063];疗程主效应有统计学意义[F(2,75)=82.154,P<0.01];组别与疗程的交互作用不明显[F(2,75)=0.153,P=0.696].RBQ-2方面:组别主效应[F(1,76)=5.273,P=0.012]、疗程主效应[F(2,75)=64.312,P<0.01]和两者交互作用[F(2,75)=14.314,P=0.004]差异都有统计学意义.SDQ方面:组别主效应[F(1,76)=7.321,P=0.011]、疗程主效应[F(2,75)=75.643,P<0.01]和两者交互作用[F(2,75)=8.752,P=0.005]差异都有统计学意义.SSP方面:组别主效应不显著[F(1,76)=2.778,P=0.071];疗程主效应差异有统计学意义[F(2,75)=122.306,P<0.01];组别与疗程的交互作用差异有统计学意义[F(2,75)=4.752,P=0.046].通过简单效应分析,进一步分析组别与疗程的交互作用发现,RBQ-2在第一疗程(P=0.001)和第二疗程(P=0.014)测量时,研究组评分均高于对照组;SDQ在第一疗程(P=0.021)和第二疗程(P=0.035)测量时,研究组评分均低于对照组;SSP仅在第一疗程结束时研究组高于对照组(P=0.027).结论左侧高频+右侧低频及双侧低频rTMS刺激ASD儿童双侧DLPFC都改善ASD的症状,左侧高频+右侧低频有利于控制患者的情绪障碍,双侧低频有利于控制患者的重复刻板行为和感觉异常.

Objective To explore the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)on the children with Autism Spectrum Disorder(ASD)with varied stimulation parameters.Methods A total of 82 Han nationality Chinese children with ASD(according to DSM-5)who were divided into study group(n=41)and control group(n=41)by random were enrolled,with the average age(6.83±2.63)years.For the study group,the dorsolateral prefrontal cortex(DLPFC)of the participants were stimulated with high frequency on the left side,while with low frequency on the right side.For the control group,the bilateral DLPFC of the participants were stimulated with low frequency.All the participants were intervened for 8 weeks,5 times per week.The childhood autism rating scale(CARS),Repetitive Behavior Questionnaire-2(RBQ-2),Strengths and Difficulties Questionnaire(SDQ)&Short Sensory Profile(SSP)were used to assess the symptoms of ASD before the intervention,after session 1 and 2 respectively.Results A total of 79 participants completed the entire experiment.There was no statistical difference on the baseline data between the two groups.For the Repeated Measure ANOVA,in terms of CARS score,the difference of main effect between groups was not statistically significant[F(1,76)=3.65,P=0.063),the difference of main effect between treatment courses was statistically significant[F(2,75)=82.154,P<0.01];there was no significant interaction between group and course of treatment[F(2,75)=0.153,P=0.696].In terms of RBQ-2,the differences of the main effect between groups[F(1,76)=5.273,P=0.012],treatment courses[F(2,75)=64.312,P<0.01],and the interaction between group and treatment course[F(2,75)=14.314,P=0.004]were all statistically significant.In terms of SDQ,the differences of the main effect between groups[F(1,76)=7.321,P=0.011],treatment courses[F(2,75)=75.643,P<0.01],and the interaction between group and treatment course[F(2,75)=8.752,P=0.005]were all statistically significant.In terms of SSP,the difference of main effect between groups was not significant[F(1,76)=2.778,P=0.071];the difference of main effect between treatment courses was statistically significant[F(2,75)=122.306,P<0.01];the interaction between groups and treatment courses was statistically significant[F(2,75)=4.752,P=0.046].Further analysis of the interaction between groups and treatment by simple effect analysis found that the scores of RBQ-2 in the study group were higher than those in the control group during session 1(P=0.001)and session 2(P=0.014);the scores of SDQ in the study group were lower than those in the control group during session 1(P=0.021)and session 2(P=0.035);the scores of SSP in the study group was higher than those in the control group during session 1(P=0.027).Conclusions Both high-frequency on left and low-frequency on right and bilateral low-frequency rTMS stimulation on DLPFC of children with ASD improve the symptoms.The treatment of high-frequency on left and low-frequency on right is helpful to control the emotion disorders,while bilateral low-frequency rTMS stimulation is helpful to control the repetitive stereotyped behavior and sensory abnormality.