重复经颅磁刺激对脑卒中后认知障碍及脂代谢的影响

Effects of repetitive transcranial magnetic stimulation on post-stroke cognitive impairment and lipid metabolism

目的:观察低频重复经颅磁刺激(rTMS)对脑卒中后认知障碍(PSCI)及脂代谢的影响。方法:43例PSCI患者随机分为rTMS组21例和假刺激组(Sham组)22例。2组患者均给予常规康复治疗及认知功能训练,rTMS组在此基础上给予健侧背外侧前额叶(DLPFC)1Hz、90%运动阈值的rTMS治疗,Sham组给予假刺激,治疗4周。于治疗前、治疗4周后采用简易精神状态量表(MMSE)和蒙特利尔认知量表(MoCA)对患者认知功能进行评估,并检测患者甲状腺激素和血脂水平。结果:治疗后2组患者MMSE评分、MoCA评分较治疗前均显著提高(P<0.05),且rTMS组患者MMSE评分、MoCA评分均显著高于Sham组(P<0.05)。rTMS组患者治疗后血清三碘甲状腺原氨酸(T3)、促甲状腺激素水平(TSH)较治疗前显著升高(P<0.05),总胆固醇(TCHO)水平较治疗前显著下降(P<0.05)。结论:低频rTMS能改善PSCI患者的认知功能,并且能够升高血清T3、TSH水平,同时降低TCHO水平。

Objective:To observe the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)on post-stroke cognitive impairment(PSCI)and lipid metabolism.Methods:Forty-three PSCI patients were randomly divided into rTMS group(n=21)and Sham rTMS group(n=22).Both groups were given conventional rehabilitation therapy.The rTMS group was given the contralateral dorsolateral prefrontal cortex(DLPFC)1Hz,90%motor threshold rTMS treatment,and the Sham group was given false stimulation for 4 weeks.Before and 4 weeks after treatment,the patient’s cognitive function was assessed with the Mini Mental State Scale(MMSE)and Montreal Cognitive Scale(MoCA),and the patient’s thyroid hormone and blood lipid levels were measured.Results:After treatment,the MMSE score and MoCA score in the two groups were significantly higher than those before treatment(P<0.05),and the MMSE score and MoCA score in the rTMS group were significantly higher than those in the Sham group(P<0.05).After treatment in the rTMS group,serum triiodothyronine(T 3)and thyroid-stimulating hormone(TSH)levels were significantly higher than those before treatment(P<0.05);total cholesterol(TCHO)levels were significantly lower than those before treatment(P<0.05).Conclusion:Low-frequency rTMS can improve the cognitive function of PSCI patients,and can increase serum T3 and TSH levels,while reducing TCHO levels.