15Hz重复经颅磁刺激与多奈哌齐联合治疗阿尔茨海默病的效果

The Effect of 15 Hz Repetitive Transcranial Magnetic Stimulation Combined with Donepezil in the Treatment of Alzheimer’s Disease

目的:分析采用15 Hz的重复经颅磁刺激与多奈哌齐联合治疗阿尔茨海默病的效果。方法:选取2019年8月-2021年2月于江西康宁医院老年医学科接受治疗的60例阿尔茨海默病(AD)患者,按照随机数字表法将其分为单一组与联合组,每组30例。单一组给予多奈哌齐口服治疗,联合组则在单一组的基础上加用重复经颅磁刺激(rTMS)治疗。比较两组患者的认知功能、生理自理能力、血清TNF-α、IL-6及不良反应发生情况。结果:治疗6、12、24周,联合组MMSE、MoCA评分均高于治疗前,ADL评分均低于治疗前,差异均有统计学意义(P<0.05)。单一组治疗12、24周的MMSE、MoCA评分均高于治疗前,ADL评分均低于治疗前,差异均有统计学意义(P<0.05)。治疗12、24周,联合组MMSE、MoCA评分均高于单一组,ADL评分均低于单一组,差异均有统计学意义(P<0.05)。治疗前,两组TNF-α、IL-6水平比较,差异均无统计学意义(P>0.05);治疗后7 d,两组TNF-α、IL-6水平均低于治疗前,且联合组均低于单一组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:与单纯使用多奈哌齐相比,联合rTMS(15 Hz)共同治疗AD,可改善AD患者的认知功能及精神状态,提高其生活自理能力,调节血清TNF-α、IL-6水平,减轻神经细胞的炎症反应,安全性高,值得推广。

Objective:To analyze the effect of 15 Hz repetitive transcranial magnetic stimulation combined with Donepezil in the treatment of Alzheimer’s disease.Method:A total of 60 patients with Alzheimer’s disease (AD) who received treatment in the Geriatrics Department of Jiangxi Kangning Hospital from August 2019 to February 2021 were selected,they were divided into single group and combined group according to random number table method,with 30 patients in each group.Patients in the single group received oral Donepezil,while patients in the combined group received repetitive transcranial magnetic stimulation (rTMS) on the basis of the single group.The cognitive function,physiological self-care ability,serum TNF-α,IL-6 and the incidence of adverse reactions were compared between two groups.Result:At 6,12 and 24 weeks of treatment,MMSE and MoCA scores in the combined group were higher than those before treatment,while ADL scores in the combined group were lower than those before treatment,the differences were statistically significant (P<0.05).MMSE and MoCA scores in the single group at 12 and 24 weeks of treatment were higher than those before treatment,ADL scores in the single group were lower than those before treatment,the differences were statistically significant (P<0.05).After 12 and 24 weeks of treatment,MMSE and MoCA scores in the combined group were higher than those in the single group,while ADL scores in the combined group were lower than those in the single group,the differences were statistically significant (P<0.05).Before treatment,there were no significant differences in TNF-α and IL-6 levels between two groups (P>0.05);7 d after treatment,the levels of TNF-α and IL-6 in both groups were lower than those before treatment,and those in the combined group were lower than those in the single group,the differences were statistically significant (P<0.05).There was no significant difference in the incidence of adverse reactions between two groups (P>0.05).Conclusion:Compared with Donepezil alone,combined with rTMS (15 Hz) in the treatment of AD can improve the cognitive function and mental state of AD patients,improve their self-care ability,regulate the levels of serum TNF-α and IL-6,and relieve the inflammatory response of nerve cells,it has high safety and is worthy of promotion.