重复经颅磁刺激联合脑循环治疗仪对痉挛型脑瘫患儿全身运动功能、脑血流动力学的影响

Effects of repetitive transcranial magnetic stimulation combined with cerebral circulation therapy instrument on the whole body motor function and cerebral hemodynamics in children with spastic cerebral palsy

目的:评价重复经颅磁刺激联合脑循环治疗仪对痉挛型脑瘫患儿全身运动功能、表面肌电图以及脑血流动力学的影响。方法:选择2020年7月~2022年4月在我院脑瘫患儿131例,随机分为对照组(43例)、rTMS组(44例)和联合组(44例)3组。对照组采用常规治疗,并采用假rTMS刺激;rTMS组在对照组基础上采用真实rTMS刺激;联合组在rTMS组基础上加用脑循环治疗仪。观察干预前和干预12周后2组的粗大运动功能评定量表(GMFM)、精细运动功能评定量表(FMFM)、粗大运动发育商(GMQ)、精细运动发育商(FMQ)、脑动脉平均血流速度(Vm)、血管阻力指数(RI)、内收肌和腓肠肌的表面肌电图均方根值(RMS)、实验室指标[高迁移率族蛋白B1(HMGB1)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)]以及干预后的临床疗效。结果:干预12周后除对照组FMFM一项数据以外,3组GMFM、GMQ、FMFM、FMQ均高于干预前(P<0.05),干预后rTMS组4项评分均高于对照组(P<0.05),联合组在GMFM、GMQ、FMQ均高于其余2组(P<0.05),而联合组在FMFM仅高于对照组(P<0.05),与rTMS组比较差异无统计学意义;3组Vm均高于干预前(P<0.05),3组RI、内收肌RMS、腓肠肌RMS均低于干预前(P<0.05),干预后rTMS组在Vm高于对照组,在RI、内收肌RMS、腓肠肌RMS均低于对照组(P<0.05),联合组Vm高于其余2组(P<0.05),内收肌RMS、腓肠肌RMS均低于其余2组(P<0.05),而在RI,联合组仅低于对照组(P<0.05),与rTMS组比较差异无统计学意义;3组HMGB1均低于干预前(P<0.05),3组BDNF、NGF均高于干预前(P<0.05),干预后rTMS组在BDNF、NGF均高于对照组(P<0.05),HMGB1与对照组比较差异无统计学意义,联合组在BDNF、NGF高于其余2组(P<0.05),在HMGB1低于其余2组(P<0.05);临床疗效比较,联合组优于其余2组(P<0.05),rTMS组优于对照组(P<0.05)。结论:脑循环治疗仪联合rTMS对痉挛型脑瘫患儿,可以缓解痉挛以及运动功能障碍,降低肌张力,提高颅内血流速度,改善各实验室指标,值得进一步推广和应用。

Objective:To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)combined with cerebral circulation therapy instrument on systemic motor function,surface electromyography(SEMG)and cerebral hemodynamics in children with spastic cerebral palsy.Methods:Children with cerebral palsy in our hospital from July 2020 to April 2022 were randomly divided into control group,rTMS group and combined group.The control group was treated with routine therapy and sham rTMS stimulation.The rTMS group was stimulated with real rTMS on the basis of the control group.The combined group was treated with cerebral circulation therapeutic instrument on the basis of rTMS group.The gross motor function measure(GMFM),fine motor function measure scale(FMFM),gross motor quotient(GMQ),fine motor quotient(FMQ),blood flow velocity(Vm),vascular resistance index(RI),root mean square(RMS)of surface electromyography of adductor and gastrocnemius,laboratory index[high mobility group protein 1(HMGB1),brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)]and clinical efficacy were observed before and 12 weeks after intervention.Results:After 12 weeks of intervention,except for one item of FMFM in the control group,GMFM,GMQ,FMFM and FMQ in the three gro-ups were higher than those before the intervention(P<0.05).After the intervention,the scores in 4 items in the rTMS group were significantly higher than those in the control group(P<0.05).In the combined group,GMFM,GMQ and FMQ were significantly higher than those in the rest two groups(P<0.05).However,FMFM in the combined group was only higher than that in the control group,and there was no significant difference between the combined group and the rTMS group(P>0.05).In three groups,Vm was significantly higher,and RI,adductor RMS and gastrocnemius RMS were significantly lower after the intervention than those before intervention(P<0.05).After intervention,Vm was significantly higher,and RI,adductor RMS and gastrocnemius RMS were significantly lower in the rTMS group than those in the control group(P<0.05).Vm was significantly higher,and adductor RMS and gastrocnemius RMS were significantly lower in the combined group than those in the rest two groups(P<0.05).RI in combined group was significantly lower than that in the control group,and there was no significant difference from rTMS group.HMGB1 was significantly lower,and BDNF and NGF were significantly higher in three groups after intervention than those before intervention(P<0.05).BDNF and NGF in the rTMS group were significantly higher than those in the control group after intervention(P<0.05).There was no significant difference in HMGB1 between the control group and the rest two groups.BDNF and NGF were significantly higher and HMGB1 was significantly lower in the combined group than those in the rest two groups(P<0.05).The clinical efficacy of the combined group was more satisfactory than that of the rest two groups(P<0.05).Conclusion:The cerebral circulation therapeutic apparatus combined with rTMS can relieve spasticity and motor dysfunction,reduce muscle tension,increase intracranial blood flow velocity,and improve laboratory indicators in children with spastic cerebral palsy,which is worthy of further promotion and application.