rTMS治疗精神分裂症阴性症状的疗效观察

Efficacy of repetitive transcranial magnetic stimulation in the treatment of negative symptoms in patients with schizophrenia

目的探讨高频重复经颅磁刺激(rTMS)治疗精神分裂症阴性症状的临床疗效及其对患者脑源性神经营养因子(BDNF)水平的影响。方法选取衢州市第三医院2021年3月至2023年3月收治的精神分裂症阴性症状患者130例进行随机对照研究,按照随机数字表法分为对照组、研究组各65例。两组均予抗精神分裂症药物治疗,在此基础上,研究组予高频rTMS治疗,对照组予伪rTMS治疗,两组持续治疗8周。评价两组治疗8周后阳性与阴性症状量表(PANSS)、阴性症状评定量表(SANS)和个人与社会表现功能量表(PSP)评分变化,比较两组治疗前后血清BDNF含量变化,观察治疗期间不良反应。结果治疗8周后,研究组PANSS阴性评分、SANS评分分别为(16.45±3.98)分、(35.41±6.29)分,均低于对照组的(20.08±4.16)分、(41.76±7.36)分(t=-7.46、-6.85,均P<0.05),PSP评分为(66.85±8.93)分,高于对照组的(58.79±8.28)分(t=5.62,P=0.001);两组PANSS阳性评分、一般精神病理量表评分及总分差异均无统计学意义(均P>0.05)。治疗8周后,研究组血清BDNF含量为(12.05±2.13)μg/L,高于对照组的(8.86±1.94)μg/L(t=9.73,P<0.001)。治疗期间,两组不良反应发生率差异无统计学意义(P>0.05)。BDNF与PANSS评分、SANS评分均呈负相关(r=-0.81、-0.85,均P<0.001),与PSP评分呈正相关(r=0.82,P<0.001)。结论高频rTMS可有效缓解精神分裂症阴性症状,促进患者BDNF分泌,具有较高的治疗安全性。

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of negative symptoms in patients with schizophrenia and its effect on brain-derived neurotrophic factor(BDNF).Methods A total of 130 patients with negative symptoms of schizophrenia who received treatment at The Third Hospital of Quzhou from March 2021 to March 2023 were included in this randomized controlled study.They were divided into a control group and a study group(n=65 per group).Both groups of patients were treated with antipsychotic drugs.Based on this,patients in the study group were treated with high-frequency rTMS,while those in the control group were treated with pseudo-rTMS.After 8 weeks of treatment,Positive and Negative Syndrome Scale(PANSS),Scale for Assessment of Negative Symptoms(SANS),and Personal and Social Performance Scale(PSP)scores were evaluated in each group before and after treatment.Serum BDNF levels were compared between the two groups before and after treatment.Adverse reactions were observed during the treatment.Results After 8 weeks of treatment,the PANSS negative subscale score and SANS score in the study group were(16.45±3.98)points and(35.41±6.29)points,respectively,which were significantly lower than(20.08±4.16)points and(41.76±7.36)points in the control group(t=-7.46,-6.85,both P<0.05).PSP score in the study group was(66.85±8.93)points,which was significantly higher than(58.79±8.28)points in the control group(t=5.62,P<0.001).There were no significant differences in PANSS positive subscale score,general psychopathology scale score or total score between the two groups(all P>0.05).After 8 weeks of treatment,the serum BDNF level in the study group was(12.05±2.13)μg/L,which was significantly higher than(8.86±1.94)μg/L in the control group(t=9.73,P<0.001).There was no significant difference in the incidence of adverse reactions during the treatment period between the two groups(P>0.05).Serum BDNF level was negatively correlated with PANSS and SANS scores(r=-0.81,-0.85,both P<0.001),while it was positively correlated with PSP score(r=0.82,P<0.001).Conclusion High-frequency rTMS can effectively alleviate the negative symptoms of schizophrenia,increase the secretion of BDNF,and be highly safe.