重复经颅磁刺激治疗精神分裂症阴性症状的随机双盲研究

目的探讨重复经颅磁刺激（rTMS）治疗精神分裂症阴性症状的疗效。方法 30例精神分裂症患者被随机分为rTMS真刺激组（治疗组,15例）和rTMS伪刺激组（对照组,15例）,采用θ短阵快速脉冲刺激（TBS）模式刺激左侧前额叶背外侧皮质（DLPFC）,每周5次,共干预20次。于基线、治疗2周及治疗4周时应用阳性与阴性症状量表（PANSS）的阴性因子分和阴性症状量表（SANS）进行疗效评定。结果共有27例患者完成研究,对照组有3例脱落。经rTMS干预4周后,治疗组与对照组的PANSS阴性因子分减分值分别为（4.67±2.47）分和（2.33±1.87）分,两组比较有统计学差异（z=-2.41,P=0.016）;SANS总分减分值分别为（11.87±8.04）分和（5.92±6.47）分,两组比较有统计学差异（z=2.08,P=0.038）。根据PANSS阴性因子分评定,治疗组的有效率达到46.7%,对照组的有效率为16.7%;根据SANS总分评定治疗组的有效率达到46.7%,而对照组的有效率为8.3%;阴性症状的组间疗效差异有统计学意义（P〈0.05）。除了轻微的一过性头痛和入睡困难,未见有其他严重不良反应。结论 TBS模式可改善精神分裂症患者的阴性症状。

Double-blind randomized controlled trial of repetitive transcranial magnetic stimulation in the treatment of the negative symptoms of schizophrenia

Objective：Assess the efficacy of repetitive transcranial magnetic stimulation（rTMS）in the treatment of the negative symptoms of schizophrenia.Methods：Thirty patients with schizophrenia were randomly assigned to a real rTMS treatment group（n=15）or a sham rTMS treatment group（n=15）.Each patient in the real rTMS group received 20 rTMS sessions over 4 weeks that delivered theta burst stimulation（TBS）to the left dorsolateral prefrontal cortex.Efficacy was evaluated blindly using the Positive And Negative Syndrome Scale（PANSS）and the Scale for the Assessment of Negative Symptoms（SANS）at baseline,at 2 weeks and at 4 weeks.Results：The mean（sd）drop in the score of the negative symptom subscale of the PANSS was significantly greater in the 15 subjects in the real rTMS group who completed the 4-week study than in the 12 subjects in the sham rTMS group who completed the study 4.67（2.47）versus 2.33（1.87）,z=-2.41,P=0.016].Reductions in the mean SANS total score in the real and sham groups were 11.87（8.04）and 5.92（6.47）,respectively（z=2.08,P=0.038）.The proportions of subjects who met efficacy criteria at the end of treatment was significantly higher among subjects in the real rTMS group than those in the sham rTMS group,both when using the score of the negative symptoms subscale of PANSS（46.7% versus 16.7%）and when using the total SANS score（46.7% versus 8.3%）.Some subjects reported mild transient headaches and other reported difficulty falling asleep,but no severe adverse events were reported.Conclusion：The TBS protocol for rTMS delivered to the left dorsolateral prefrontal cortex can reduce the severity of negative symptoms in schizophrenia.