重复经颅磁刺激对慢性精神分裂症患者认知功能及血清 C 反应蛋白的影响

目的 探索重复经颅磁刺激(rTMS)治疗对住院慢性精神分裂症患者认知功能的改善作用以及对患者血清C反应蛋白(CRP)水平的影响,初步探索rTMS影响患者认知功能的潜在机制.方法 选取2013年1月~2016年1月在天津市精神卫生中心住院治疗的精神分裂症患者60例,按照病情、性别、年龄等因素进行配对,随机分配每对患者接受rTMS真刺激治疗(治疗组)和伪刺激治疗(对照组)4周,应用阳性与阴性症状量表(PANSS)和可重复的成套神经心理状态测量(RBANS)在治疗前后评估患者的精神症状及认知功能.所有患者治疗前后均检测血清CRP水平.结果 (1)治疗后,治疗组患者的血清CRP水平明显下降,差异有统计学意义(P<0.05),而对照组无变化;(2)治疗组治疗后PANSS总分及阴性症状因子分较治疗前均有下降,差异有统计学意义(P<0.05),而对照组无变化;(3)治疗后,治疗组RBANS总分、视觉广度分、注意分、延时记忆分较前均有升高,差异有统计学意义(P<0.05),对照组RBANS总分及各因子分较治疗前差异均无统计学意义;(4)治疗组患者治疗前后PANSS总分差值与即刻记忆分差值、阴性量表分差值与RBANS总分差值及延时记忆分差值均呈负相关(P<0.05);(5)治疗组患者的血清CRP变化值与RBANS总分差值、即刻记忆、注意和延时记忆各因子差值均呈负相关(P<0.05).结论 rTMS可以有效改善慢性精神分裂症患者的认知功能,其机制可能与rTMS治疗缓解炎性反应有关.

Effects of repetitive transcranial magnetic stimulation on cognitive function and serum C reactive pro-tein of patients with chronic schizophrenia

Objective To explore the effects of repetitive transcranial magnetic stimulation (rTMS) on the improvement of cognitive function and serum C-reactive protein (CRP) of inpatients with chronic schizophrenia, in order to probe the possible mechanism of rTMS on the cognitive function.Methods To-tals of 60 participants were selected from the inpatients of Tianjin Mental Health Center from January, 2013 to January, 2016. They were paired by the severity of the disease, gender and age. Either patient was treated by real rTMS or sham rTMS for 4 weeks by random in each pair. Positive and Negative Symptom Scale (PANSS) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were assessed twice (before and after treatment) in all participants. Serum CRP was determined simultaneously.Results (1) Level of CRP was declined significantly in treatment group (P<0.05), but not in control group; (2) Compared to the baseline, the total score and Negative factor score of PANSS in treatment group were statistically decreased (P<0.05), while there was no change in control group; (3) The total score and the scores of visual span, attention and prolonged memory in RBANS were significantly improved in treatment group (P<0.05), no changes were found in control group; (4)In treatment group, there was the negative correlation between"Δtotal score of PANSS" and"Δimme-diate memory","Δnegative factor score of PANSS" and"Δtotal score of RBANS","Δnegative factor score of PANSS" and"Δprolonged memory" respectively(P<0.05); (5)There was negative correlation between"Δtotal score of RBANS","Δscore of immediate memory","Δscore of attention" and"Δscore of prolonged memo-ry" and"ΔCRP"(P<0.05) separately.Conclusions rTMS could improve cognitive function of patients with chronic schizophrenia, and the possible mechanism may be the remission of inflammatory reaction.