重复经颅磁刺激对军人慢性精神分裂症患者阴性症状及认知功能的疗效分析

目的研究高频重复经颅磁刺激（rTMS）对军人慢性精神分裂症患者阴性症状及认知功能的疗效。方法将42例以阴性症状为主的住院军人慢性精神分裂症患者随机分为研究组（21例）和对照组（21例）。研究组在原有抗精神病药物种类及剂量不变的同时给予经左侧背外侧前额叶的4周共20次高频（15Hz）rTMS刺激,对照组采用假rTMS刺激。治疗前后对两组分别进行阳性和阴性症状量表（PANSS）、17项汉密尔顿抑郁量表（HAMD17）、治疗中出现的不良反应量表（TESS）评定及事件相关电位P300测定。结果研究组治疗后PANSS量表阴性症状因子分由（35.1±4.5）降至（25.5±4.1）,治疗后较治疗前显著下降（t=2.92,P〈0.05）,而对照组治疗前后则无变化（P〉0.05）,研究组疗效明显优于对照组（F=21.6,P〈0.05）;其它因子分及HAMD17治疗前、后均无变化。与治疗前比较,治疗后在CZ点,研究组P300的P2、P3波幅升高（P均〈0.05）;而对照组P300各项指标治疗前后变化均无统计学意义（P均〉0.05）。结论高频rTMS能有效治疗慢性精神分裂症患者的阴性症状,并改善认知功能。

The effect of repetitive transcranial magnetic stimulation on the negative symptoms and cognitive function in the soldiers with chronic schizophrenia

Objective To explore the effects of high repetitive transcranial magnetic stimulation（rTMS）in the treatment of negative symptoms and cognitive function in soldiers with chronic schizophrenia. Method Forty-two chronic schizophrenia patients mainly with negative symptoms were randomly assigned to active high rTMS group（21 cases）and sham rTMS group（21 cases）.All patients received antipsychotic drugs and were maintained on these drugs without change in dose throughout the study period.The Positive and Negative Syndrome Scale（PANSS）,17-item Hamilton Depression Rating Scale（HAMD 17 ）,Treatment Emergent Symtom Scale（TESS）and P 300 were examined before and after 20 daily high rTMS（60 2-sec trains of 15Hz stimulation with 28-sec intervals;delivered at 90% motor threshold with the figure-of-eight coil positioned over the left dorsolateral prefrontal cortex）. Results The negative symptom factor points of PANSS in rTMS group before and after treatment were separately for（35.1±4.5） and （25.5±4.1）,while no change in the control group（ P 〉0.05） and the efficacy of the rTMS group was significantly superior to the control group（ F =21.6,P 〈0.05）.The other factor points and HAMD 17 scores were no significantly defferent before and after treatment.The amplitude of waves P 2,P 3 was heightened after rTMS（ P 〈0.05）,while there was no significant different from controls（ P 〉0.05）. Conclusion The results indicated that the high rTMS can be an effective treatment of chronic schizophrenic patients with negative symptoms and improve cognitive function.