重复经颅磁刺激技术应用于精神分裂症患者烟草依赖的疗效分析

目的探讨重复经颅磁刺激(rTMS)技术对降低住院精神分裂症患者烟草依赖程度的有效性与安全性.方法采用随机、双盲对照研究,前瞻性连续纳入2018年10月至2019年5月武汉大学人民医院精神科封闭病区住院的男性精神分裂症合并吸烟患者82例,所有患者符合精神分裂症与烟草依赖诊断标准.按随机数字表将所有患者随机分为治疗组(41例)与对照组(41例),治疗组给予高频rTMS(10 Hz,110%运动阈值),刺激左侧前额叶背外侧皮质,5次/周,治疗4周,共观察8周;对照组接受rTMS伪刺激治疗.比较两组患者治疗前后的日均吸烟数、尼古丁依赖检验量表(FTND)、吸烟渴求量表(TCQ)及阳性与阴性症状量表(PANSS)评分,评价两组患者的疗效及精神状况;比较两组患者不良反应发生率,评价其安全性.结果治疗组41例患者脱落3例,对照组41例脱落5例.脱落原因:4例为提前出院,2例为不依从,2例为精神症状复发不适宜继续试验.最终入组患者治疗组38例,对照组36例.两组患者治疗前后日均吸烟量、FTND、TCQ自评量表评分差异均有统计学意义(交互效应F值分别为61.398、43.117、77.144,均P<0.01),治疗组治疗第2、4和8周日均吸烟量、FTND、TCQ自评量表评分均显著低于对照组[日均吸烟量治疗第2、4和8周:(20.37±4.82)、(16.71±4.05)、(17.21±4.07)支比(27.72±7.21)、(27.17±7.11)、(26.06±5.86)支;FTND评分治疗第2、4和8周:(5.53±1.13)、(4.21±1.02)、(4.34±0.84)分比(7.11±1.47)、(7.06±1.43)、(7.06±1.53)分;TCQ评分治疗第2、4和8周:(62.74±4.20)、(55.26±4.92)、(54.97±5.03)分比(68.14±6.57)、(66.94±6.01)、(66.31±5.87)分],差异均有统计学意义(均P<0.01).两组治疗4周后PANSS总分、分量表评分及前后评分差值差异均无统计学意义(均P>0.05).治疗组发生不良反应7例(18.4%),其中头痛4例,失眠2例,坐立不安1例;对照组4例(11.1%),其中恶心2例,失眠1例,坐立不安1例,两组不良反应总发生率比较,差异无统计学意义(χ^2=0.781,P>0.05).不良反应均未经过处理,患者自行缓解.结论高频rTMS治疗可以降低精神分裂症患者日吸烟量和对烟草渴求程度,且安全性较好.

Effect of repetitive transcranial magnetic stimulation on tobacco dependence in schizophrenics

Objective To explore the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)in reducing tobacco dependence in schizophrenic inpatients.Methods A total of 82 male schizophrenic patients with smoking in the closed psychiatric ward of Wuhan University People's Hospital from October 2018 to May 2019 were enrolled in the randomized,double-blind control study.All patients met the diagnostic criteria for schizophrenia and tobacco dependence.The patients were randomly divided into treatment group(41 cases)and control group(41 cases)by random number table.The treatment group was given high frequency rTMS stimulation(10 Hz,110%motor threshold),left prefrontal dorsolateral cortex stimulation,5 times per week,for 4 weeks of treatment and 8 weeks of observation,while the control group received rTMS pseudo stimulation treatment.The average number of daily smoking before and after treatment,Fagerstrom Test for Nicotine Dependence(FTND),Tobacco Craving Questionnaire(TCQ)and positive and negative symptoms scale(PANSS)were compared between the two groups to evaluate the efficacy and mental status of the two groups.The incidence of adverse reactions was compared between the two groups to evaluate the safety.Results Among 41 cases,3 cases fell off in the treatment group and 5 cases in the control group.The reasons of falling off were 4 cases discharged in advance,2 cases disobedience and 2 cases with relapse of mental symptoms who were not suitable to continue the trial.Finally,there were 38 cases in the treatment group and 36 cases in the control group.There were statistically significant differences between the two groups in the number of daily smoking,the scores of FTND and TCQ self-assessment scale before and after treatment(F value of interaction effect was 61.398,43.117 and 77.144,respectively,P<0.01).The number of daily smoking,the scores of FTND and TCQ self-assessment scale after treatment of the treatment group were significantly lower than those of the control group at the 2nd treatment week,the 4th treatment week and the 8th week[the number of daily smoking at the 2nd treatment week,the 4th treatment week and the 8th week of the treatment group and the control group:(20.37±4.82),(16.71±4.05)(17.21±4.07)vs.(27.72±7.21),(27.17±7.11),(26.06±5.86);the score of FTND:(5.53±1.13),(4.21±1.02),(4.34±0.84)vs.(7.11±1.47),(7.06±1.43),(7.06±1.53);the score of TCQ:(62.74±4.20),(55.26±4.92),(54.97±5.03)vs.(68.14±6.57),(66.94±6.01),(66.31±5.87)],with statistical significance(P<0.01).There was no significant difference in PANSS score(including total score,positive scale score,negative scale score and general scale score)between the two groups after 4 weeks of treatment(P>0.05).There were 7 cases(18.4%)of adverse reactions in the treatment group,including 4 cases of headache,2 cases of insomnia and 1 case of restlessness.There were 4 cases(11.1%)of adverse reactions in the control group,including 2 cases of nausea,1 case of insomnia and 1 case of restlessness.There was no significant difference in the total incidence of adverse reactions between the two groups(χ^2=0.781,P>0.05).All the adverse reactions were not treated and self-relieved.Conclusions High frequency rTMS treatment can reduce the amount of daily smoking and the level of tobacco craving in schizophrenic patients,with good safety.