不同重复经颅磁刺激模式对精神分裂症认知功能和精神症状的影响

目的：评价不同重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）模式对精神分裂症患者认知功能及精神症状的影响。方法：收集80例精神分裂症患者，并随机分配至4个rTMS干预组。4种rTMS干预模式分别是伪刺激、θ短阵快速脉冲刺激 (theta burst stimulation, TBS)、10 Hz及20 Hz刺激，刺激部位均选择左侧前额叶背外侧皮质区（dorsolateral prefrontal cortex，DLPFC），刺激强度为80%运动阈值，每天的刺激总脉冲数均为1 200，连续刺激5 d。干预期间，原抗精神病药治疗方案不变。采用视空间工作记忆测试和词汇流畅性测试评估患者的认知功能，阳性症状与阴性症状量表（positive and negative symptom scale, PANSS）评估患者的精神症状。结果：20 Hz刺激可以改善患者的视空间工作记忆（t=-2.469，P=0.024），TBS刺激可以改善患者的词汇流畅性测试（t=-4.538，P=0.000），TBS刺激和10 Hz刺激均可以改善患者的阴性症状（TBS: t=5.373, P=0.000; 10 Hz: t=2.272, P=0.036），10 Hz刺激和20 Hz刺激则可以改善患者的一般精神病理症状（10 Hz：t=2.725, P=0.014；20 Hz：t=3.632, P=0.002）。结论：rTMS对精神分裂症患者认知功能和精神症状的影响随刺激参数的改变而不同，提示rTMS为精神分裂症患者的个体化治疗提供了新途径。

Effects of repetitive transcranial magnetic stimulation with different paradigms on the cognitive function and psychotic symptoms of schizophrenia patients

Objective:To evaluate the effect of different paradigms of repetitive transcranial magnetic stimulation(rTMS) on the treatment of schizophrenia through assessing cognitive function and psychotic symptoms.Methods: Eighty patients diagnosed with schizophrenia were randomly assigned to four groups,which were sham intervention group,theta burst stimulation(TBS) group,10 Hz group and 20 Hz group.All the subjects were exposed to 5 daily treatments at 80% of motor threshold over the left dorsolateral prefrontal cortex with a total stimuli of 1 200 per day,while being maintained on their former antipsychotic treatment.Visual spatial working memory test and verbal fluency test were applied to evaluate the cognitive function,while Positive and Negative Symptom Scale(PANSS) was used to assess the psychotic symptoms.Results: 20 Hz of rTMS could improve the visual spatial working memory of schizophrenia patients(t=-2.469,P=0.024).Only patients in TBS group showed significant improvement of verbal fluency test after rTMS treatment(t=-4.538,P=0.000).The negative symptoms were alleviated significantly both in TBS and 10 Hz groups(TBS: t=5.373,P=0.000;10 Hz: t=2.272,P=0.036).General psychopathology symptoms were improved significantly both in 10 Hz and 20 Hz groups(10 Hz:t=2.725,P=0.014;20 Hz:t=3.632,P=0.002).Conclusion: The effects of rTMS on the cognitive function and psychotic symptoms of schizophrenia vary according to the changes in stimulus parameters,suggesting that rTMS could provide a new way for the individual therapy of schizophrenia.