小脑蚓部θ短阵快速脉冲刺激模式的重复经颅磁刺激对老年慢性精神分裂症患者阴性症状、认知功能及血清炎症因子水平的影响：随机对照试验
he Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms，Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia：Randomized Controlled Trial
背景 小脑蚓部与情感调节、认知功能密切相关。小脑蚓部的重复经颅磁刺激（rTMS）能否改善老年慢性精神分裂症（CSZ）患者的临床症状，既往少有报道。目的 观察小脑蚓部 θ 短阵快速脉冲刺激（TBS）模式的 rTMS 对老年 CSZ 患者阴性症状、认知功能和血清炎症因子水平的影响。方法 本研究为单盲随机对照试验。选取2022 年 10 月—2023 年 8 月沈阳市精神卫生中心收治的 50 例稳定期老年 CSZ 患者为对象。采用随机数字表法将 CSZ 患者分为观察组和对照组，各 25 例。观察组采用 TBS 模式的 rTMS 治疗，刺激部位为小脑蚓部，每周治疗 5 d，1 次 /d，连续治疗 4 周。对照组进行伪刺激，治疗时间和参数同观察组。采用阳性与阴性症状量表（PANSS）评估总体精神病性症状，阴性症状量表（SANS）评估阴性症状，用 MATRICS 公认认知成套测验（MCCB）评估认知功能。检测血清白介素 1β（IL-1β）、白介素 6（IL-6）、肿瘤坏死因子 α（TNF-α）水平。结果 与对照组比较，观察组治疗后PANSS 量表阴性症状评分［（17.11±2.00）分与（19.21±2.76）分］、一般精神病理症状评分［（19.21±2.76）分与（29.33±4.27）分］和总分［（29.33±4.27）分与（58.99±5.53）分］及 SANS 评分［（54.00±3.78 与 57.83±4.15）分］均较低（P<0.05）。与对照组比较，观察组治疗后信息处理加工速度评分（39.78±2.45 与 37.24±1.10）、注意警觉性评分［（47.07±4.27）分与（40.01±2.17）分］、工作记忆评分［（45.12±3.20）分与（41.89±4.11）分］和社会认知评分［（46.40±4.29）分与（41.42±7.45）分］均较高（P<0.05）。与对照组比较，观察组治疗后 IL-1β水平［（41.09±7.34）μg/L与（47.03±12.45）μg/L］、IL-6水平［（35.03±10.23）μg/L与（41.28±7.32）μg/L］、TNF-α水平［（53.28±14.15）μg/L 与（61.35±12.79）μg/L］较低（P<0.05）。rTMS 治疗过程中，观察组仅 4 例在首次治疗时出现头晕、头痛症状，随着治疗时间延长均逐渐耐受。其余患者均无不适主诉。结论 小脑蚓部 TBS 模式的 rTMS 可以改善老年 CSZ 患者的阴性症状、认知功能和血清炎症因子水平。
Background The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulationrTMSof the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophreniaCSZ. Objective Observing the effects of cerebellar vermis rTMS with theta burst stimulationTBSparadigm on negative symptomscognitive functionand serum inflammatory cytokine levels in elderly CSZ patients. Methods This study is a single blind randomized controlled trial. Fifty elderly CSZ patients in stable condition admitted to Shenyang Mental Health Center were selected between October 2022 and August 2023 as the subjects. Using a random number table methodCSZ patients were divided into an observation group and a control groupwith 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigmthe stimulation site is the vermis of the cerebellum. The treatment was conducted 5 days a weekonce a dayfor 4 consecutive weeks. The patients in control group were intervention with pseudo stimulationand the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom ScalePANSSto evaluate overall psychiatric symptomsand use the Negative Symptom ScaleSANSto evaluate negative symptoms. Evaluate cognitive function using the MATRICS Recognized Cognitive Set Test MCCB. Detecting serum interleukin-1IL-1Interleukin-6IL-6and tumor necrosis factor TNF-.Results Compared with the control groupthe observation group had lower PANSS negative symptom scores 17.112.00scores vs 19.212.76scoresgeneral psychopathological symptom scores 17.112.00scores vs 19.212.76scorestotal scores after treatment 29.334.27scores vs 58.995.53scoresand lower SANS scale scores 54.003.78scores vs 57.834.15scoresP<0.05. Compared with the control groupthe observation group had higher post-treatment information processing speed scores 39.782.45scores vs 37.241.10scoresattention alertness scores47.074.27scores vs40.012.17scoresworking memory scores45.123.20scores vs41.894.11scoresand social cognitive scores 46.404.29scores vs 41.427.45scoresP<0.05. Compared with the control groupthe observation group had lower levels of IL-1 41.097.34g/L vs 47.0312.45g/LIL-635.0310.23g/L vs 41.287.32g/Land TNF- 53.2814.15g/L vs 61.3512.79g/ L after treatmentP<0.05. During the rTMS treatment processonly 4 cases in the observation group experienced dizziness and headache symptoms during the first treatmentwhich gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort. Conclusion The rTMS with TBS paradigm can improve negative symptomscognitive functionand serum inflammatory factor levels in elderly patients with CSZ.
王奇、徐天朝、耿忠丽、赵红岩、董晓梅
10.12114/j.issn.1007-9572.2024.0161
神经病学、精神病学
慢性精神分裂症重复经颅磁刺激炎症因子阴性症状认知功能随机对照试验
王奇,徐天朝,耿忠丽,赵红岩,董晓梅.小脑蚓部θ短阵快速脉冲刺激模式的重复经颅磁刺激对老年慢性精神分裂症患者阴性症状、认知功能及血清炎症因子水平的影响：随机对照试验[EB/OL].(2024-08-01)[2025-08-02].https://chinaxiv.org/abs/202408.00014.点此复制
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