重复经颅磁刺激对首发精神分裂症患者认知功能和社会功能的影响

申变红; 汪程鹏; 张开元; 高可润; 张智雯; 朱春燕; 方玲; 汤剑平

doi:10.16766/j.cnki.issn.1674-4152.003384

重复经颅磁刺激对首发精神分裂症患者认知功能和社会功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003384

浙江大学医学院附属精神卫生中心杭州市第七人民医院精神科，浙江杭州 310013

基金项目:

浙江省医药卫生科技计划项目 2019RC073

详细信息

通讯作者:
申变红，E-mail：bhsh0513005@126.com

中图分类号: R749.05 R454.1
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出版历程
- 收稿日期: 2023-04-23
- 网络出版日期: 2024-03-27

Effects of repeated transcranial magnetic stimulation on cognitive and social function in patients with first-episode schizophrenia

Department of Psychiatry, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的探讨重复经颅磁刺激(rTMS)对首发精神分裂症患者认知和社会功能的改善效果，为临床治疗提供依据。方法选取杭州市第七人民医院2019年2月—2022年2月收治的精神分裂症患者96例，采用随机数字表法分为观察组(采用rTMS真刺激)和对照组(行伪刺激)，各48例，比较2组治疗前后认知功能[重复性成套神经心理状态量表(RBANS)]、社会功能[住院精神病患者社会功能评定量表(SSPI)]评分及不良反应发生情况。结果治疗1个月后，观察组RBANS量表中即刻记忆、延时记忆、言语功能、视觉空间结构、注意力及RBANS总分分别为(45.69±2.31)分、(46.79±3.15)分、(33.87±2.25)分、(35.81±2.91)分、(53.75±3.82)分、(237.75±9.79)分，对照组分别为(38.62±1.29)分、(42.65±3.78)分、(27.75±2.91)分、(28.62±2.79)分、(48.85±3.95)分、(203.96±9.89)分；观察组SSPI量表中日常生活能力、社会性活动技能、动性和交往情况、SSPI总分分别为(7.84±0.63)分、(11.76±1.73)分、(12.72±1.52)分、(32.95±1.87)分，对照组分别为(6.58±0.31)分、(9.82±1.79)分、(10.58±1.42)分、(28.89±1.98)分，观察组RBANS和SSPI量表评分均明显高于对照组(P＜0.05)。观察组不良反应总发生率(31.25%，15/48)与对照组(27.08%, 13/48)比较差异无统计学意义(χ²=0.202，P=0.653)。结论 rTMS能有效改善首发精神分裂症患者的认知和社会功能，具有较高的安全性。
- 精神分裂症 /
- 重复经颅磁刺激 /
- 认知功能 /
- 社会功能
Abstract: Objective To explore the effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive and social function in patients with first-episode schizophrenia, and to provide evidence for clinical treatment. Methods A total of 96 patients with schizophrenia admitted to Hangzhou Seventh People's Hospital from February 2019 to February 2022 they were used the random number table method to randomly divide 48 cases into the observation group (with rTMS true stimulation) and the control group (with pseudo-stimulation), and the scores of cognitive functions [repeatable battery for the assessment of neuropsychological status (RBANS)] and social function [scale of social function in psychosis inpatients (SSPI)] and adverse reactions before and after treatment were compared between the two groups. Results After one month of treatment, immediate memory, delayed memory, speech function, visuospatial structure, attention and total scores of RBANS in observation group were (45.69±2.31), (46.79±3.15), (33.87±2.25), (35.81±2.91), (53.75±3.82), and (237.75±9.7) points, respectively, and in the control group were (38.62±1.29), (42.65±3.78), (27.75±2.91), (28.62±2.79), (48.85±3.95), (203.96±9.89) points, respectively. The SSPI scale scores of daily living skills, social and sexual activity skills, mobility and interaction, and total SSPI scores in the observation group were (7.84±0.63), (11.76±1.73), (12.72±1.52), and (32.95±1.87) points, respectively, and in the control group were (6.58±0.31), (9.82±1.79), (10.58 ± 1.42), (28.89 ± 1.98) points, respectively. The scores of RBANS and SSPI in the observation group were significantly higher than those in the control group (P < 0.05). There was no significant difference in adverse reactions between the observation group (31.25%, 15/48) and the control group (27.08%, 13/48), χ²=0.202, P=0.653. Conclusion rTMS can effectively improve cognitive and social function in patients with first-episode schizophrenia, and has high safety.
- Schizophrenia /
- Repeated transcranial magnetic stimulation /
- Cognitive function /
- Social function

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表 1 2组首发精神分裂症患者治疗前后RBANS评分比较(x±s，分)

Table 1. Comparison of RBANS scores before and after treatment in two groups of first-episode schizophrenia patients (x±s, points)

组别	例数	即刻记忆		延时记忆		言语功能
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	48	26.28±1.69	45.69±2.31^a	29.71±2.12	46.79±3.15^a	23.98±2.76	33.87±2.25^a
对照组	48	25.96±1.66	38.62±1.29^a	29.85±2.19	42.65±3.78^a	23.82±2.25	27.75±2.91^a
t值		0.936	18.513	-0.318	5.829	0.311	11.527
P值		0.352	＜0.001	0.751	＜0.001	0.756	＜0.001

组别	例数	视觉空间结构		注意力		RBANS总分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	48	25.71±2.81	35.81±2.91^a	28.97±2.82	53.75±3.82^a	133.85±5.92	237.75±9.79^a
对照组	48	25.73±2.72	28.62±2.79^a	29.27±2.86	48.85±3.95^a	132.76±5.87	203.96±9.89^a
t值		-0.035	12.356	-0.517	6.178	0.906	16.823
P值		0.972	＜0.001	0.606	＜0.001	0.367	＜0.001
注：与同组治疗前比较，^a P＜0.05。

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表 2 2组首发精神分裂症患者治疗前后SSPI评分比较(x±s，分)

Table 2. Comparison of SSPI scores before and after treatment in two groups of first-episode schizophrenia patients (x±s, points)

组别	例数	日常生活能力		社会性活动技能		动性和交往情况		SSPI总分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	48	5.15±0.35	7.84±0.63^a	7.92±0.16	11.76±1.73^a	8.75±0.92	12.72±1.52^a	21.67±1.92	32.95±1.87^a
对照组	48	5.12±0.83	6.58±0.31^a	7.89±0.26	9.82±1.79^a	8.62±0.97	10.58±1.42^a	21.82±1.87	28.89±1.98^a
t值		0.231	12.433	0.681	5.399	0.674	7.128	-0.388	10.328
P值		0.818	＜0.001	0.498	＜0.001	0.502	＜0.001	0.699	＜0.001
注：与同组治疗前比较，^a P＜0.05。

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表 3 2组首发精神分裂症患者治疗后不良反应比较[例(%)]

Table 3. Comparison of adverse reactions after treatment in two groups of first-episode schizophrenia [cases (%)]

组别	例数	口干	恶心	失眠	便秘	合计
观察组	48	2(4.17)	4(8.33)	5(10.42)	4(8.33)	15(31.25)
对照组	48	4(8.33)	2(4.17)	3(6.25)	4(8.33)	13(27.08)
注：2组不良反应总发生率比较，χ²=0.202，P=0.653。

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参考文献(17)

[1]	吕伟, 李美花. 不同频率重复经颅磁刺激对精神分裂症患者性激素水平及认知功能的影响[J]. 中国现代医学杂志, 2020, 30(12): 83-87. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY202012015.htm LYU W, LI M H. Effects of transcranial magnetic stimulation with different frequencies on sex hormone level and cognitive function in patients with schizophrenia[J]. China Journal of Modern Medicine, 2020, 30(12): 83-87. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY202012015.htm
[2]	SILVA M A, RESTREPO D. Functional recovery in schizophrenia[J]. Rev Colomb Psiquiatr (Engl Ed), 2019, 48(4): 252-260.
[3]	邵小惠. 重复经颅磁刺激在精神分裂症患者认知功能障碍康复中的作用[J]. 黑龙江医药, 2020, 33(4): 928-930. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY202004089.htm SHAO X H. The role of repetitive transcranial magnetic stimulation in the rehabilitation of cognitive dysfunction in patients with schizophrenia[J]. Heilongjiang Medicine Journal, 2020, 33(4): 928-930. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY202004089.htm
[4]	YANG L L, ZHAO D, KONG L L, et al. High-frequency repetitive transcranial magnetic stimulation(rTMS) improves neurocognitive function in bipolar disorder[J]. J Affect Disord, 2019, 246: 851-856. doi: 10.1016/j.jad.2018.12.102
[5]	中华医学会精神科分会. 中国精神疾病分类方案与诊断标准[M]. 3版. 济南: 山东科学技术出版社, 2001: 75-78. Chinese Medical Association Psychiatric Branch. Classification scheme and diagnostic criteria of mental diseases in China[M]. 3rd edition. Jinan: Shandong Science and Technology Press, 2001: 75-78.
[6]	余金鸣, 胡新伟, 牛亚辉. 高频重复经颅磁刺激对慢性精神分裂症患者吸烟及认知功能的影响[J]. 中国现代药物应用, 2022, 16(7): 6-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202207002.htm YU J M, HU X W, NIU Y J. Effect of high-frequency repetitive transcranial magnetic stimulation on smoking and cognitive function in patients with chronic schizophrenia[J]. Chinese Journal of Modern Drug Application, 2022, 16(7): 6-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202207002.htm
[7]	王鑫, 李盛延, 赵顺程, 等. 经颅直流电刺激对精神分裂症患者认知功能、社会功能及神经营养因子的影响[J]. 临床与病理杂志, 2022, 42(6): 1403-1409. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202206020.htm WANG X, LI S Y, ZHAO S C, et al. Effects of transcranial direct current stimulation on cognitive function, social function and neurotrophic factors in patients with schizophrenia[J]. Journal of Clinical and Pathological Research, 2022, 42(6): 1403-1409. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202206020.htm
[8]	沈志华, 周相宜, 韩雨, 等. 精神分裂症浓缩版社会认知交互训练干预程序的设计及应用评价[J]. 中华全科医学, 2023, 21(4): 641-645. doi: 10.16766/j.cnki.issn.1674-4152.002950 SHEN Z H, ZHOU X Y, HAN Y, et al. Design and application evaluation of condensed version of social cognition interaction training intervention program in schizophrenia[J]. Chinese Journal of General Practice, 2023, 21(4): 641-645. doi: 10.16766/j.cnki.issn.1674-4152.002950
[9]	郝蕊, 刘寰忠, 夏磊, 等. 儿童青少年首发精神分裂症认知障碍特征[J]. 安徽医科大学学报, 2018, 53(7): 1118-1121. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE201807027.htm HAO R, LIU H Z, XIA L, et al. Cognitive impairment in adolescents with first-episode schizophrenia[J]. Acta Universitatis Medicinalis Anhui, 2018, 53(7): 1118-1121. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE201807027.htm
[10]	杨丹, 关涛. 重复经颅磁刺激联合帕利哌酮对精神分裂症患者认知功能的影响[J]. 国际精神病学杂志, 2021, 48(1): 33-35, 41. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202101011.htm YANG D, GUAN T. Effect of repetitive transcranial magnetic stimulation combined with paliperidone on cognitive function of schizophrenic patients[J]. Journal Of International Psychiatry, 2021, 48(1): 33-35, 41. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202101011.htm
[11]	关恒永, 李喜泼, 潘艳芬, 等. 经颅磁刺激与精神分裂症认知障碍[J]. 精神医学杂志, 2018, 31(4): 308-311. https://www.cnki.com.cn/Article/CJFDTOTAL-SDJB201804021.htm GUAN H Y, LI X P, PAN Y F, et al. Transcranial magnetic stimulation and cognitive impairment in schizophrenia[J]. Journal of Psychiatry, 2018, 31(4): 308-311. https://www.cnki.com.cn/Article/CJFDTOTAL-SDJB201804021.htm
[12]	贺守彬. 高频重复经颅磁刺激对精神分裂症患者认知功能的影响[J]. 中国医药指南, 2020, 18(33): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202033026.htm HE S B. Effect of high frequency repetitive transcranial magnetic stimulation on cognitive function of schizophrenia[J]. Guide of China Medicine, 2020, 18(33): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202033026.htm
[13]	陆晶晶, 孙莲芳, 张莉. 重复经颅磁刺激治疗对精神分裂症患者阴性症状、认知功能、脑内神经递质及血清炎症因子的影响[J]. 临床与病理杂志, 2022, 42(8): 1945-1951. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202208025.htm LU J J, SUN L F, ZHANG L. Effects of repetitive transcranial magnetic stimulation on negative symptoms, cognitive function, brain neurotransmitters and serum inflammatory factors in patients with schizophrenia[J]. Journal of Clinical and Pathological Research, 2022, 42(8): 1945-1951. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202208025.htm
[14]	蒋晓春, 黄婉立, 陈燕娣, 等. 重复经颅磁刺激对精神分裂症患者认知功能的影响[J]. 中国现代医生, 2021, 59(19): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202119007.htm JIANG X C, HUANG W L, CHEN Y D, et al. Effect of repeated transcranial magnetic stimulation on the cognitive function of patients with schizophrenia[J]. China Modern Doctor, 2021, 59(19): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202119007.htm
[15]	何孔亮, 梁丹丹, 李智勇, 等. 高精度经颅直流电刺激对精神分裂症患者认知及社会功能的影响[J]. 安徽医科大学学报, 2020, 55(11): 1787-1791. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202011028.htm HE K L, LIANG D D, LI Z Y, et al. Effects of high definition transcranial direct current stimulation on cognitive and social functions in convalescent schizophrenics[J]. Acta Universitatis Medicinalis Anhui, 2020, 55(11): 1787-1791. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202011028.htm
[16]	朱虹, 职利花, 贾竑晓. 齐拉西酮治疗对精神分裂症患者认知功能和生活质量的治疗效果研究[J]. 首都医科大学学报, 2018, 39(2): 199-203. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD201802009.htm ZHU H, ZHI L H, JIA H X. Evaluating the efficacy of ziprasidone in improving cognition, quality of life and clinical symptom in schizophrenia[J]. Journal of Capital Medical University, 2018, 39(2): 199-203. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD201802009.htm
[17]	倪花, 朱旻, 曹俊, 等. 重复经颅磁刺激对首发精神分裂症患者认知及社会功能的影响[J]. 临床精神医学杂志, 2022, 32(6): 434-437. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS202206004.htm NI H, ZHU M, CAO J, et al. Effect of repeated transcranial magnetic stimulation on cognitive and social function in first-episode schizophrenia[J]. Journal of Clinical Psychiatry, 2022, 32(6): 434-437. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS202206004.htm