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θ短阵快速脉冲模式的重复经颅磁刺激联合利培 酮治疗首发精神分裂症患者疗效及对催乳素的影响
田涛戴立磊李芬杜晖郭青山
0
()
摘要:
目的 探讨θ 短阵快速脉冲模式(TBS)的重复经颅磁刺激(rTMS)联合利培酮治疗对首发 精神分裂症患者的疗效,并观察血清催乳素(PRL)水平变化。方法 收集荆门市第二人民医院2019 年 1—12 月住院治疗的首发精神分裂症患者100 例,随机分为研究组与对照组各50 例,两组患者均给予 利培酮口服液治疗,研究组联合TBS 模式的rTMS 治疗,疗程4 周。治疗前及治疗2 周末、4 周末采用阳 性与阴性症状量表(RANSS)进行心理测评,检测血浆PRL;rTMS 治疗结束后4 周随访,复测血浆PRL水 平。结果 (1)两组患者治疗前PANSS 总分及因子分比较均差异无统计学意义(均P > 0.05),治疗后两 组患者PANSS 总分及各因子分在时间效应上比较,差异均有统计学意义(均P< 0.05);在组间效应的比 较上,阴性症状的差异存在统计学意义(F组间=4.419,P< 0.05),其他因子及PANSS 总分差异均无统计学 意义(均P > 0.05);在交互效应的比较上,PANSS 总分及各因子分差异均存在统计学意义(均P < 0.05); (2)两组患者治疗前血清PRL比较差异无统计学意义(P > 0.05),治疗后两组患者血清PRL在时间效应、 组间效应、交互效应的比较,差异均有统计学意义(F时间=558.270,F组间=70.257,F交互=51.863,均P<0.05); 治疗2 周末、4 周末及4 周随访时两组患者血清PRL比较,差异均有统计学意义(t1=43.296,t2=78.881, t3=92.162;P < 0.05)。结论 TBS 模式的rTMS 治疗可以改善首发精神分裂症患者阴性症状,延缓利培 酮所致的血浆PRL升高,不良反应小,但长期疗效难以维持。
关键词:  精神分裂症  利培酮  经颅磁刺激  θ 短阵快速脉冲模式  催乳素
DOI:10.3969/j.issn.1009-6574.2020.11.010
基金项目::荆门市科学技术研究与开发计划(2019YDKY035);湖北省卫生计生委指导性项目 (WJ2017F094)
Effect of repeated transcranial magnetic stimulation combined with risperidone under theta burststimulation mode on treatment effect and prolactin in patients with first-episode schizophrenia
Tian Tao, Dai Lilei, Li Fen, Du Hui, Guo Qingshan
()
Abstract:
Objective To investigate the efficacy of repeated transcranial magnetic stimulation (rTMS) combined with risperidone under theta burst stimulationin( TBS) mode in the treatment of first-episode schizophrenia, and to observe the changes of serum prolactin( PRL) levels. Methods From January 2019 to December 2019, a total of 100 patients with first-episode schizophrenia in Jingmen NO.2 People's Hospital were randomly divided into study group and control group, with 50 patients in each group. Before treatment, Positive And Negative Syndrome Scale( PANSS) scale was used to evaluate the patients, and plasma PRL was detected. The patients in both groups were treated with risperidone oral liquid. The study group was treated with rTMS under TBS mode for four weeks, and at the end of 2 weeks and 4 weeks after treatment, psychological assessment was carried out and plasma PRL was detected. Patients were followed up for 4 weeks after rTMS treatment, and plasma PRL was redetected. Rusults (1) There was no statistically significant difference on the total score and factor score of PANSS scale between the two groups before treatment, but there was statistically significant difference in time effect between the two groups after treatment( all P<0.05). In the comparison of effects between groups, there were statistically significant differences in negative symptoms( F=4.419;P < 0.05), but there was no statistically significant difference in the other factors and the total score of PANSS( all P > 0.05). In the comparison of interactive effects, there were statistically significant differences in the total score of PANSS and the scores of all factors( all P<0.05).( 2) There was no statistically significant difference in serum PRL between the two groups before treatment, but there were statistically significant differences in time effect, intergroup effect, and interaction effect between the two groups after treatment( Ftime=558.270, Fgroup=70.257,Finteraction=51.863, all P < 0.05). After treatment, there were statistically significant differences in serum PRL between the two groups at different time points( t1=43.296,t2=78.881,t3=92.162;P < 0.05). Conclusions rTMS therapy under TBS mode can improve the negative symptoms of first-episode schizophrenia, delay the increase of plasma PRL caused by risperidone, and have slight adverse reactions. However, the long-term efficacy is difficult to maintain.
Key words:  Schizophrenia  Risperidone  Transcranial magnetic stimulation  Theta burst stimulation  Prolactin

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