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和认知功能及血清炎症因子水平的影响：一项随机对照试验

doi:10.12114/j.issn.1007-9572.2024.0161

中国全科医学 ›› 2025, Vol. 28 ›› Issue (05): 575-580.DOI: 10.12114/j.issn.1007-9572.2024.0161

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和认知功能及血清炎症因子水平的影响：一项随机对照试验

董晓梅¹, 赵红岩², 耿忠丽³, 徐天朝¹, 王奇¹^,^*()

1．110015　辽宁省沈阳市，北部战区总医院精神心理科
2．100842　北京市，解放军总医院京中医疗区礼士路门诊部
3．110168　辽宁省沈阳市精神卫生中心（沈阳市精神疾病预防控制中心）

收稿日期:2024-04-10 修回日期:2024-07-10 出版日期:2025-02-15 发布日期:2024-11-25
通讯作者: 王奇
作者贡献：
董晓梅、王奇进行文章的构思和设计，负责论文的修订；董晓梅进行数据整理和论文写作；赵红岩进行统计学处理；耿忠丽负责收集资料；徐天朝对实验进行指导；王奇对文章监督管理。
基金资助:
辽宁省科学技术计划项目(2022JH2/101500040)

The Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms, Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia: a Randomized Controlled Trial

DONG Xiaomei¹, ZHAO Hongyan², GENG Zhongli³, XU Tianchao¹, WANG Qi¹^,^*()

1. Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang 110015, China
2. Lishi Road Outpatient Department of Jingzhong Medical District, General Hospital of the People's Liberation Army, Beijing 100842, China
3. Shenyang Mental Health Center (Shenyang Mental Disease Prevention and Control Center) , Shenyang 110168, China

Received:2024-04-10 Revised:2024-07-10 Published:2025-02-15 Online:2024-11-25
Contact: WANG Qi

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摘要/Abstract

摘要： 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[（26.34±2.07）分与（29.33±4.27）分]和总分[（53.10±3.61）分与（58.99±5.53）分]及SANS评分[（54.00±3.78）分与（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）分与（37.24±1.10）分]、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[（41.28±7.32）μg/L与（47.03±9.45）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。

关键词: 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

Abstract:

Background

The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulation (rTMS) of the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophrenia (CSZ) .

Objective

Observing the effects of cerebellar vermis rTMS with theta burst stimulation (TBS) paradigm on negative symptoms, cognitive function, and serum inflammatory cytokine levels in elderly CSZ patients.

Methods

This study was 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 method, CSZ patients were divided into an observation group and a control group, with 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigm, the stimulation site was the vermis of the cerebellum. The treatment was conducted 5 days a week, once a day, for 4 consecutive weeks. The patients in control group were intervention with pseudo stimulation, and the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom Scale (PANSS) to evaluate overall psychiatric symptoms, and use the SANS to evaluate negative symptoms. Evaluate cognitive function using the MATRICS Consensus Cognitive Battery (MCCB) . Detecting serum interleukin-1β (IL-1β) , Interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) .

Results

Compared with the control group, the observation group had lower PANSS negative symptom scores [ (17.11±2.00) scores vs (19.21±2.76) scores], general psychopathological symptom scores [ (26.34±2.07) scores vs (29.33±4.27) scores], total scores after treatment [ (53.10±3.61) scores vs (58.99±5.53) scores], and lower SANS scale scores [ (54.00±3.78) scores vs (57.83±4.15) scores] (P<0.05) . Compared with the control group, the observation group had higher post-treatment information processing speed scores [ (39.78±2.45) scores vs (37.24±1.10) scores], attention alertness scores [ (47.07±4.27) scores vs (40.01±2.17) scores], working memory scores [ (45.12±3.20) scores vs (41.89±4.11) scores], and social cognitive scores [ (46.40±4.29) scores vs (41.42±7.45) scores] (P<0.05) . Compared with the control group, the observation group had lower levels of IL-1β [ (41.09±7.34) μg/L vs (47.03±12.45) μg/L], IL-6 [ (41.28±7.32) μg/L vs (47.03±9.45) μg/L], and TNF-α [ (53.28±14.15) μg/L vs (61.35±12.79) μg/L] after treatment (P<0.05) . During the rTMS treatment process, only 4 cases in the observation group experienced dizziness and headache symptoms during the first treatment, which gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort.

Conclusion

The rTMS with TBS paradigm can improve negative symptoms, cognitive function, and serum inflammatory factor levels in elderly patients with CSZ.

Key words: Chronic schizophrenia, Repetitive transcranial magnetic stimulation, Inflammatory cytokines, Negative symptoms, Cognitive function, Randomized controlled trial

中图分类号:

R 749.3

董晓梅,赵红岩,耿忠丽,等. 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和认知功能及血清炎症因子水平的影响：一项随机对照试验[J]. 中国全科医学, 2025, 28(05): 575-580. DOI: 10.12114/j.issn.1007-9572.2024.0161.
DONG Xiaomei,ZHAO Hongyan,GENG Zhongli, et al. The Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms, Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia: a Randomized Controlled Trial[J]. Chinese General Practice, 2025, 28(05): 575-580. DOI: 10.12114/j.issn.1007-9572.2024.0161.

图/表 3

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组别	例数	阴性症状评分		阳性症状评分		一般精神病理症状评分		PANSS总分		SANS评分
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	治疗前	治疗后
对照组	25	20.08±2.15	19.21±2.76	9.05±1.32	8.93±2.15	31.19±3.75	29.33±4.27	61.21±4.27	58.99±5.53	59.35±2.64	57.83±4.15
观察组	25	20.71±1.98	17.11±2.00^a	9.15±1.18	8.93±2.19^a	30.86±3.20	26.34±2.07^a	60.87±3.41	53.10±3.61^a	58.76±3.72	54.00±3.78^a
t值		1.078	3.081	0.282	0.005	0.335	3.151	0.311	4.459	0.647	3.411
P值		0.287	0.004	0.779	0.996	0.739	0.003	0.757	<0.001	0.521	0.001

组别	例数	阴性症状评分		阳性症状评分		一般精神病理症状评分		PANSS总分		SANS评分
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	治疗前	治疗后
对照组	25	20.08±2.15	19.21±2.76	9.05±1.32	8.93±2.15	31.19±3.75	29.33±4.27	61.21±4.27	58.99±5.53	59.35±2.64	57.83±4.15
观察组	25	20.71±1.98	17.11±2.00^a	9.15±1.18	8.93±2.19^a	30.86±3.20	26.34±2.07^a	60.87±3.41	53.10±3.61^a	58.76±3.72	54.00±3.78^a
t值		1.078	3.081	0.282	0.005	0.335	3.151	0.311	4.459	0.647	3.411
P值		0.287	0.004	0.779	0.996	0.739	0.003	0.757	<0.001	0.521	0.001

组别	例数	信息处理加工速度		注意警觉性		工作记忆
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	25	36.78±5.12	37.24±1.10	39.34±2.13	40.01±2.17	40.03±3.25	41.89±4.11
观察组	25	35.34±3.12	39.78±2.45^a	38.67±3.00	47.07±4.27^a	41.76±5.12	45.12±3.20^a
t值		1.201	4.729	0.910	7.369	1.426	3.100
P值		0.237	<0.001	0.368	<0.001	0.161	0.003
组别	言语学习		视觉学习		推理问题解决		社会认知
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	44.87±2.85	42.18±4.07	53.23±6.19	51.29±7.14	49.27±5.10	47.09±5.24	40.13±4.00	41.42±7.45
观察组	43.76±3.45	44.09±4.26	51.23±3.00	49.12±3.75	47.23±4.15	47.17±3.98	38.26±3.25	46.40±4.29^a
t值	1.240	1.621	1.454	1.345	1.551	0.061	1.814	2.896
P值	0.221	0.112	0.155	0.187	0.128	0.952	0.076	0.006

组别	例数	信息处理加工速度		注意警觉性		工作记忆
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	25	36.78±5.12	37.24±1.10	39.34±2.13	40.01±2.17	40.03±3.25	41.89±4.11
观察组	25	35.34±3.12	39.78±2.45^a	38.67±3.00	47.07±4.27^a	41.76±5.12	45.12±3.20^a
t值		1.201	4.729	0.910	7.369	1.426	3.100
P值		0.237	<0.001	0.368	<0.001	0.161	0.003
组别	言语学习		视觉学习		推理问题解决		社会认知
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	44.87±2.85	42.18±4.07	53.23±6.19	51.29±7.14	49.27±5.10	47.09±5.24	40.13±4.00	41.42±7.45
观察组	43.76±3.45	44.09±4.26	51.23±3.00	49.12±3.75	47.23±4.15	47.17±3.98	38.26±3.25	46.40±4.29^a
t值	1.240	1.621	1.454	1.345	1.551	0.061	1.814	2.896
P值	0.221	0.112	0.155	0.187	0.128	0.952	0.076	0.006

组别	例数	IL-1β		IL-6		TNF-α
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	25	50.03±15.21	47.03±12.45	43.78±8.32	47.03±9.45	64.05±14.20	61.35±12.79
观察组	25	49.24±10.83	41.09±7.34^a	50.03±15.21	41.28±7.32^a	62.54±12.53	53.28±14.15^a
t值		0.211	2.055	1.803	2.405	0.398	2.116
P值		0.833	0.047	0.079	0.020	0.692	0.039

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和认知功能及血清炎症因子水平的影响：一项随机对照试验

The Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms, Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia: a Randomized Controlled Trial

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