张恒,季荣霞,李佳.经颅磁刺激治疗阿尔茨海默病的临床疗效[J].中华物理医学与康复杂志,2019,41(1):18-22 |
经颅磁刺激治疗阿尔茨海默病的临床疗效 |
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DOI:DOI:10.3760/cma.j.issn.0254-1424.2019.01.004 |
中文关键词: 阿尔茨海默病 经颅磁刺激 银杏叶提取物注射液 疗效 |
英文关键词: Alzheimer′s disease Transcranial magnetic stimulation Ginkgo biloba extract |
基金项目:第三届中国科协青年人才托举工程资助(2017QNRC001);湖北中医药大学针灸治未病科研团队项目(2017ZXZ004) |
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中文摘要: |
目的 观察经颅磁刺激治疗阿尔茨海默病(AD)的临床疗效。 方法 选取AD患者196例按随机数字表法分为观察组和对照组,每组98例。观察组应用经颅磁刺激治疗,将刺激探头分别安装于大脑左右背外侧前额叶,同时给予 “8”字型线圈刺激,刺激的强度设置为80% MT,频率为5.0 Hz,刺激时间2 s,刺激序列30个,间歇时间30 s,每次治疗0.5 h,2次/日,疗程28 d;对照组应用假性刺激治疗,采用仪器同观察组,线圈与头皮的角度为90°,但无实质刺激,每次0.5 h,2次/日,疗程28 d。2组患者均联合用银杏叶提取物注射液20 ml溶于氯化钠或葡萄糖注射液250 ml中静脉滴注治疗,1次/日,疗程14 d。分别于治疗前和治疗28 d后(治疗后),采用简易精神状态检查量表(MMSE)、AD评定量表认知分表(ADAS-cog)、日常生活活动能力(ADL)量表、神经精神问卷(NPI)、AD行为病理评定量表(BEHAVE-AD)评分对2组患者的认知功能、行为能力及神经心理症状进行评定,并对2组患者治疗后的临床疗效进行统计学分析比较。 结果 治疗前,2组患者的MMSE、ADAS-cog、ADL、NPI、BEHAVE-AD各指标评分组间比较,差异均无统计学意义(P>0.05);治疗后,2组患者的MMSE、ADAS-cog评分均明显高于组内治疗前(P<0.05),且观察组治疗后的MMSE、ADAS-cog评分亦明显高于对照组治疗后,组间差异有统计学意义(P<0.05)。治疗后,观察组的ADL、NPI、BEHAVE-AD评分及对照组的ADL评分较组内治疗前显著降低(P<0.05),而对照组的NPI、BEHAVE-AD评分较组内治疗前降低不明显,差异无统计学意义(P>0.05);观察组治疗后的ADL、NPI、BEHAVE-AD评分均显著低于对照组治疗后,且组间差异有统计学意义(P<0.05)。治疗后,观察组患者的总有效率(90.82%)明显高于对照组(62.24%),且差异有统计学意义(P<0.01)。 结论 经颅磁刺激治疗AD可以显著改善AD患者的认知功能、行为能力及神经心理学状况。 |
英文摘要: |
Objective To observe the clinical effect of treating Alzheimer′s disease (AD) using transcranial magnetic stimulation. Methods One hundred and ninety-six patients with Alzheimer′s disease were randomly divided into an observation group and a control group, each of 98. The observation group was given transcranial magnetic stimulation of the left and right dorsolateral frontal lobes of the brain and simultaneously given “8-shaped” coil stimulation. The stimulation intensity was 80% of the motor threshold with a sequence of 2 s of stimulation at 5 Hz and 30 s rest for 30 min in each session. There were two sessions a day for 28 days. The control group was treated with identical pseudo-stimulation. Moreover, both groups were treated with intravenous injections of 20 ml of Ginkgo biloba extract dissolved in 250 ml of sodium chloride, or in the control group a glucose injection, one daily for two weeks. Before and after the treatment, the cognition, behavior and neuropsychological symptoms of both groups were evaluated using the mini mental state examination scale (MMSE), the AD rating scale (ADAS-cog), the activity of daily living (ADL) scale, a neuropsychiatric questionnaire (NPI) and an AD behavioral pathology rating scale (BEHAVE-AD) to compare the clinical effects. Results There were no significant differences in the groups′ average scores on any of the evaluations before the treatment. After the treatment, the average MMSE and ADAS-cog scores in both groups had improved significantly, but with significantly greater improvement in the observation group. After the treatment, the average ADL, NPI and BEHAVE-AD scores of the observation group and the average ADL score of the control group were significantly lower than before the treatment. No significant differences were observed in the average NPI and BEHAVE-AD scores of the control group. After the intervention, the average ADL, NPI and BEHAVE-AD scores in the observation group were significantly lower than those of the control group. The total effectiveness rate of the observation group (90.8%) was significantly higher than that of the control group (62.2%). Conclusion Transcranial magnetic stimulation can significantly improve the cognitive, behavioral and neuropsychological status of patients with Alzheimer′s disease. |
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