低频rTMS联合作业疗法在缺血性脑卒中恢复期中的应用
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摘要
目的探讨低频rTMS(重复经颅磁刺激)联合作业疗法在缺血性脑卒中恢复期患者中的应用效果。方法选取郑州大学第二附属医院2016-10—2018-06收冶的缺血性脑卒中恢复期患者98例为研究对象,按随机数字表法分为对照组(n=49)与研究组(n=49)。对照组采取作业疗法,研究组于对照组基础上采取低频rTMS,均持续干预3个月。统计2组干预前及干预3个月后认知功能(MMSE)及肢体运动功能(Fugl-Meyer)评分、运动诱导电位(MEP)、中枢传导时间(CMCT)、血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平及执行能力(BADS)评分。结果 (1)认知及肢体运动功能:干预3个月后2组MMSE及FMA评分均较干预前增高,研究组高于对照组(P<0.05);(2)MEP及CMCT:2组MEP及CMCT均较干预前减少,研究组少于对照组(P<0.05);(3)血清神经细胞因子:2组血清NGF及BDNF水平均较干预前增高,研究组高于对照组(P<0.05);(4)执行能力:2组BADS评分均较干预前增高,研究组高于对照组(P<0.05)。结论联合采取作业疗法及低频rTMS对缺血性脑卒中恢复期患者实施干预,可增加血清神经细胞因子含量,利于改善其认知功能与肢体运动功能,并提升其执行能力。
Objective To investigate the effect of low frequency rTMS(repetitive transcranial magnetic stimulation) combined with occupational therapy in patients with ischemic stroke recovery.Methods A total of 98 patients with ischemic stroke recovery in our hospital(October 2016-June 2018) were enrolled.The random number table method was used to divide them into control group(n=49) and study group(n=49).The control group was treated with occupational therapy.The study group took low-frequency rTMS on the basis of the control group and continued to intervene for 3 months.Cognitive function(MMSE) and limb motor function(Fugl-Meyer) scores,motor induction potential(MEP),central conduction time(CMCT),and serum nerve growth factor(NGF) were compared before and 3 months after intervention.Brain-derived neurotrophic factor(BDNF) levels and performance(BADS) scores were counted.Results(1) Cognitive and limb motor function:After 3 months of intervention,the MMSE and FMA scores of the two groups were higher than those before the intervention,and the study group was higher than the control group(P<0.05);(2) MEP and CMCT:intervention 3 After the month,the MEP and CMCT of the two groups decreased compared with the intervention group,and the study group was less than the control group(P<0.05).(3) Serum nerve cytokines:the levels of serum NGF and BDNF in the two groups increased after intervention for 3 months.The study group was higher than the control group(P<0.05);(4) Execution ability:After 3 months of intervention,the BADS scores of the two groups were higher than those before the intervention,and the study group was higher than the control group(P<0.05).Conclusion Combined interventional therapy and low-frequency rTMS intervention in patients with ischemic stroke recovery can increase serum neurocytokine levels,improve cognitive function and limb motor function,and improve their ability to perform.
Objective To investigate the effect of low frequency rTMS(repetitive transcranial magnetic stimulation) combined with occupational therapy in patients with ischemic stroke recovery.Methods A total of 98 patients with ischemic stroke recovery in our hospital(October 2016-June 2018) were enrolled.The random number table method was used to divide them into control group(n=49) and study group(n=49).The control group was treated with occupational therapy.The study group took low-frequency rTMS on the basis of the control group and continued to intervene for 3 months.Cognitive function(MMSE) and limb motor function(Fugl-Meyer) scores,motor induction potential(MEP),central conduction time(CMCT),and serum nerve growth factor(NGF) were compared before and 3 months after intervention.Brain-derived neurotrophic factor(BDNF) levels and performance(BADS) scores were counted.Results(1) Cognitive and limb motor function:After 3 months of intervention,the MMSE and FMA scores of the two groups were higher than those before the intervention,and the study group was higher than the control group(P<0.05);(2) MEP and CMCT:intervention 3 After the month,the MEP and CMCT of the two groups decreased compared with the intervention group,and the study group was less than the control group(P<0.05).(3) Serum nerve cytokines:the levels of serum NGF and BDNF in the two groups increased after intervention for 3 months.The study group was higher than the control group(P<0.05);(4) Execution ability:After 3 months of intervention,the BADS scores of the two groups were higher than those before the intervention,and the study group was higher than the control group(P<0.05).Conclusion Combined interventional therapy and low-frequency rTMS intervention in patients with ischemic stroke recovery can increase serum neurocytokine levels,improve cognitive function and limb motor function,and improve their ability to perform.
引文
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[25] WALDOWSKI K,SENIOW J,LESNIAK M,et al.Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients:a prospective,randomized,double-blind sham-controlled study[J].ScientificWorldJournal,2012,20(12):518-530.
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[29] DU J,TIAN L,LIU W,et al.Effects of repetitive transcranial magnetic stimulation on motor recovery and motor cortex excitability in patients with stroke:a randomized controlled trial[J].Eur J Neurol,2016,23(11):1 666-1 672.
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[32] SHEN X,LIU M,CHENG Y,et al.Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression:A systematic review and meta-analysis of randomized controlled clinical trials[J].J Affect Disord,2017,211(1):65-74.
[33] HEO M,KIM E.Beneficial effects of antecedent exercise training on limb motor function and calpain expression in a rat model of stroke[J].J Phys Ther Sci,2013,25(8):943-946.
[34] OZKAN A K,YEMISCI O U,SARACGIL COSAR S N.Can high-sensitivity C-reactive protein and ferritin predict functional outcome in acute ischemic stroke?A prospective study[J].Top Stroke Rehabil,2013,20(6):528-536.
[35] MITUF,COBZARU R,LEON M M.Influence of metabolic syndrome profile on cardiovascular risk[J].Rev Med Chir Soc Med Nat Iasi,2013,117(2):308-314.
[36] YANG S A.Association of TLR6 single nucleotide polymorphisms and clinicalfeatures of ischemic stroke in Korean population[J].J Exerc Rehabil,2013,9(6):526-531.
[37] GAO H,LI X,GAO X,et al.Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke[J].Neural Regen Res,2013,8(31):2 914-2 922.
[38] EMARA T,El NAHAS N,ELKADER H A,et al.MRI can Predict the Response to Therapeutic Repeti-tive Transcranial Magnetic Stimulation (rTMS) in Stroke Patients[J].J Vasc Interv Neurol,2009,2(2):163-168.
[39] KHEDR E M,ETRABY A E,HEMEDA M,et al.Long-term effect of repetitive transcranial magnetic stimulation on motor function recovery after acute ischemic stroke[J].Acta Neurol Scand,2010,121(1):30-37.
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[41] YANG Y M,ZHANG Y,LI Y,et al.U-Shaped Relationship Between Functional Outcome and Serum Uric Acid in Ischemic Stroke[J].Cell Physiol Biochem,2018,47(6):2 369-2 379.
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[2] MESCHIA J F.Subtyping in ischemic stroke genetic research[J].J Stroke Cerebrovasc Dis,2002,11(5):208-219.
[3] MENON B K,ALMEKHLAFI M A,PEREIRA V M,et al.Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke:Analysis of the Solitaire FR Thrombectomy for Acute Revascularization Study[J].Stroke,2014,45(7):2 024-2 029.
[4] RAMIREZ-MORENO J M,MUNOZ-VEGA P,ALBERCA S B,et al.Health-Related Quality of Life and Fatigue After Transient Ischemic Attack and Minor Stroke[J].J Stroke Cerebrovasc Dis,2019,28(2):276-284.
[5] MINS W,OH S H,KIM G C.Clinical Importance of Peak Cough Flow in Dysphagia Evaluation of Patients Diagnosed With Ischemic Stroke[J].AnnRehabil Med,2018,42(6):798-803.
[6] TRETRILUXANA J,THANAKAMCHOKCHAI J,JALAYONDEJA C,et al.The Persisted Effects of Low-FrequencyRepetitive Transcranial Magnetic Stimulation toAugment Task-Specific Induced Hand RecoveryFollowing Subacute Stroke:Extended Study[J].Ann Rehabil Med,2018,42(6):777-787.
[7] ZIEMANN U,WITTENBERG G F,COHEN L G.Stimulation-induced within-representation and across-representation plasticity in human motorCortex[J].J Neurosci,2002 22(13):5 563-5 571.
[8] SLOTEMA C W,BLOM J D,HODK H W,et al.Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS) A meta-analysis of the efficacy of rTMS in psychiatric disorders[J].J Clin Psychiatry,2010,71(7):873-884.
[9] SENIOW J,WALDOWSKI K,LESNIAK M,et al.Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation:a randomized double-blind controlled pilot study[J]Top Stroke Rehabil,2013,20(3):250-261.
[10] LI J Z,XUE W Z,ZHEN T,et al.Cerebral Functional Reorganization in Ischemic Stroke after Repetitive Transcranial Magnetic Stimulation:An fMRI Study[J].CNS Neurosci Ther,2016,22(12):952-960.
[11] DICHGANS M,MALIK R,KONIG I R,et al.Shared genetic susceptibility to ischemic stroke and coronary artery disease:a genome-wide analysis of common variants[J].Stroke,2014,45(1):24-36.
[12] KIMURA K.Diagnosis and treatment in acute stroke[J].Rinsho Shinkeigaku,2010,50(11):783-786.
[13] CHIQUETE E,CANTU B C,VILLARREAL C J,et al.Obesity paradox and functional recovery in first-ever acute ischemic stroke survivors:the PREMIER study[J].Rev Neurol,2010,51(12):705-713.
[14] HUANG C Y,HSU M C,HSU S P,et al.Mediating roles of social support on poststroke depression and quality of life in patients with ischemic stroke[J].J Clin Nurs,2010,19(19/20):2 752-2 762.
[15] VASILEVA D,LUBENOVA D,MIHOVA M,et al.Influenceof Kinesitherapy on Balance Reactions in Patients with Ischemic Stroke in the Chronic Period[J].Open Access Maced J Med Sci,2015,3(4):601-606.
[16] HESSAM M,SALEHI R,YAZDIM J S,et al.Relationship between functional balance and walking ability in individuals with chronic stroke[J].J Phys Ther Sci,2018,30(8):993-996.
[17] CICHON N,RZEZNICKA P,BIJAK M,et al.Extremely low frequency electromagnetic field reduces oxidative stress during the rehabilitation of post-acute stroke patients[J].Adv Clin Exp Med,2018,27(9):1 285-1 293.
[18] BASHIR S,VERNET M,NAJIB U,et al.Enhanced motor function and its neurophysiological correlatesa-fter navigated low-frequency repetitive transcranial magneticstimulation over the contralesional motor cortex in stroke[J].HHS Public Access,2016,34(4):677-689.
[19] VASILEVA D,LUBENOVA D,MIHOVAM,et al.Influence of Kinesitherapy on Balance Reactions in Patients with Ischemic Stroke in the Chronic Period[J].Open Access Maced J Med Sci,2015,3(4):601-606.
[20] LJUBISAVLJEVIC M R,JAVID A,OOMMEN J,et al.The Effects of Different Repetitive Transcranial Magnetic Stimulation (rTMS) Protocols on Cortical Gene Expression in a Rat Model of Cerebral Ischemic-Reperfusion Injury[J].PLoS One,2015,10(10):e0139892.
[21] LEE J H,KIM SBLEEK W,et al.Effect of Repetitive Transcranial Magnetic Stimulation According to the Stimulation Site in Stroke Patients With Dysphagia[J].Ann Rehabil Med,2015,39(3):432-439.
[22] KHALEEL S H,BAYOUMY I M,El-NABIL L M,et al.Differential hemodynamic response to repetitive transcranial magnetic stimulation in acute stroke patients with cortical versus subcortical infarcts[J].Eur Neurol,2010,63(6):337-342.
[23] VANDERWERKER C J,ROSS R E,STIMPSON K H,et al.Combining therapeutic approaches:rTMS and aerobic exercise in post-stroke depression:a case series[J].Top Stroke Rehabil,2017,25(4):1-7.
[24] 张志慧.不同频率重复经颅磁刺激治疗脑卒中后抑郁障碍的疗效分析[J].中国实用神经疾病杂志,2017,20(17):102-103.
[25] WALDOWSKI K,SENIOW J,LESNIAK M,et al.Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients:a prospective,randomized,double-blind sham-controlled study[J].ScientificWorldJournal,2012,20(12):518-530.
[26] CONFORTO A B,ANJOS S M,SAPOSNIK G,et al.Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke:a proof of principle and novel approach to improve motor function[J].J Neurol,2012,259(7):1 399-1 405.
[27] YOON K J,LEE Y T,HAN T R.Mechanism of functional recovery after repetitive transcranial magnetic stimulation (rTMS) in the subacute cerebral ischemic rat model:neural plasticity or anti-apoptosis?[J].Exp Brain Res,2011,214(4):549-556.
[28] KHEDR E M,AHMED M A,FATHY N,et al.Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke[J].Neurology,2005,65(3):466-468.
[29] DU J,TIAN L,LIU W,et al.Effects of repetitive transcranial magnetic stimulation on motor recovery and motor cortex excitability in patients with stroke:a randomized controlled trial[J].Eur J Neurol,2016,23(11):1 666-1 672.
[30] BLESNEAG A V,SLAVOACA D F,POPA L,et al.Low-frequency rTMS in patients with subacute ischemic stroke:clinical evaluation of short and long-term outcomes and neurophysiological assessment of cortical excitability[J].J Med Life,2015,8(3):378-387.
[31] TAKATOSHI H,MASAHIRO A,KIYOHITO K,et al.Doesa combined interventionprogramofrepetitivetranscranialmagneticstimulation and intensiveoccupational therapyaffectcognitivefunction inpatientswithpost-stroke upperLimbhemiparesis?[J].Neural Regen Res,2016,11(12):1932-1939.
[32] SHEN X,LIU M,CHENG Y,et al.Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression:A systematic review and meta-analysis of randomized controlled clinical trials[J].J Affect Disord,2017,211(1):65-74.
[33] HEO M,KIM E.Beneficial effects of antecedent exercise training on limb motor function and calpain expression in a rat model of stroke[J].J Phys Ther Sci,2013,25(8):943-946.
[34] OZKAN A K,YEMISCI O U,SARACGIL COSAR S N.Can high-sensitivity C-reactive protein and ferritin predict functional outcome in acute ischemic stroke?A prospective study[J].Top Stroke Rehabil,2013,20(6):528-536.
[35] MITUF,COBZARU R,LEON M M.Influence of metabolic syndrome profile on cardiovascular risk[J].Rev Med Chir Soc Med Nat Iasi,2013,117(2):308-314.
[36] YANG S A.Association of TLR6 single nucleotide polymorphisms and clinicalfeatures of ischemic stroke in Korean population[J].J Exerc Rehabil,2013,9(6):526-531.
[37] GAO H,LI X,GAO X,et al.Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke[J].Neural Regen Res,2013,8(31):2 914-2 922.
[38] EMARA T,El NAHAS N,ELKADER H A,et al.MRI can Predict the Response to Therapeutic Repeti-tive Transcranial Magnetic Stimulation (rTMS) in Stroke Patients[J].J Vasc Interv Neurol,2009,2(2):163-168.
[39] KHEDR E M,ETRABY A E,HEMEDA M,et al.Long-term effect of repetitive transcranial magnetic stimulation on motor function recovery after acute ischemic stroke[J].Acta Neurol Scand,2010,121(1):30-37.
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