蔡广超　关勇　齐明　李朝晖　王江

[摘要]目的 探討高频重复经颅磁刺激治疗对精神分裂症慢性病程患者的阴性症状改善作用的持续性。方法 选择2015年9月～2016年9月在北京市大兴区精神病医院住院的以阴性症状为主的慢性精神分裂症患者40例，使用高频重复经颅磁刺激进行治疗，收集治疗前，治疗结束，治疗结束后1、3、6个月的相关数据，采用阳性和阴性症状量表（PANSS）、副反应量表（TESS）评价疗效及不良反应。结果 患者治疗前，治疗结束，治疗结束后1、3、6个月的PANSS量表中的阴性症状评分与总评分数据差异均有统计学意义（F=45.621，57.369，P<0.05），q检验结果显示，治疗结束与治疗结束后1个月的数值均低于治疗前，治疗结束后3个月，治疗结束后6个月，差异均有统计学意义（P<0.05）。治疗前统计有2例“震颤”患者和1例“流涎”患者，在治疗结束后症状无明显变化，在不同治疗时间点的TESS量表中严重程度评分数据差异无统计学意义（F=1.254，P<0.05）。结论 高频重复经颅磁刺激治疗精神分裂症可以在短期内改善其临床症状，特别是阴性症状的改善幅度较大，但是改善的效果会因时间的延长而逐渐减弱，建议进行连续治疗。

[关键词]重复经颅磁刺激；精神分裂症；阴性症状；随访

[中图分类号] R749.3 [文献标识码] A [文章编号] 1674-4721（2018）6（a）-0012-04

[Abstract]Objective To investigate the sustainability of high frequency repetitive transcranial magnetic stimulation on sustainability of the improvement role for negative symptoms in schizophrenic patients with chronic course of disease.Methods From September 2015 to September 2016，40 patients with negative symptoms of chronic schizophrenia hospitalized in Mental Hospital of Daxing District in Beijing City were selected.High frequency repetitive transcranial magnetic stimulation was used for treatment.Data were collected before treatment，end of treatment，1，3 months and 6 months after treatment.Positive and negative symptom scale （PANSS） and side effects scale （TESS） were used to evaluate efficacy and side effects.Results The difference between the negative symptom scores and the total score data in the PANSS scale before treatment，at the end of treatment，1，3 months and 6 months after treatment were statistically significant （F=45.621，57.369，P<0.05）.The results of q test showed that the values at the end of treatment and 1 months after treatment were all lower than those before treatment，after the end of treatment 3，6 months，the differences were statistically significant （P<0.05）.Before treatment，there were 2 cases of "tremor" patients and 1 case of "cast" patients，there was no significant change in symptoms after treatment.There was no statistical significance in the difference of severity score data in the TESS scale of different time points （F=1.254，P<0.05）.Conclusion High frequency repetitive transcranial magnetic stimulation treating schizophrenia can improve their clinical symptoms in the short term.In particular，the negative symptoms have been improved greatly，but the effect of the improvement will be gradually weakened due to the prolongation of the time，continuous treatment is recommended.

[Key words]Repetitive transcranial magnetic stimulation；Schizophrenia；Negative symptoms；Follow-up

精神分裂症是临床最常见的重性精神病性疾病，到目前为止病因尚不明确，起病多在青壮年，临床表现复杂，主要是以感知觉、情感、思维和行为等多方面的障碍为表现的精神活动的不协调。病程一般迁延难愈，其中约有半数以上的分裂症患者呈慢性化，阳性症状不再为主要临床表现，或只是残留症状[1]，大多数以认知功能损害和阴性症状为主，表现为思维贫乏、注意力障碍、情感淡漠或迟钝、意志力缺乏、兴趣及社交缺乏等，部分患者认知功能的损害可加重阴性症状，这些症状通常持续存在，对患者的整体生活质量及全面的社会功能造成了较为严重影响[2]。目前的药物治疗几乎或很少有针对性地改善这些症状，如果这些症状得到治疗或改善，大部分患者都能够回归家庭，走向社会，而使致残率下降，减少长期住院带来的社会和经济负担。……