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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (05) : 269 -273. doi: 10.3877/cma.j.issn.2095-123X.2022.05.003

临床研究

高频重复经颅磁刺激规律间歇治疗丘脑梗死后中枢性疼痛的临床研究
江伟1, 袁良津1,†(), 唐向阳1, 张斗凤1, 王少敏1   
  1. 1. 246003　安徽安庆，安庆市立医院神经内科
  • 收稿日期:2022-06-07 出版日期:2022-10-15
  • 通信作者: 袁良津
  • 基金资助:
    安徽医科大学科研基金项目(2019xkj228)

Clinical study of high-frequency repetitive transcranial magnetic stimulation regularly and intermittently in the treatment of central pain after thalamic infarction

Wei Jiang1, Liangjin Yuan1,†(), Xiangyang Tang1, Doufeng Zhang1, Shaomin Wang1   

  1. 1. Department of Neurology, Anqing Municipal Hospital, Anqing 246003, China
  • Received:2022-06-07 Published:2022-10-15
  • Corresponding author: Liangjin Yuan
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江伟, 袁良津, 唐向阳, 张斗凤, 王少敏. 高频重复经颅磁刺激规律间歇治疗丘脑梗死后中枢性疼痛的临床研究[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(05): 269-273.

Wei Jiang, Liangjin Yuan, Xiangyang Tang, Doufeng Zhang, Shaomin Wang. Clinical study of high-frequency repetitive transcranial magnetic stimulation regularly and intermittently in the treatment of central pain after thalamic infarction[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(05): 269-273.

目的

探究高频重复经颅磁刺激（hrTMS）规律间歇治疗丘脑梗死后中枢性疼痛的临床疗效和作用机制。

方法

选取安庆市立医院神经内科自2020年4月至2021年12月收治的64例丘脑梗死后中枢性疼痛患者，采用单盲-随机数字表法分为hrTMS组和对照组，每组32例。2组患者治疗期间口服布洛芬缓释胶囊0.4 g，bid。hrTMS组行hrTMS治疗，对照组行无磁场脉冲发射的伪线圈治疗。比较2组患者的视觉模拟量表（VAS）评分、运动诱发电位（MEP）潜伏期变化及治疗总有效率。

结果

hrTMS组患者治疗前和治疗2、4、8周后的VAS评分逐渐下降，差异有统计学意义（P<0.05）。对照组治疗前和治疗2、4周后的VAS评分比较，差异有统计学意义（P<0.05），但治疗后4、8周的VAS评分比较，差异无统计学意义（P>0.05）。2组患者治疗前和治疗2周后VAS评分比较，差异均无统计学意义（P>0.05）；治疗4、8周后的VAS评分比较，差异均有统计学意义（P<0.05）。治疗8周后，hrTMS组患者的MEP潜伏期较治疗前明显缩短，且较对照组MEP潜伏期明显缩短，差异具有统计学意义（P<0.05）。hrTMS组患者治疗8周后的总有效率（71.88%）明显高于对照组（15.63%），差异具有统计学意义（P<0.05）。

结论

hrTMS规律间歇治疗可缓解丘脑梗死后中枢性疼痛患者的疼痛程度且疗效持续显著，可能作用机制与提高脑梗死患者大脑皮质兴奋性有关。

关键词: 丘脑梗死, 中枢性疼痛, 经颅磁刺激, 运动诱发电位
Objective

To explore the clinical efficacy and mechanism of high-frequency repetitive transcranial magnetic stimulation (hrTMS) in the treatment of central pain after thalamic infarction.

Methods

Sixty-four patients with central pain after thalamic infarction were selected from Neurology Department of Anqing Municipal Hospital from April 2020 to December 2021, and were divided into hrTMS group and control group by single-blind randomized method, with 32 cases in each group. Two groups were given ibuprofen sustained-release capsules 0.4 g orally bid during treatment. The hrTMS group received hrTMS treatment, and the control group received pseudo-coil treatment without magnetic pulse emission. Visual analog scale (VAS) scores, motor evoked potential (MEP) latency and total response rate were compared between the two groups.

Results

VAS scores in hrTMS group decreased gradually before treatment and at 2, 4 and 8 weeks after treatment, with statistical significance (P<0.05). Comparison of VAS scores in the control group before treatment, 2 weeks after treatment and 4 weeks after treatment showed statistically significant difference (P<0.05), but there was no statistically significant difference between 4 weeks after treatment and 8 weeks after treatment (P>0.05). There was no significant difference in VAS scores between 2 groups before treatment and 2 weeks after treatment (P>0.05). VAS scores at 4 and 8 weeks after treatment were statistically significant (P<0.05). After 8 weeks of treatment, the latency of MEP in the hrTMS group was significantly shorter than that before treatment, and the latency of MEP in the control group was significantly shorter, the difference was statistically significant (P<0.05). After 8 weeks of treatment, the total effective rate of hrTMS group (71.88%) was significantly higher than that of control group (15.63%), and the difference was statistically significant (P<0.05).

Conclusion

Regular intermittent treatment with hrTMS can relieve the pain degree of the patients with central pain after thalamic infarction and the effect is significant. The possible mechanism of action is related to the improvement of cerebral cortical excitability in the patients with cerebral infarction.

Key words: Thalamic infarction, Central pain, Transcranial magnetic stimulation, Motor evoked potentials
表1 2组患者基本资料的比较
组别 例数 年龄（岁，Mean±SD） 性别（男/女） 受教育程度（年，Mean±SD） 发病病程（d，Mean±SD） VAS评分（分，Mean±SD）
hrTMS组 32 61.56±6.36 19/13 12.13±2.97 33.25±7.66 7.06±0.91
对照组 32 60.13±7.87 17/15 11.59±2.78 32.81±6.29 6.84±0.85
t/χ2值   0.804 0.254 0.739 0.250 0.993
P值   0.425 0.614 0.463 0.804 0.324
表2 2组患者治疗前后各时间点VAS评分比较（分，Mean±SD）
时间 hrTMS组（n=32） 对照组（n=32） t值 P值
治疗前 7.06±0.91 6.84±0.85 0.993 0.324
治疗2周后 6.16±1.05a 6.56±0.91a -1.885 0.064
治疗4周后 5.34±0.90ab 6.40±0.87ab -4.784 <0.001
治疗8周后 4.25±1.19abc 6.25±0.95ab -7.424 <0.001
F值 91.420 13.786    
P值 <0.001 <0.001    
表3 2组治疗8周后总有效率的比较
组别 例数 显效 有效 无效 总有效率[例（%）]
hrTMS组 32 2 21 9 23（71.88）
对照组 32 0 5 27 5（15.63）
Z/χ2值     -4.527   20.570
P值     <0.001   <0.001
表4 2组患者治疗前后MEP的潜伏期比较（ms，Mean±SD）
组别 例数 治疗前 治疗8周后 t值 P值
hrTMS组 32 25.50±1.55 21.33±2.39 -8.288 <0.001
对照组 32 25.41±1.80 24.72±1.44 -1.703 0.094
t值   0.208 -6.876    
P值   0.836 <0.001    
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