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中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (01) : 34 -38. doi: 10.3877/cma.j.issn.2095-123X.2023.01.003

临床研究

经颅磁刺激结合前庭康复训练对ADHD患儿注意力缺陷的影响及临床机制
邓艳媚1, 龙耀斌1,†(), 李鑫1, 莫丽华1   
  1. 1. 530000　广西南宁，广西医科大学第二附属医院康复医学科
  • 收稿日期:2022-05-12 出版日期:2023-02-15
  • 通信作者: 龙耀斌

Effect of transcranial magnetic stimulation combined with vestibular rehabilitation training on attention deficit in children with ADHD and its clinical mechanism

Yanmei Deng1, Yaobin Long1,†(), Xin Li1, Lihua Mo1   

  1. 1. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530000, China
  • Received:2022-05-12 Published:2023-02-15
  • Corresponding author: Yaobin Long
  • Supported by:
    Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project(S2019010); Guangxi Zhuang Autonomous Region Medical and Health Key Discipline Construction Project(Gui Wei Ke Jiao Fa [2022] No.4)
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邓艳媚, 龙耀斌, 李鑫, 莫丽华. 经颅磁刺激结合前庭康复训练对ADHD患儿注意力缺陷的影响及临床机制[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(01): 34-38.

Yanmei Deng, Yaobin Long, Xin Li, Lihua Mo. Effect of transcranial magnetic stimulation combined with vestibular rehabilitation training on attention deficit in children with ADHD and its clinical mechanism[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(01): 34-38.

目的

重复经颅磁刺激（rTMS）联合前庭康复训练方案对注意缺陷多动障碍（ADHD）患儿注意力缺陷症状的影响，并分析其临床机制。

方法

选取广西医科大学第二附属医院康复医学科自2020年1月至2021年7月收治的74例ADHD患儿，按照随机数字表法分为对照组和rTMS组，每组37例。对照组予以前庭训练模式与rTMS伪刺激治疗，rTMS组予以前庭训练模式与rTMS治疗。比较2组患者视听整合测试（IVA-CPT）评分、Conner’s多动指数量表(ASQ)评分、25-羟维生素D[25-(OH)-D]和多肽蛋白激素（PRL）指标值。

结果

2组患儿治疗后的IVA-CPT评分均较治疗前升高，且rTMS组高于对照组，差异具有统计学意义（P<0.05）。2组患儿治疗后ASQ评分均较治疗前降低，且rTMS组低于对照组，差异具有统计学意义（P<0.05）。2组患儿治疗后体内25-(OH)-D和PRL指标水平较治疗前呈上升趋势，且rTMS组高于对照组，差异具有统计学意义（P<0.05）。

结论

rTMS技术结合前庭康复训练方式疗效好、安全性高，对减轻患儿多动症状具有明显效果，对患儿注意力缺陷症状的改善具备积极影响。

关键词: 注意缺陷多动障碍, 重复经颅磁刺激, 前庭训练, 25-羟维生素D, 注意力缺陷
Objective

To analyze the effect of repetitive transcranial magnetic stimulation (rTMS) combined with vestibular rehabilitation training on attention deficit symptoms in children with attention deficit hyperactivity disorder (ADHD) and its clinical mechanism.

Methods

Seventy-four children with ADHD admitted to the Rehabilitation Medicine Department of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to July 2021 were randomly divided into the control group and the rTMS group, with 37 cases in each group. The control group was treated with vestibular training mode and rTMS pseudo-stimulation, while the rTMS group was treated with vestibular training mode and rTMS. The audio-visual Integration test (IVA-CPT) scores, Conner's Hyperactivity index (ASQ) scores, 25-hydroxyvitamin D[25-(OH)-D] and polypeptide protein hormone (PRL) index values between two groups were compared.

Results

Compared with before treatment, the IVA-CPT scores of the two groups increased, and the rTMS group was higher than the control group, with a statistically significant difference (P<0.05). After treatment, the ASQ scores of both groups of children decreased compared to before treatment, and the rTMS group was lower than the control group, with a statistically significant difference (P<0.05). After the treatment, the 25-(OH)-D and PRL index levels of the two groups were higher than before treatment, and the rTMS group was higher than the control group, with a statistically significant difference (P<0.05).

Conclusion

rTMS technology combined with vestibular rehabilitation training has higher efficacy and safety, has obvious effect on reducing ADHD symptoms in children, and has a positive impact on the improvement of attention deficit symptoms in children.

Key words: Attention deficit hyperactivity disorder, Repetitive transcranial magnetic stimulation, Vestibular training, 25-hydroxyvitamin D, Deficit of attention
表1 2组患儿的基线资料比较
Tab.1 Comparison of baseline data between 2 groups
组别 例数 年龄（岁，Mean±SD） 男性[例（%）] C-WISC评分（分，Mean±SD）
rTMS组 37 3.16±1.12 18（48.65） 94.06±3.72
对照组 37 3.32±1.08 20（54.05） 93.97±4.26
t/χ2值   -0.626 0.216 0.097
P值   0.534 0.642 0.923
表2 2组患儿视听连续整合测试评分结果对比（分，Mean±SD）
Tab.2 Comparison of audiovisual continuous integration test scores between 2 groups (score, Mean±SD)
组别 例数 TRCQ FAQ
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
对照组 37 82.28±4.17 91.33±4.91 -8.546 <0.001 62.03±4.78 78.92±5.21 -14.530 <0.001
rTMS组 37 82.06±3.75 98.47±5.26 -15.452 <0.001 62.91±4.96 85.66±5.16 19.334 <0.001
t值   0.239 6.036     0.580 5.591    
P值   0.812 <0.001     0.564 <0.001    
表3 2组患儿ASQ评分结果对比（分，Mean±SD）
Tab.3 Comparison of ASQ scores between 2 groups (score, Mean±SD)
组别 例数 治疗前 治疗后 t值 P值
对照组 37 20.37±2.88 16.14±2.16 7.147 <0.001
rTMS组 37 20.74±2.56 12.22±1.94 16.135 <0.001
t值   0.584 8.213    
P值   0.561 <0.001    
表4 2组患儿25-（OH）-D和PRL指标水平结果对比（ng/mL，Mean±SD）
Tab.4 Comparison of 25-(OH)-D and PRL indexes between the 2 groups (ng/mL, Mean±SD)
组别 例数 25-(OH)-D PRL
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
对照组 37 14.45±1.92 19.66±1.87 -11.824 <0.001 6.07±0.91 8.85±1.17 -11.409 <0.001
rTMS组 37 14.29±1.73 28.12±2.06 -31.272 <0.001 6.13±1.08 11.26±1.96 -13.944 <0.001
t值   0.377 18.496     0.258 6.422    
P值   0.708 <0.001     0.797 <0.001    
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