经颅磁刺激联合康复训练在孤独症谱系障碍儿童中的疗效及低频振幅分析研究

A study on the efficacy of transcranial magnetic stimulation combined with rehabilitation training in children with autism spectrum disorders and analysis of low-frequency amplitude

扫码查看

原文链接

维普
万方数据

中文摘要：目的通过静息态功能核磁共振低频振幅(ALFF)分析观察低频重复经颅磁刺激(rTMS)对孤独症谱系障碍(ASD)儿童核心症状的改善作用.方法纳入2021年10月-2023年12月于南京医科大学附属儿童医院康复医学科就诊的34例ASD儿童,采用随机数字表法将患儿分为ASD1组和ASD2组,每组17例.ASD1组予常规训练+低频rTMS刺激左前额叶背外侧区(DLPFC),ASD2组予常规训练+假刺激.每组各脱落1例,治疗前、治疗12周后采用孤独症行为量表(ABC)、孤独症评定量表(CARS)、重复刻板行为量表修订版(RBS-R)、孤独症治疗评价量表(ATEC)评估2组ASD患儿核心症状.对2组患儿进行静息态fMRI扫描,观察治疗前后2组ASD患儿核心症状改善情况及静息态下脑区低频振幅值指标变化.结果治疗后,2组ASD患儿CARS、RBS-R、ATEC评分均较治疗前明显改善;治疗后,ASD1 组 CARS[(32.50±1.63)分vs.(34.75±3.94)分]、RBS-R[7.00(6.00,7.00)分vs.8.00(7.00,11.75)分]、ATEC[(60.20±12.29)分 vs.(69.80±13.52)分]总分均优于 ASD2 组(P＜0.05).治疗后ASD1组ALFF增高脑区主要有右侧眶部额下回、右侧角回、右背外侧额上回等,ASD2组治疗前后脑区无显著变化.结论在常规康复干预基础上,低频rTMS治疗能有效改善ASD儿童核心症状及行为学评价指标,静息态下对脑默认网络、认知等相关脑区的自发神经元调节作用可能是其作用机制.

外文摘要：Objective To observe the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)on the core symptoms of children with autism spectrum disorders(ASD)by ALFF analysis of resting-state functional magnetic resonance imaging.Methods Thirty-four children with ASD from the Department of Rehabilitation of Children's Hospi-tal of Nanjing Medical University from October 2021 to December 2023 were divided into two groups(ASD1 and ASD2)by a randomized numeric table method.The ASD1 group was given regular training and low frequency rTMS stimulation to the dorsolateral prefrontal region(DLPFC),while the ASD2 group was given regular training and sham stimulation.One case was dislodged from each group.Core symptoms were assessed using the autism behavioral scale(ABC),autism rat-ing scale(CARS),repetitive stereotyped behavioral scale-revised(RBS-R),and autism treatment evaluation scale(ATEC)before and after 12 weeks of treatment.Resting-state fMRI scans were performed in both groups before and after treatment,and their resting-state fMRI data were analyzed to observe improvements in core symptoms and changes in ALFF indexes in the resting state.Results After 12 weeks of treatment,the CARS,RBS-R,and ATEC scores of chil-dren with ASD in both groups were significantly improved compared to those before treatment.The total scores of CARS[(32.50±l.63)points vs.(34.75±3.94)points],RBS-R[7.00(6.00,7.00)points vs.8.00(7.00,11.75)points],and ATEC[(60.20±12.29)points vs.(69.80±13.52)points]in the ASD1 group were better than those in the ASD2 group after treatment(P＜0.05).Increased ALFF in the ASD1 group was observed mainly in the superior tem-poral gyrus,inferior frontal gyrus,and parahippocampal gyrus,while no significant changes were seen in the ASD2 group before and after treatment.Conclusion On the basis of conventional rehabilitation intervention,low-frequency rTMS therapy can effectively improve the core symptoms and behavioral evaluation indexes of children with ASD,which is con-firmed by the convergence of compensation in related brain regions at rest.

外文关键词：

Autism spectrum disorderTranscranial magnetic stimulationEfficacyResting-state functional magnetic resonance imagingAmplitude of low frequency fluctuation

作者：

李章、吕静、赵晓科、徐红、张玲、朱敏

展开 >

作者单位：

南京医科大学附属儿童医院康复医学科,江苏南京 210008

江苏大学第四附属医院儿科,江苏镇江 212001

关键词：

孤独症谱系障碍经颅磁刺激疗效静息态功能磁共振低频振幅值

基金：

江苏省科教强卫青年人才项目江苏省妇幼保健协会科研项目南京市卫健委一般性课题

项目编号：

QNRC2016089FYX201907YKK19108

出版年：

2024

DOI：

10.16766/j.cnki.issn.1674-4152.003604

中华全科医学

中华预防医学会,安徽省全科医学会

中华全科医学

CSTPCD

影响因子：1.688

ISSN：1674-4152

年,卷(期)：2024.22(7)