重复经颅磁刺激联合认知训练对阿尔茨海默病患者血清炎症因子及T 淋巴细胞亚群的影响

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摘要目的探讨重复经颅磁刺激（rTMS）联合计算机认知训练（CCT）对阿尔茨海默病（AD）患者血清炎症因子及T淋巴细胞亚群的影响。方法选取2020 年10 月至2022 年5 月在郑州大学第二附属医院治疗且符合纳入标准的76例轻度AD 患者作为研究对象，采用随机数字表法将其分为治疗组和对照组，每组各38 例。治疗组患者采用rTMS 联合CCT 治疗，对照组患者采用经颅磁伪刺激联合CCT 治疗。治疗后采用简易智能精神状态量表（MMSE）及阿尔茨海默病认知功能评定量表（ADAS-COG）比较两组患者治疗前后的认知功能，并比较两组患者治疗前后的白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、γ 干扰素（IFN-γ）、杀伤T 细胞（TC）、辅助T 细胞（TH）及调节性T 细胞（Tregs）水平。结果治疗组患者治疗后的IL-6、TNF-α 水平低于对照组，差异有统计学意义（P＜0.05）。治疗组患者治疗后的TH、Tregs 水平高于对照组，差异有统计学意义（P＜0.05）。治疗组患者治疗后的ADAS-COG评分低于对照组，MMSE 评分高于对照组，差异有统计学意义（P＜0.05）。治疗后两组患者的IFN-γ、TC 水平比较，差异无统计学意义（P＞0.05）。治疗后，治疗组患者的IL-6、TNF-α 水平低于本组治疗前，对照组患者的IL-6水平低于本组治疗前，差异有统计学意义（P＜0.05）。治疗后，治疗组患者的TH、Tregs 水平高于本组治疗前，差异有统计学意义（P＜0.05）。治疗后，两组患者的ADAS-COG 评分均低于本组治疗前，MMSE 评分均高于本组治疗前，差异有统计学意义（P＜0.05）。结论 rTMS 联合CCT 能够降低AD 患者血清IL-6、TNF-α，提高血清TH、Tregs水平，改善认知功能。

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关键词 ：重复经颅磁刺激, 认知训练, 阿尔茨海默病, 认知功能, 阿尔茨海默病认知功能评定量表, 炎症因子, T 淋巴细胞亚群

Abstract：Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with computerized cognitive training(CCT)on serum inflammatory factors and T lymphocyte subsets in Alzheimer's disease(AD).Methods A total of 76 patients with mild AD who met the inclusion criteria and treated in the Second Affiliated Hospital of Zhengzhou University from October 2020 to May 2022 were selected as the study objects.They were divided into treatment group and control group by random number method,with 38 patients in each group.Patients in the treatment group were treated with rTMS combined with CCT,and patients in the control group were treated with transcranial magnetic pseudo-stimulation combined with CCT.After treatment,the cognitive functions of the two groups were compared by the mini-mental state examination(MMSE)and the Alzheimer's disease assessment scale-cognition(ADAS-COG).The levels of interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α),interferon-γ (IFN-γ),killer T cells (TC),helper T cells (TH)and regulatory T cells (Tregs)before and after treatment were compared between the two groups.Results The levels of IL-6 and TNF-α in the treatment group were lower than those in the control group,and the differences were statistically significant(P＜0.05).TH and Tregs levels in the treatment group were higher than those in the control group after treatment,and the differences were statistically significant(P＜0.05).After treatment,the ADAS-COG score of the treatment group was lower than that of the control group,and the MMSE score was higher than that of the control group,with statistical significances (P＜0.05).There were no significant differences in IFN-γ and TC levels between the two groups after treatment (P＞0.05).After treatment,the levels of IL-6 and TNF-α in the treatment group were lower than those before treatment,and the level of IL-6 in the control group was lower than those before treatment,the differences were statistically significant (P＜0.05).After treatment,TH and Tregs levels in the treatment group were higher than those before treatment,and the differences were statistically significant(P＜0.05).After treatment,the ADAS-COG scores of both groups were lower than those before treatment,and the MMSE scores were higher than those before treatment,with statistical significances(P＜0.05).Conclusion rTMS combined with CCT can reduce serum IL-6,TNF-α,increase serum TH,Tregs levels and improve cognitive function in AD patients.

Key words： Repetitive transcranial magnetic stimulation Cognitive training Alzheimer's disease Cognitive function Alzheimer's disease assessment scale-cognition Inflammatory factors T lymphocyte

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作者简介: 董靖雯（1996-），女，郑州大学第二临床医学院2020 级神经病学专业在读硕士研究生；研究方向：阿尔茨海默病。

引用本文:

董靖雯；杜玉洁；王理鑫；陈淅泠. 重复经颅磁刺激联合认知训练对阿尔茨海默病患者血清炎症因子及T 淋巴细胞亚群的影响[J]. 中国当代医药, 2023, 30(21): 8-13.
DONG Jingwen DU Yujie WANG Lixin CHEN Xiling. Study on serum inflammatory factors and T lymphocyte subsets in Alzheimer's disease by repetitive transcranial magnetic stimulation combined with cognitive training. 中国当代医药, 2023, 30(21): 8-13.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2023/V30/I21/8

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