重复经颅磁刺激对缺血性脑卒中患者运动功能和血清MMP-9、hs-CRP的影响
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摘要
目的评价重复经颅磁刺激(rTMS)对缺血性脑卒中(IS)患者运动功能和血清基质金属蛋白酶9(MMP-9)、超敏C反应蛋白(hs-CRP)的影响。方法将符合纳入标准的54例IS患者随机分成低频刺激组、高频刺激组和假刺激组,各18例。所有患者均给予常规内科处理和康复训练,低频刺激组在健侧初级运动皮质区(M1)以0.5 Hz的rTMS进行治疗,高频刺激组患侧M1区以10 Hz的rTMS治疗,假刺激也在患侧M1区进行操作,不通电流,只有声音,治疗每天1次,每周5 d,共3周。分别于治疗前3 d及治疗3周后,采用酶联免疫吸附法(ELISA)测定3组患者血清MMP-9和hs-CRP水平,同时行患侧简易运动功能评估(FMA)并记录患侧M1区运动诱发电位(MEP)潜伏期和中枢运动传导时间(CMCT),比较3组患者治疗前后运动功能和血清MMP-9及hs-CRP表达差异。结果治疗前3组患者血清MMP-9和hs-CRP浓度、FMA得分、MEP潜伏期及CMCT差异均无统计学意义(P>0.05);治疗3周后,低频和高频刺激组血清MMP-9和hs-CRP浓度均低于假刺激组,上下肢FMA评分均高于假刺激组,MEP潜伏期和CMCT均较假刺激组缩短(P<0.05);低频和高频刺激组间上述指标差异均无统计学意义(P>0.05)。治疗3周后,rTMS治疗组(低频与高频)血清MMP-9和hs-CRP浓度与相应的上下肢FMA评分均呈负相关(P<0.01)。结论 rTMS可加速IS患者运动功能的恢复,可能与下调血清MMP-9和hs-CRP表达水平有关。
Objective To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS) on motor function and serum levels of matrix metalloproteinase-9(MMP-9)/high-sensitivity C-reactive protein(hs-CRP) in patients with ischemic stroke(IS).Methods A total of 54 patients met the inclusion criteria were randomly divided into low-frequency stimulation group, high-frequency stimulation group and sham stimulation group with 18 in each group. All the patients were given routine medical treatment and rehabilitation training. Then the 0.5 Hz rTMS treatment was performed on the healthy side in the primary motor cortex(M1) of the low-frequency stimulation group, and the 10 Hz rTMS treatment was performed on the affected side of the high-frequency stimulation group. It was worth noting that the sham stimulation was also performed on the affected side of the M1 area, but no current, only sound, and the treatment lasted 3 weeks, 5 d per week.Finally, serum levels of MMP-9 and hs-CRP were measured by enzyme-linked immunosorbent assay(ELISA) at 3 days before treatment and 3 weeks after treatment, and the simple motor function on the affected side was evaluated by the FMA scale, meanwhile, the motor evoked potential(MEP) latency and central motor conduction time(CMCT) were recorded. The motor function and serum expression levels of MMP-9 and hs-CRP were compared before and after treatment between the three groups.Results There were no significant differences in serum concentrations of MMP-9 and hs-CRP, FMA scores,MEP latency and CMCT before treatment between the three groups(P>0.05). After 3 weeks of treatment, the serum concentration of MMP-9 and hs-CRP were lower in low frequency stimulation and high frequency stimulation groups than those of the sham-stimulated group, and the FMA scores of the upper and lower limbs were higher than those of the shamstimulated group, and the MEP latency/CMCT were shorter than those of sham-stimulated group. There were no significant differences in above indicators between low frequency stimulation and high frequency stimulation groups(P<0.05). After 3 weeks of treatment, the serum concentrations of MMP-9 and hs-CRP were negatively correlated with the corresponding upper and lower FMA scores in the rTMS treatment group(low and high frequency groups, P<0.01).Conclusion rTMS can accelerate the recovery of motor function in patients with IS, which may be related to the down-regulation of serum expression levels of MMP-9 and hs-CRP.
Objective To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS) on motor function and serum levels of matrix metalloproteinase-9(MMP-9)/high-sensitivity C-reactive protein(hs-CRP) in patients with ischemic stroke(IS).Methods A total of 54 patients met the inclusion criteria were randomly divided into low-frequency stimulation group, high-frequency stimulation group and sham stimulation group with 18 in each group. All the patients were given routine medical treatment and rehabilitation training. Then the 0.5 Hz rTMS treatment was performed on the healthy side in the primary motor cortex(M1) of the low-frequency stimulation group, and the 10 Hz rTMS treatment was performed on the affected side of the high-frequency stimulation group. It was worth noting that the sham stimulation was also performed on the affected side of the M1 area, but no current, only sound, and the treatment lasted 3 weeks, 5 d per week.Finally, serum levels of MMP-9 and hs-CRP were measured by enzyme-linked immunosorbent assay(ELISA) at 3 days before treatment and 3 weeks after treatment, and the simple motor function on the affected side was evaluated by the FMA scale, meanwhile, the motor evoked potential(MEP) latency and central motor conduction time(CMCT) were recorded. The motor function and serum expression levels of MMP-9 and hs-CRP were compared before and after treatment between the three groups.Results There were no significant differences in serum concentrations of MMP-9 and hs-CRP, FMA scores,MEP latency and CMCT before treatment between the three groups(P>0.05). After 3 weeks of treatment, the serum concentration of MMP-9 and hs-CRP were lower in low frequency stimulation and high frequency stimulation groups than those of the sham-stimulated group, and the FMA scores of the upper and lower limbs were higher than those of the shamstimulated group, and the MEP latency/CMCT were shorter than those of sham-stimulated group. There were no significant differences in above indicators between low frequency stimulation and high frequency stimulation groups(P<0.05). After 3 weeks of treatment, the serum concentrations of MMP-9 and hs-CRP were negatively correlated with the corresponding upper and lower FMA scores in the rTMS treatment group(low and high frequency groups, P<0.01).Conclusion rTMS can accelerate the recovery of motor function in patients with IS, which may be related to the down-regulation of serum expression levels of MMP-9 and hs-CRP.
引文
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[6]吴冰洁,郭记宏,岳巍,等.高频重复经颅磁刺激对脑梗死患者运动功能的影响[J].中国全科医学,2014,17(23):2751-2753.Wu BJ,Guo JH,Yue W,et al.Effects of high-frequency repetitive transcranial magnetic stimulation on motor function in patients with cerebral infarction[J].Chin Gen Pract,2014,17(23):2751-2753.doi:10.3969/j.issn.1007-9572.2014.23.023.
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[8]朱卫香,刘彦敏,韩亚军,等.缺血性脑卒中患者血清基质金属蛋白酶-9、超敏C反应蛋白水平与颈动脉粥样硬化的相关性[J].疑难病杂志,2014,13(11):1111-1113.Zhu WX,Liu YM,Han YJ,et al.Relationship between levels of serum MMP-9,hsCRP and carotid atherosclerosis in ischemic stroke[J].Chin JDiffic and Compl Cas,2014,13(11):1111-1113.doi:10.3969/j.issn.1671-6450.2014.11.004.
[9]中华神经内科学会,中华神经外科学会.各类脑血管疾病的诊断要点[J].中华神经科杂志,1996,29(6):379-381.Chinese Neuroscience Association,Chinese Society of Neurosurgery.The tips of diagnosis of various cerebrovascular diseases[J].Chin JNeurol,1996,29(6):379-381.
[10]Sung WH,Wang CP,Chou CL,et al.Efficacy of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation to enhance motor recovery in hemiplegic stroke patients.[J].Stroke,2013,44(5):1375-1382.doi:10.1161/STROKEAHA.111.000522.
[11]马玉娟,黄杰,方征宇,等.高频重复经颅磁刺激对脑梗死大鼠运动诱发电位皮质潜伏时间和中枢运动传导时间的影响[J].中国康复医学杂志,2011,26(10):898-902.Ma YJ,Huang J,Fang ZY,et al.Effects of high-frequency repeptitive transcranial magnetic stimulation on cortical latency and central motor conduction time of motor evoked potential of rats with cerebral infarction[J].Chin J Rehabil Med,2011,26(10):898-902.doi:1001-1242(2011)-10-0898-05.
[12]Shen XY,Liu MY,Cheng Y,et al.Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression:Asystematic review and meta-analysis of randomized controlled clinical trials[J].J Affect Disord,2017,211:65-74.doi:10.1016/j.jad.2016.12.058.
[13]Murase N,Duque J,Mazzocchio R,et al.Influence of interhemispheric interactions on motor function in chronic stroke[J].Ann of Neurol,2004,55(3):400-409.doi:10.1002/ana.10848.
[14]Bella R,Ferri R,Lanza G,et al.TMS follow-up study in patients with vascular cognitive impairment-no dementia[J].Neurosci Lett,2013,534(3):155-159.doi:10.1016/j.neulet.2012.12.017.
[15]Uddin MN,Islam F,Ai AM.Psychometric evaluation of an interview-administered version of the Kessler 10-item questionnaire(K10)for measuring psychological distress in rural Bangladesh[J].BMJ Open,2018,8(6):e022967.doi:10.1136/bmjopen-2018-022967.
[16]薛慧,王宝军,刘国荣,等.高频及低频重复经颅磁刺激对急性期脑梗死患者运动功能恢复的临床研究[J].中国康复医学杂志,2013,28(11):1030-1034.Xue H,Wang BJ,Liu GR,et al.The clinical study of high and low-frequency repetitive transcranial magnetic stimulation on motor function recovery in patients with acute ischemic stroke[J].Chin J Rehabil Med,2013,28(11):1030-1034.doi:1001-1242(2013)-11-1030-05.
[17]Chan CP,Jiang H,Leung L,et al.Multiple atherosclerosis-related biomarkers associated with short-and long-term mortality after stroke[J].Clin Biochem,2012,45(16/17):1308-1315.doi:10.1016/j.clinbiochem.2012.06.014.
[18]朱卫香,刘彦敏,韩亚军,等.缺血性脑卒中患者血清MMP-9、Hs-CRP与脑梗死体积及神经功能缺损的关系[J].中国免疫学杂志,2012,28(4):341-343.Zhu WX,Liu YM,Han YJ,et al.Relationship of MMP-9,Hs-CRP in serum with infarction volume and neurologic impairment in patients with acute ischemic stroke[J].Chin J Immun,2012,28(4):341-343.doi:10.3969/j.issn.1000-484X.2012.04.012.
[19]Matsumotomiyazaki J,Asano Y,Yonezawa S,et al.Acupuncture increases the excitability of the cortico-spinal system in patients with chronic disorders of consciousness following traumatic brain injury[J].J Altern Complement Med,2016,22(11):887-894.doi:10.1089/acm.2014.0356.2018-10-112018-12-02
[2]潘明罗,邵大荣,刘燕红,等.缺血脑卒中和出血脑卒中危险因素的比较研究[J].中华疾病控制杂志,2015,19(9):883-886.Pan ML,Shao DR,Liu YH,et al.A comparison study on risk factors in patients with ischemic stroke versus hemorrhagicstroke[J].Chin J Dis Control Prev,2015,19(9):883-886.doi:10.16462/j.cnki.zhjbkz.2015.09.006.
[3]Koganemaru S,Mima T,Thabit MN,et al.Recovery of upper-limb function due to enhanced use-dependent plasticity in chronic stroke patients[J].Brain,2010,133(11):3373-3384.doi:10.1093/brain/awq193.
[4]Perera T,George MS,Grammer G,et al.The clinical tms society consensus review and treatment recommendations for TMS therapy for major depressive disorder[J].Brain Stimul,2016,9(3):336-346.doi:10.1016/j.brs.2016.03.010.
[5]Gu SY,Chang MC.The effects of 10-Hz repetitive transcranial magnetic stimulation on depression in chronic stroke patients[J].Brain Stimul,2016,10(2):270-274.doi:10.1016/j.brs.2016.10.010.
[6]吴冰洁,郭记宏,岳巍,等.高频重复经颅磁刺激对脑梗死患者运动功能的影响[J].中国全科医学,2014,17(23):2751-2753.Wu BJ,Guo JH,Yue W,et al.Effects of high-frequency repetitive transcranial magnetic stimulation on motor function in patients with cerebral infarction[J].Chin Gen Pract,2014,17(23):2751-2753.doi:10.3969/j.issn.1007-9572.2014.23.023.
[7]赵利娜,张志强,张立新,等.1Hz重复经颅磁刺激对缺血性脑卒中后上肢运动功能的疗效[J].中国康复理论与实践,2015,21(2):216-219.Zhao LN,Zhang ZQ,Zhang LX,et al.Effect of 1 Hz repetitive transcranial magnetic stimulation on upper limb motor function after stroke[J].Chin J Rehabil Theory Pract,2015,21(2):216-219.doi:10.3969/j.issn.1006-9771.2015.02.022.
[8]朱卫香,刘彦敏,韩亚军,等.缺血性脑卒中患者血清基质金属蛋白酶-9、超敏C反应蛋白水平与颈动脉粥样硬化的相关性[J].疑难病杂志,2014,13(11):1111-1113.Zhu WX,Liu YM,Han YJ,et al.Relationship between levels of serum MMP-9,hsCRP and carotid atherosclerosis in ischemic stroke[J].Chin JDiffic and Compl Cas,2014,13(11):1111-1113.doi:10.3969/j.issn.1671-6450.2014.11.004.
[9]中华神经内科学会,中华神经外科学会.各类脑血管疾病的诊断要点[J].中华神经科杂志,1996,29(6):379-381.Chinese Neuroscience Association,Chinese Society of Neurosurgery.The tips of diagnosis of various cerebrovascular diseases[J].Chin JNeurol,1996,29(6):379-381.
[10]Sung WH,Wang CP,Chou CL,et al.Efficacy of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation to enhance motor recovery in hemiplegic stroke patients.[J].Stroke,2013,44(5):1375-1382.doi:10.1161/STROKEAHA.111.000522.
[11]马玉娟,黄杰,方征宇,等.高频重复经颅磁刺激对脑梗死大鼠运动诱发电位皮质潜伏时间和中枢运动传导时间的影响[J].中国康复医学杂志,2011,26(10):898-902.Ma YJ,Huang J,Fang ZY,et al.Effects of high-frequency repeptitive transcranial magnetic stimulation on cortical latency and central motor conduction time of motor evoked potential of rats with cerebral infarction[J].Chin J Rehabil Med,2011,26(10):898-902.doi:1001-1242(2011)-10-0898-05.
[12]Shen XY,Liu MY,Cheng Y,et al.Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression:Asystematic review and meta-analysis of randomized controlled clinical trials[J].J Affect Disord,2017,211:65-74.doi:10.1016/j.jad.2016.12.058.
[13]Murase N,Duque J,Mazzocchio R,et al.Influence of interhemispheric interactions on motor function in chronic stroke[J].Ann of Neurol,2004,55(3):400-409.doi:10.1002/ana.10848.
[14]Bella R,Ferri R,Lanza G,et al.TMS follow-up study in patients with vascular cognitive impairment-no dementia[J].Neurosci Lett,2013,534(3):155-159.doi:10.1016/j.neulet.2012.12.017.
[15]Uddin MN,Islam F,Ai AM.Psychometric evaluation of an interview-administered version of the Kessler 10-item questionnaire(K10)for measuring psychological distress in rural Bangladesh[J].BMJ Open,2018,8(6):e022967.doi:10.1136/bmjopen-2018-022967.
[16]薛慧,王宝军,刘国荣,等.高频及低频重复经颅磁刺激对急性期脑梗死患者运动功能恢复的临床研究[J].中国康复医学杂志,2013,28(11):1030-1034.Xue H,Wang BJ,Liu GR,et al.The clinical study of high and low-frequency repetitive transcranial magnetic stimulation on motor function recovery in patients with acute ischemic stroke[J].Chin J Rehabil Med,2013,28(11):1030-1034.doi:1001-1242(2013)-11-1030-05.
[17]Chan CP,Jiang H,Leung L,et al.Multiple atherosclerosis-related biomarkers associated with short-and long-term mortality after stroke[J].Clin Biochem,2012,45(16/17):1308-1315.doi:10.1016/j.clinbiochem.2012.06.014.
[18]朱卫香,刘彦敏,韩亚军,等.缺血性脑卒中患者血清MMP-9、Hs-CRP与脑梗死体积及神经功能缺损的关系[J].中国免疫学杂志,2012,28(4):341-343.Zhu WX,Liu YM,Han YJ,et al.Relationship of MMP-9,Hs-CRP in serum with infarction volume and neurologic impairment in patients with acute ischemic stroke[J].Chin J Immun,2012,28(4):341-343.doi:10.3969/j.issn.1000-484X.2012.04.012.
[19]Matsumotomiyazaki J,Asano Y,Yonezawa S,et al.Acupuncture increases the excitability of the cortico-spinal system in patients with chronic disorders of consciousness following traumatic brain injury[J].J Altern Complement Med,2016,22(11):887-894.doi:10.1089/acm.2014.0356.2018-10-112018-12-02
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