天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (2): 184-188.doi: 10.11958/20181534

• 临床研究 • 上一篇    下一篇

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

刘超猛1 ， 孟瑶1 ， 李浩浩1 ， 张桂青2△   

  1. 1石河子大学医学院 （邮编832003）； 2石河子大学医学院第一附属医院
  • 收稿日期:2018-10-11 修回日期:2018-12-08 出版日期:2019-02-15 发布日期:2019-02-15
  • 通讯作者: 张桂青 E-mail:firstli1@126.com
  • 基金资助:
    精神创伤后应激相关障碍的识别与干预技术研究

Effects of repetitive transcranial magnetic stimulation on motor function and serum levels of MMP-9/hs-CRP of ischemic stroke patients

LIU Chao-meng1 , MEGN Yao1 , LI Hao-hao1 , ZHANG Gui-qing2△   

  1. 1 The College of Medicine Shihezi University, Shihezi 832003, China; 2 The First Affiliated Hospital of Medical College, Shihezi University
  • Received:2018-10-11 Revised:2018-12-08 Published:2019-02-15 Online:2019-02-15

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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。

关键词: 经颅磁刺激, 卒中, 基质金属蛋白酶9, 超敏C反应蛋白, 运动功能

Abstract:  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 sham- stimulated 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.

Key words:  transcranial magnetic stimulation, stroke, matrix metalloproteinase 9, hypersensitive C-reactive protein, motor function