| 柳秋,朱新臣,刘菲菲,王建晖.基于弥散张量成像探讨高频重复经颅磁刺激联合动静态平衡训练对血管性帕金森综合征冻结步态患者的影响[J].中国康复,2025,40(8):467-473 |
| 基于弥散张量成像探讨高频重复经颅磁刺激联合动静态平衡训练对血管性帕金森综合征冻结步态患者的影响 |
| Effect of high-frequency repetitive transcranial magnetic stimulation combined with dynamic and static balance training on frozen gait in patients with vascular Parkinson’s syndrome based on diffusion tensor imaging |
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| DOI：10.3870/zgkf.2025.08.004 |
| 中文关键词: 血管性帕金森综合征 重复经颅磁刺激 动静态平衡训练 冻结步态 弥散张量成像 |
| 英文关键词: vascular Parkinson’s syndrome repetitive transcranial magnetic stimulation dynamic and static balance training freezing gait diffusion tensor imaging |
| 基金项目:2022年南阳南石医院科研立项项目（KJGG116）；2024年河南省科技攻关项目（242102311136） |
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| 中文摘要: |
| 目的：探讨高频重复经颅磁刺激（HF-rTMS）联合动静态平衡训练对血管性帕金森综合征（VP）冻结步态患者的影响，并利用弥散张量成像（DTI）技术分析其潜在的神经机制。方法：选取VP冻结步态患者187例，随机分为观察组（n=93）与对照组（n=94），2组在常规康复训练的基础上结合动静态平衡仪训练，对照组另外给予HF-rTMS假刺激，观察组给予HF-rTMS刺激，于治疗前、治疗4周后，观察2组患者步态、平衡功能、统一帕金森病评定量表（UPDRS）、39项帕金森病生存质量调查问卷(PDQ-39)、DTI参数。结果：治疗4周后，2组步频较治疗前降低（P＜0.01），其中观察组低于对照组（P＜0.01），2组步速、优势侧及非优势侧步长均较治疗前增大（P＜0.01），且观察组均高于对照组（P＜0.01），2组治疗4周后冻结步态（FOG）评分均较治疗前降低（P＜0.05，0.01），但观察组低于对照组（P＜0.05）；平衡功能：治疗4周后，2组Berg平衡量表（BBS）、躯干损伤量表（TIS）评分、姿势稳定极限（LOS）百分值均较治疗前明显增高（P＜0.05,0.01），2组计时起立-行走测试（TUGT）时间较治疗前缩短（P＜0.05），观察组BBS评分、TIS评分、LOS百分值均高于对照组（P＜0.05,0.01），TUGT时间短于对照组（P＜0.05）；治疗4周后，UPDRS Ⅱ、Ⅲ、PDQ-39评分均较治疗前明显降低（P＜0.01），观察组低于对照组（P＜0.01）；治疗4周后，2组壳核、红核、黑质、中脑被盖、丘脑各向异性分数（FA）值均较治疗前增高（P＜0.05,0.01），且观察组高于对照组（P＜0.05,0.01）；治疗后2组DTI检查中壳核、红核、苍白球、丘脑区域FA值与治疗后UPDRS Ⅱ、Ⅲ评分无明显相关性，黑质、中脑被盖FA值与UPDRS Ⅱ、Ⅲ评分呈负相关（r=-0.563、-0.620、-0.723、-0.754，P＜0.01）。结论：HF-rTMS联合动静态平衡训练可显著改善早期VP冻结步态患者的姿势平衡功能，改善冻结步态，其机制可能通过影响黑质、中脑被盖等区域的神经纤维完整性实现的。 |
| 英文摘要: |
| Objective: To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with dynamic and static balance training on frozen gait in patients with vascular Parkinson’s syndrome (VP), and to analyze its potential neural mechanism by diffusion tensor imaging (DTI). Methods: A total of 187 patients with VP freezing gait were randomly divided into observation group (n=93) and control group (n=94). The control group was given dynamic and static balance instrument training and sham HF-rTMS stimulation on the basis of routine rehabilitation training. The observation group was subjected to HF-rTMS in combination with dynamic and static balance instrument training on the basis of routine rehabilitation training. The gait, balance function, unified Parkinson’s disease rating scale (UPDRS) and DTI parameters of VP patients were observed before and 4 weeks after treatment. Results: After 4 weeks of treatment, the step frequency of the two groups decreased (P<0.01), and that in the observation group was lower than in the control group (P<0.01). The step speed, dominant side and non-dominant side step length of the two groups increased (P<0.01), and those in the observation group were increased as compared with those in the control group (P<0.01). After 4 weeks of treatment, the FOG scores of the two groups decreased (P<0.05), and that in the observation group was lower than in the control group (P<0.05). For balance function, after 4 weeks of treatment, the scores of Berg balance scale (BBS), trunk injury scale (TIS) and postural stability limit (LOS) in the two groups were significantly increased (P<0.05,0.01), and the score of timed up and go test (TUGT) was decreased (P<0.05, 0.01). However, the BBS score, TIS score and LOS in the observation group were higher than those in the control group (P<0.05), and the TUGT score was lower than that in the control group (P<0.05). After 4 weeks of treatment, UPDRS Ⅱ, Ⅲ and 39 Parkinson’s disease quality of life questionnaire (PDQ-39) scores were significantly decreased (P＜0.01), and those in the observation group were reduced as compared with the control group (P<0.01). After 4 weeks of treatment, the fractional anisotropy (FA) values of putamen, red nucleus, substantia nigra, midbrain tegmentum and thalamus in the two groups increased (P<0.05, 0.01), and those in the observation group were higher than in the control group (P<0.05, 0.01). There was no significant correlation between the FA values of putamen, red nucleus, globus pallidus and thalamus in DTI after treatment and UPDRS Ⅱ and Ⅲ after treatment. The FA values of substantia nigra and tegmental area were negatively correlated with UPDRS Ⅱ and Ⅲ scores (r=-0.563, -0.620, -0.723, -0.754, P<0.01). Conclusion: HF-rTMS combined with dynamic and static balance training can significantly improve the postural balance function of patients with early VP freezing gait and improve the freezing gait. The mechanism may be achieved by affecting the integrity of nerve fibers in the substantia nigra, midbrain tegmental area and other areas. |
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