Objective To investigate the efficacy and white matter integrity of low frequency repetitive transcranial magnetic stimulation (rTMS) and the modified electroconvulsive therapy (MECT) in patients with schizophrenia. Methods From May 2015 to October 2016,120 cases with schizophrenia were randomly enrolled into the MECT group and of the rTMS group. Patients in the MECT group were treated with the modified electric convulsive therapy for 8 times ,while patients in the rTMS group were treated with the repetitive transcranial magnetic stimulation for 12 times. PANSS were used to evalue the clinical effects. Repeatable battery for the assess-ment of neuropsychological status was used to assess the cognitive function. Treatment emergent side-effect scale was used to assess the adverse effects. Brain fractional anisotropy was used to assess white matter integrity. Results After treatment,the PANSS scores were significantly lowered,however,the RBANS scores were signifi-cantly higher in the MECT group and rTMS group than those before treatment ,with significant differences (P <0.05). No significant differences for the PANSS scores and the RBANS scores were observed between the two groups before and after treatment. There was no significant difference for the TESS scores between the two groups before treatment(P > 0.05). After treatment,the TESS scores in the MECT group were significantly higher than those in the rTMS group(P < 0.05). After treatment,the FA values of left anterior cingulate gyrus,left posterior cingulate gyrus ,left prefrontal cortex and genu of corpus callosum for both MECT group and rTMS group were significantly increased (P < 0.05 ,respectively). Compared with the MECT group ,the FA value significantly increased in the rTMS group after treatment (P < 0.05). Conclusions Both MECT and rTMS have significant clinical efficacies and can improve the cognitive function of schizophrenics. rTMS is more safe than MECT ,with a stronger effect on preventing the integrity of white matter than MECT.%目的 探索低频重复经颅磁刺激(rTMS)与无抽搐电休克(MECT)对精神分裂症患者的疗效及白质完整性分析.方法 选取2015年5月至2016年10月于我院收治的精神分裂患者120例,随机分为MECT组(60例)和rTMS组(60例),分别给予无抽搐电休克治疗8次和重复经颅磁刺激治疗12次.采用PANSS评定临床疗效;RBANS评价认知功能;TESS评定不良反应;通过FA值评估白质结构完整性.结果 治疗后MECT组与rTMS组PANSS评分较治疗前均显著下降,差异具有统计学意义(P<0.05),两组治疗前及治疗后PANSS评分差异均无统计学意义(P>0.05).治疗后MECT组与rTMS组RBANS评分较治疗前均显著升高,差异具有统计学意义(P<0.05),两组治疗前及治疗后RBANS评分差异均无统计学意义(P>0.05).两组患者治疗前TESS评分差异无统计学意义(P>0.05),治疗后MECT组TESS评分高于rTMS组,差异具有统计学意义(P<0.05).治疗后MECT组与rTMS组左侧扣带回前部、左侧扣带回后部、左侧前额叶以及胼胝体膝部较治疗前FA值都有所升高,差异有统计学意义(P<0.05).rTMS组较MECT组治疗后各脑区FA值增幅大,差异有统计学意义(P<0.05).结论 MECT及rTMS均具有显著的临床疗效,可提高精神分裂症患者的认知功能,且rTMS较MECT更为安全,对阻止白质完整性损害的作用较MECT强.
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