【作者】 朱桂东； 宋清海；

【机构】 丽水二院；

【摘要】 目的:探讨低频重复经颅磁刺激(rTMS)治疗孤独症谱系障碍(ASD)儿童对症状及表情识别过程神经功能活动的影响。方法:选择2017年1月～2019年12月间医院收治的65例ASD患儿为研究对象,所有患儿均接受低频rTMS治疗,4周为1疗程,治疗3个疗程。分别于治疗前后采用孤独症行为量表(ABC)、儿童孤独症评定量表(CARS)、0～6岁小儿神经心理发育量表(DQ)对患儿进行测评,采用近红外脑功能成像(fNIRS)技术检测治疗前后表情识别任务时前额叶皮质(PFC)中的氧合血红蛋白(HbO)浓度变化,并观察核心症状改善情况。结果:治疗后,患儿的ABC、CARS量表总分均低于治疗前,而DQ量表总分高于治疗前,差异均具有统计学意义(P均<0.05);ABC量表各因子中,交往、躯体运动、语言评分均低于治疗前,差异均具有统计学意义(P均<0.05),而感觉、生活自理评分与治疗前比较,差异均无统计学意义(P均>0.05)。高兴表情识别任务中通道2 (左背外侧前额叶)HbO相对浓度降低,通道18 (右背外侧前额叶)HbO相对浓度升高,差异具有统计学意义(P<0.05);中性表情识别任务中通道1 (左腹外侧前额叶)、通道8 (左后侧前额叶)HbO相对浓度降低,通道2 (左背外侧前额叶)、通道16 (右眶额叶)HbO相对浓度升高,差异具有统计学意义(P<0.05);悲伤表情识别任务中各通道HbO相对浓度均无明显变化(P>0.05)。6例ASD患儿核心症状无减轻,39例ASD患儿1项核心症状减轻、20例ASD患儿2项核心症状减轻,核心症状总改善率为90.77%(59/65)。结论:低频rTMS治疗可改善儿童的症状,并对其表情识别过程神经功能活动造成一定影响。更多还原

【Abstract】 Objective:To investigate the effect of low frequency repetitive transcranial magnetic stimulation（rTMS） on the neurological function of children with autism spectrum disorder（ASD）.Methods:65 children with ASD admitted to the hospital from January 2017 to December 2019 were selected as the study objects.All the children were treated with low frequency rTMS,4 weeks as a course of treatment,3 courses of treatment.Before and after treatment,the children were assessed with Autism Behavior Scale（ABC）,Children Autism Rating Scale（cars）,children’ s neuropsychological development scale（DQ） for 0-6 years old.The changes of oxyhemoglobin（HBO） in prefrontal cortex（PFC） during expression recognition task before and after treatment were detected with near-infrared brain function imaging（fNIRS）,and the core symptoms were observed Improve the situation.Results:After treatment,the total scores of the children’ s ABC and CARS scales were lower than before treatment,and the total scores of the DQ scale were higher than before treatment,and the differences were statistically significant(P_all<0.05);The scores of communication,physical movement,and language were lower than before treatment,and the differences were statistically significant(P_all<0.05),while the sensation,life self-care scores were not statistically different from those before treatment(P_all>0.05).In the happy expression recognition task,the relative concentration of HbO in channel 2（left dorsolateral prefrontal lobe） decreased,and the relative concentration of channel 18（right dorsolateral prefrontal lobe） increased,the difference was statistically significant（P<0.05）;neutral expression recognition task The relative concentration of HbO in middle channel 1（left ventrolateral prefrontal lobe）,channel 8（left posterior prefrontal lobe） decreased,and the relative concentration of HbO increased in channel 2（left dorsal lateral prefrontal lobe） and channel 16（right orbital frontal lobe）.It was statistically significant（P<0.05）;there was no significant change in the relative concentration of HbO in each channel in the sad expression recognition task（P>0.05）.6 patients with ASD had no reduction in core symptoms,39 children with ASD had one core symptom relief,and 20 children with ASD had two core symptom reliefs.The total improvement rate of core symptoms was 90.77%（59/65）.Conclusion:Lowfrequency rTMS treatment can improve children’s symptoms and have a certain effect on the neurological activity during the facial recognition process.更多还原