不同频率低频重复经颅磁刺激对癫痫儿童骨代谢、脂代谢及生活质量的影响

　　[摘要] 目的 觀察不同频率低频重复经颅磁刺激（rTMS）对癫痫儿童骨代谢、脂代谢及生活质量的影响。 方法 选取2014年3月～2017年3月保定市第一中心医院收治的156例癫痫患儿，采用简单随机抽样法分为对照组（50例）、0.5 Hz组（53例）和1.0 Hz组（53例）。在原抗癫痫治疗方案基础上，对照组给予假刺激治疗，0.5Hz组给予0.5Hz的rTMS治疗，1.0 Hz给予1.0 Hz的rTMS治疗，三组均持续治疗3个月；比较三组治疗前后癫痫发作频率及头痛发生情况、骨代谢指标[钙（Ca）、磷（P）、碱性磷酸酶（ALP）]、脂代谢指标[总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）]及儿童生活质量普适量表4.0（PedsQL4.0）评分变化。 结果 治疗后，三组癫痫发作频率均少于治疗前（P < 0.05），且1.0Hz组癫痫发作频率少于对照组和0.5Hz组（P < 0.05）； 三组治疗期间头痛发生率比较，差异无统计学意义（P > 0.05）；三组患儿Ca、P、ALP、TC、TG、LDL-C水平治疗前后及治疗后组间比较，差异无统计学意义（P > 0.05）；治疗后，三组PedsQL4.0各维度评分均高于治疗前（P < 0.05），且1.0 Hz组高于对照组和0.5 Hz组（P < 0.05）。 结论 1.0 Hz的rTMS可减少癫痫患儿癫痫发作频率，改善患儿生活质量，且短期对患儿骨代谢、脂代谢无明显影响。
　　[关键词] 经颅磁刺激；癫痫；儿童；骨代谢；脂代谢；生活质量
　　[中图分类号] R748 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0106-04
　　Effects of low-frequency repetitive transcranial magnetic stimulation of different frequency on bone metabolism， lipid metabolism and quality of life of children with epilepsy
　　XU Bei1 WANG Guilan2
　　1.Department of General Pediatrics， the First Central Hospital of Baoding City， Hebei Province， Baoding 071000， China； 2.Department of Pediatrics， the First Hospital of Qinhuangdao City， Hebei Province， Qinhuangdao 066000， China
　　[Abstract] Objective To observe the effect of low-frequency repetitive transcranial magnetic stimulation （rTMS） of different frequency on bone metabolism， lipid metabolism and quality of life of children with epilepsy. Methods From March 2014 to March 2017， 156 children with epilepsy in the First Central Hospital of Baoding City were selected， and randomly divided into the control group （50 cases）， 0.5 Hz group （53 cases） and 1.0 Hz group （53 cases）. On the basis of the original antiepileptic treatment scheme， the control group was treated with sham stimulation， 0.5 Hz group was treated with rTMS of 0.5 Hz， and 1.0 Hz group was treated with rTMS of 1.0 Hz， all three groups were treated for 3 months. The seizure frequency of epilepsy and incidence of headache， bone metabolism indexes [calcium （Ca）， phosphorus （P）， alkaline phosphatase （ALP）]， lipid metabolism indexes [total cholesterol （TC）， triacylglycerol （TG）， low density lipoprotein cholesterol （LDL-C）]， and scores of the pediatric quality of life inventory measurement models （PedsQL4.0） before and after treatment in the three groups were compared. Results After treatment， the seizure frequency of epilepsy in the three groups was all lower than before treatment （P < 0.05）， and the seizure frequency of epilepsy in the 1.0 Hz group was lower than those in the control group and 0.5 Hz group （P < 0.05）， the incidence of headache in the three groups was compared， the difference was not statistically significant （P > 0.05）. In levels of Ca， P， ALP， TC， TG and LDL-C in the three groups before and after treatment and between groups after treatment were compared， the difference were not statistically significant （P > 0.05）. After treatment， The PedsQL4.0 each dimension score in three groups were higher than those before treatment （P < 0.05）， and the 1.0 Hz group was higher than those of the control group and 0.5 Hz group（P < 0.05）. Conclusion The rTMS of 1.0 Hz can reduce the seizure frequency of epilepsy and improve the quality of life of children. It has no obvious effect on lipid metabolism and bone metabolism in short term.

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