重复经颅磁刺激治疗对孤独症谱系障碍儿童大脑认知功能及行为能力的影响

关键词：孤独症谱系障碍  儿童  重复经颅磁刺激  认知功能  行为问题

Keywords:autism spectrum disorder  children  repeated transcranial magnetic stimulation  cognitive function  behavior problem

摘要：

      摘要 目的：探讨应用重复经颅磁刺激（rTMS）治疗对孤独症谱系障碍（ASD）儿童认知功能及行为能力的影响。 方法：选取2022年1月—2024年5月我院儿童神经康复门诊招募的74例ASD儿童作为研究对象，并按照随机数字表顺序分配至观察组和对照组中，各37例。对照组采用常规康复治疗及创造性游戏干预，观察组则在此基础上联合rTMS治疗6个月。采用OSU孤独症评定量表-Ⅳ（OARS-4）和0—6岁儿童神经行为发育量表-Ⅱ评估ASD患儿行为问题的严重程度及认知功能发育水平。 结果：观察组和对照组一般资料比较差异无显著性意义（P>0.05）；经双因素重复测量方差分析结果显示，两组的社交障碍、交流障碍、刻板行为评分和总平均得分在组内不同时间点呈降低趋势，且差异均有显著性意义（P<0.05）；治疗1个月后观察组的交流障碍评分显著低于对照组（P<0.05）；治疗3个月后，观察组交流障碍评分和总平均得分显著低于对照组（P<0.05）；治疗6个月后，观察组社交障碍、交流障碍、刻板行为评分和总平均得分均显著低于对照组（P<0.05）。观察组和对照组在组内不同时间点的适应性、大运动、精细动作和语言评分均呈升高趋势，差异有显著性意义（P<0.05），但两组患儿在治疗1个月后的适应性、大运动、精细动作、语言与个人社交评分比较差异均无显著性意义（P>0.05）；治疗3个月后，观察组适应性评分显著高于对照组（P<0.05）；治疗6个月后，观察组适应性和语言评分显著高于对照组（P<0.05）。 结论：在常规康复治疗及创造性游戏干预的基础上联合rTMS治疗有助于改善ASD儿童行为问题及认知功能发育障碍，治疗效果显著。

Abstract:

      Abstract Objective：To investigate the effects of repetitive transcranial magnetic stimulation （rTMS） on cognitive function and behavioral outcomes in children with autism spectrum disorder （ASD）. Method： A total of 74 children with ASD recruited from the Children's Neurological Rehabilitation Clinic of Nanyang First People's Hospital from January 2022 to May 2024 were enrolled in this prospective study. Participants were randomly assigned to either the observation group (n=37) or the control group (n=37) using a random number table. The control group received routine rehabilitation therapy combined with creative play intervention， whereas the observation group received additional rTMS for 6 months. Behavioral symptoms and cognitive developmental levels were assessed using the OSU Autism Rating Scale-Ⅳ （OARS-4） and Development Scale for Children age 0-6 years-Ⅱ. Result：There was no significant difference in general information between the observation group and control group （P>0.05）. Two-way repeated-measures analysis of variance (ANOVA) showed significant reductions over time in social disorder， communication disorder， stereotypical behavior and total OARS-4 scores in both groups （all P<0.05）. After 1 month of treatment， the communication disorder score was significantly lower in the observation group than in the control group （P<0.05）. After 3 months， the observation group showed significantly lower communication disorder score and total OARS-4 scores than the control group （P<0.05）. After 6 months， the stereotyped behavior scores and total OARS-4 of the observation group were lower than the control group （P<0.05）. The scores of adaptability， gross motor， fine motor and language in both groups showed an increasing trend at different time points（all P<0.05）. But there was no statistical significance in adaptability， gross motor， fine motor， language and personal social score of the two groups after 1 month of intervention （all P>0.05）. After 3 months， the fine motor score of observation group was higher than the control group （P<0.05）. After 6 months， the observation group demonstrated significantly higher adaptability and language scores than the control group （P<0.05）. Conclusion：Adjunctive rTMS combined with routine rehabilitation therapy and creative play intervention may effectively improve behavior problems and cognitive developmental function in children with ASD.