经颅直流电刺激对脑小血管病患者执行功能和TREM2相对表达水平的影响及其相关性研究OA

Objective To investigate the effects of transcranial direct current stimulation(tDCS)on executive function(EF)and the relative expression level of triggering receptor expressed on myeloid cells 2(TREM2)in patients with cerebral small vessel disease(CSVD),and to explore their correlation.Methods A total of 43 CSVD patients from the outpatient and inpatient depart-ments of Mental Health Center of Jiangnan University(Wuxi Mental Health Center)between May 2022 and December 2023 were enrolled.The patients were divided into control group with 21 cases and experimental group with 22 cases using the random number table method.During the treatment,one case dropped out from the control group and two from the experimental group,resulting in 20 cases included in each group for final analysis.Both groups received conventional medication and cognitive training(30 min per session,once daily,5 days per week for 4 weeks).The experimental group additionally received tDCS treatment concurrent with cog-nitive training,with a current intensity of 2 mA,30 min per session,once daily,5 days per week for 4 weeks.The control group received sham tDCS during cognitive training,with identical equipment,procedures,duration,frequency,and period as the experi-mental group.To mimic the slight tingling sensation of real stimulation and ensure blinding,the control group received a 30-second current ramp-up(0→2 mA)at the beginning and a 30-second current ramp-down(2→0 mA)at the end,with 0 mA current for the remainder of the session.Before and after treatment,EF impairment was assessed using the Executive Interview-25(EXIT25);glob-al cognitive impairment was assessed using the Mini-Mental State Examination(MMSE);EF was assessed using the Stroop Color-Word Test(SCWT);the relative expression level of TREM2 was measured by enzyme-linked immunosorbent assay;and adverse reactions were recorded using a tDCS experience questionnaire.Results Compared with pre-treatment,EXIT25 scores decreased in both groups after treatment(P<0.05).Compared with the control group,the experimental group showed a lower EXIT25 score after treatment(P<0.05).Compared with pre-treatment,MMSE scores increased in both groups after treatment(P<0.05);there was no significant difference in MMSE scores between the two groups after treatment(P>0.05).Compared with pre-treatment,both groups showed reduced reaction time for both congruent and incongruent conditions in the SCWT after treatment(P<0.05),while no significant differences were found in accuracy between the congruent and incongruent conditions of the SCWT(P>0.05).Compared with the control group,the experimental group showed a shorter congruent reaction time in the SCWT after treatment(P<0.05).Compared with pre-treatment,the relative expression level of TREM2 increased in both groups after treatment(P<0.05).Compared with the control group,the experimental group had a lower TREM2 relative expression level before treatment(P<0.05).Compared with the control group,the experimental group showed a greater change(post-treatment minus before treatment)in the relative expression level of TREM2(P<0.05).In the experimental group,the change in TREM2 relative expression level was negatively cor-related with changes in EXIT25 scores,congruent reaction time,and incongruent reaction time(P<0.05).No adverse reactions were reported in the control group.In the experimental group,mild tingling was reported by 20 cases(100%),itching by 13 cases(65%),a burning sensation by 12 cases(60%),drowsiness by 1 cases(5%),and skin redness by 15 cases(75%).Conclusion tDCS can improve EF in CSVD patients,and its mechanism may be related to the modulation of the relative expression level of TREM2.