rTMS联合抗抑郁剂治疗对重性抑郁障碍神经可塑性影响的研究  

Study the Effects of Neuroplasticity on Major Depression Disorder in rTMS Combined with Antidepressant Treatments

作　　者：郑博 郑重[2,3] 邹可[2,3] 鄢婷婷[2] 莫丽玲[2] 陈喆思[4] 孙学礼[2] 

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西医院心理卫生中心,成都610041 [3]四川大学华西医院睡眠医学中心,成都610041 [4]成都中医药大学针灸推拿学院,成都610072

出　　处：《四川大学学报（医学版）》2013年第4期596-601,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(No.30770778)资助

摘　　要：目的采用事件相关电位(ERPs)失匹配负波(MMN)、感觉门控电位P50探讨重复经颅磁刺激(rTMS)联合抗抑郁剂治疗对重性抑郁障碍(MDD)神经可塑性的影响。方法 159例MDD患者随机分为2组,A组75例给予2周(15d)rTMS治疗,并常规持续给予选择性5-羟色胺重摄抑制剂(SSRI)抗抑郁药物治疗,B组84例仅给予足量同类抗抑郁剂治疗。两治疗组于治疗前、治疗后第2周和第10周进行24项Hamilton抑郁量表(HAMD)、MMN潜伏期、S1-P50波幅、S2-P50波幅、S2-P50/S1-P50波幅比值和异常P50(S2-P50/S1-P50≥0.5)百分率评估和测试。同时设90例正常对照组(C组)。结果 A和B组治疗2周后和10周后,HAMD评分均低于治疗前(P<0.001),且治疗后A组评分低于B组(P<0.001)。A组MMN潜伏期和S2-P50波幅均较治疗前和B组治疗后缩短和降低(P<0.05)(除外治疗后10周S2-P50波幅的组间比较)。A组治疗后S2-P50/S1-P50比值(除外治疗后2周)和异常P50百分率与C组间的差异无统计学意义(P>0.05);A组治疗后2周和10周间各ERPs指标差异无统计学意义(P>0.05)。B组治疗后各ERPs指标与治疗前比较差异无统计学意义(P>0.05)。结论 rTMS联合抗抑郁剂治疗优于单纯抗抑郁剂治疗,并显著改善与自动加工、感觉门控有关的大脑高级功能电生理指标。rTMS可能对大脑诱导长时程增强/长时程抑制样可塑效应,使脑功能处于动态的稳定和平衡。MMN和P50可能成为反映与大脑高级功能有关的神经可塑性指标。Objective To explore the effects of neuroplasticity on major depression disorder （MDD） with event related potentials （ERPs） of mismatch negativity （MMN） and sensory gating potentials P50 for repetitive transcranial magnetic stimulation （rTMS） combined with antidepressant treatments. Methods A total of 159 patients with MDD randomly divided into two groups： 75 patients in group A was administrated rTMS treatment for 2 weeks （15 days）, and continues tO give antidepressant of selective serotonin reuptake inhibitor （SSRI） regularly. 84 patients in group 13 was consistently administered the similar antidepressant. The 24-item Hamilton Depression Scale （HAMD-24）, MMN latency, S1-P50 amplitude, S2-P50 amplitude and S2-P50/S1-P50 amplitude ratio, and the percentages of abnormal P40 （S2-P50/S1-P50≥0.5） were assessed and measured before treatment, at the 2nd and the 10th weekend after treatment in two treatment groups. Meanwhile, 90 normal control cases was set up as control group （group C）. Results At 2th and 10th week after treatment, the HAMD-24 scores were reduced remarkably than those before treatment in group A and B （P〈0. 001）, and the scores in group A was lower than that in group B （P〈0. 001）. MMN latencies and S2-P50 amplitudes after treatment in group A were significant shorter and lower than those before treatment in group A and after treatment in group B （P〈0.05） （except for intergroup comparison of $2-P50 amplitude after treatment 10 weeks ）. No significant difference was found in S2- P50/S1-P50 ratio （ except for after treatment 2 weeks ） and percentage of abnormal Ps0 between group A after treatment and group C （P〈0.05）. There were no statistical significance difference of ERPs between after treatment 2 weeks and 10 weeks in group A （P〉0.05）. No statistical differences of ERPs between before and after treatment in group B （P〉0. 05） was observed. Conclusion rTMS combined with antidepressant therapy was superior to single anti

关 键 词：重性抑郁障碍 重复经颅磁刺激 抗抑郁剂治疗 可塑性 

分 类 号：R749.4[医药卫生—神经病学与精神病学]