重复经颅磁刺激联合碳酸锂、喹硫平治疗双相障碍抑郁发作的4周单盲随机对照试验  

A 4-week single-blind randomized controlled trial of repetitive transcranial magnetic stimulation combined with lithium and quetiapine in treatment of patients with bipolar depression

作　　者：李凝[1,2] 王学义[1,2] 秦振洲[1,2] 宋美[1,2] 

机构地区：[1]河北医科大学第一医院精神卫生科 [2]河北医科大学精神卫生研究所,河北省脑老化与认知神经科学重点实验室,石家庄050031

出　　处：《中国心理卫生杂志》2013年第12期896-900,共5页Chinese Mental Health Journal

基　　金：河北省医学科学研究重点课题计划(08273)(20090334)

摘　　要：目的:探讨重复经颅磁刺激(rTMS)联合碳酸锂、喹硫平治疗双相障碍抑郁发作的疗效。方法:本研究为单盲随机对照试验。选取符合精神障碍诊断与统计手册第4版(DSM-IV)双相障碍Ⅰ型或Ⅱ型抑郁发作患者67例,随机分为rTMS组(n=33)和伪rTMS组(n=34),接受碳酸锂[(0.8±0.1)mmol/L vs.(0.8±0.2)mmol/L)]和喹硫平[(333.3±87.4)mg/d vs.(343.1±94.2)mg/d]治疗。rTMS组接受右侧背外侧前额叶皮层rTMS刺激,伪rTMS组接受相同部位的伪线圈刺激,每周5次,连续4周。治疗前及治疗第1、2、3、4周末对两组患者进行汉密顿抑郁量表(HAMD)、Bech-Rafaelsen躁狂量表(BRMS)评估,分别累计合并使用氯硝西泮片剂量。治疗前和治疗4周末对两组患者评估匹兹堡睡眠质量指数量表(PQSI),记录治疗中的不良事件。治疗4周末HAMD<8分定义为治愈。结果:治疗第2周[(27.6±4.6)vs.(30.9±5.8)]、第3周[(19.8±3.9)vs.(22.5±5.2)]、第4周[(10.3±3.0)vs.(12.6±5.3)]末,rTM S组HAM D评分均低于伪rTM S组(均P<0.05)。第4周末,rTM S组治愈率高于伪rTMS组(73.0%vs.44.8%,P<0.05)。第4周末,rTMS组PQSI评分低于伪rTMS组[(2.5±1.4)vs.(3.5±1.9),P<0.05]。第2周[(8.7±4.8)mg vs.(10.0±4.1)mg]、第3周[(2.7±1.8)mg vs.(3.9±1.6)mg]、第4周[(1.0±0.9)mg vs.(2.0±1.4)mg]末,rTMS组使用氯硝西泮剂量均低于伪rTMS组(均P<0.05)。两组不良反应发生率差异无统计学意义(10.0%vs.6.9%,P>0.05)。结论:低频rTM S联合碳酸锂、喹硫平治疗双相障碍抑郁发作有较好疗效,并可改善睡眠,具有良好的耐受性。[Abstract] Objective： To explore the efficacy of repetitive transcranial magnetic stimulation （rTMS） com- bined with lithium and quetiapine for bipolar depression. Methods： In this single-blind randomized controlled trial,67 patients with depressive episode for bipolar I or bipolar II meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） criteria were randomly divided into rTMS group （n = 33） and sham rTMS group （n = 34） on the right dorsolateral prefrontal cortex （DLPFC） during 4 weeks. All patients received treatment of lithium （plasma levels [（0. 8 ±0. 1） mmol/L vs. （0. 8 ±0. 2） mmol/L）] and quetiapine [（333.3 ±87. 4） mg/d vs. （343.1±94. 2） mg/d]. The rTMS group received 20 sessions （5 sections per week） of 1 Hz （80% motor threshold and 1500 pulse per session）. Sham stimulation followed the same schedule, however, using a sham coil without any magnetic field. The efficacy was evaluated with the Hamilton Depression Rating Scale-24 i- tems （HAMD）, Pittsburgh sleep quality index （PQSI） and Bech-Rafaelsen Mania Raring Scal （BRMS）. The side effect during the treatment was recorded. Subjects were followed up in time point of before treatment and 1 st, 2ed, 3th and 4th week after treatment. Remission was defined as a HAMD total score 8. Results： After treatment, the rT- MS group showed a significantly faster reduction than the sham [（27.6 ±4. 6） vs. （30. 9 ±5.8）, （19. 8 ±3.9） vs. （22. 5 ±5.2）, （ 10. 3 ±3.0） vs. （ 12. 6 ±5.3）, P 〈 0. 05] in HAMD scores from 2th to 4th week. The remission rates in the rTMS group were significantly higher than the sham after the stimulation period （73.0% vs. 44. 8%, P 〈0.05）. The dose of clonazepam administrated in the rTMS group was lower than that in the sham group at the end of 2ed [（8.7±4.8） mg vs. （10.0±4. 1） mg],3rd [（2.7±1.8） mg vs. （3.9±1.6） mg] and 4th [（1.0 ± 0. 9） mg vs. （2.0 ±1.4） mg] week （Ps 〈0. 0

关 键 词：重复经颅磁刺激 双相障碍抑郁发作 心境稳定剂 喹硫平 疗效 随机对照试验 

分 类 号：R749.4[医药卫生—神经病学与精神病学]