高、低频重复经颅磁刺激治疗帕金森病伴发抑郁障碍的研究  

A study on high-and low-frequency repetitive transcranial magnetic stimulation in the treatment of Parkinson's disease complicated with depressive disorder

作　　者：汤义平[1] 陈倩倩[1] 曹敏敏[1] 赵群峰[1] 裘银虹[2] 

机构地区：[1]浙江省台州市第二人民医院心身科,浙江天台317200 [2]浙江省天台县人民医院神经内科,浙江天台317200

出　　处：《中国现代医生》2015年第3期7-10,15,共5页China Modern Doctor

基　　金：浙江省医学会临床科研资金项目(2011ZYCA115)

摘　　要：目的比较高、低频重复经颅磁刺激(r-TMS)治疗帕金森病伴发抑郁障碍的疗效和临床安全性。方法将92例帕金森病伴发抑郁障碍的患者随机分为三组:采用抗震颤麻痹药联合高频(5Hz)重复经颅磁刺激治疗(高频组);采用抗震颤麻痹药联合低频(0.5Hz)重复经颅磁刺激治疗(低频组);采用抗震颤麻痹药联合假性经颅磁刺激治疗(假刺激组)。各组r-TMS每周治疗2次,共治疗4周。每2周评定UPDRS、HAMD-17,记录不良反应,治疗4周后作临床评价。结果入组时三组患者HAMD得分和UPDRS得分差异无显著性(P>0.05)。干预后第2周高频刺激组HAMD得分有明显改善,差异有统计学意义(P=0.0144),第4周差异进一步扩大,差异有极显著性意义(P=0.0000);干预后第2周UPDRSⅡ得分高频、低频和假刺激组差异无统计学意义(P=0.1981),第4周经单因素方差分析差异无统计学意义(P=0.0219)。干预后第2周及第4周UPDRSⅢ得分三组得分差异无统计学意义(P=0.6105、0.4248)。三组不良反应发生率低,无明显差异(P>0.05)。结论左前额叶背外侧高频磁刺激具有改善帕金森患者的抑郁症状,对日常生活的能力亦有所改善,临床疗效确切且不良反应少。Objective To compare the curative effect and safety of high-frequency and low-frequency repetitive tran-scranial magnetic stimulation（r-TMS） in the treatment of Parkinson＆#39;s disease complicated with depressive disorder. Methods All 92 patients with Parkinson＆#39;s disease complicated with depressive disorder were randomly allocated to three groups. High frequency group received antiparkinsonian drugs combined with high frequency r-TMS （5 Hz）;Low frequency group received antiparkinsonian drugs combined with low frequency r-TMS （0.5 Hz）;Sham group re-ceived antiparkinsonian drugs combined with sham r-TMS （s-rTMS）. Each group received r-TMS twice a week for four weeks. UPDRS and HAMD-17 were assessed every two weeks , adverse events were recorded , and clinical global im-pression was carried out four weeks after the treatment. Results Upon enrollment, scores of HAMD and UPDRS among the three groups were not significantly different （P〉0.05）. During the second week of the intervention, the HAMD score in high frequency group improved significantly , and the differences between three groups were statistically signif-icant according to one-way ANOVA （P=0.0144）. The differences changed larger in the fourth week, with greatly sig-nificant differences between the two groups （P=0.0000）;During the second week of the intervention, the differences of UPDRSⅡscores in high frequency, low frequency and sham group were not statistically significant according to one-way ANOVA （P=0.1981）. The differences appeared in the fourth week, but the differences between groups were not statistically significant according to one-way ANOVA （P=0.0219）. During the second week and the fourth week of the intervention, UPDRS Ⅲ scores in the three groups were not significantly different （P=0.6105, 0.4248 respectively）.＆amp;nbsp;Adverse events in the three groups were rare, and the differences were not statistically significant. Conclusion High-frequency stimulation on dorsal-lateral left prefronta

关 键 词：帕金森病 抑郁障碍 重复经颅磁刺激(r-TMS) 高频 低频 

分 类 号：R742.5[医药卫生—神经病学与精神病学]