扩散张量成像评估重复经颅磁刺激治疗食管癌相关抑郁疗效及微结构影响  

Evaluation of the therapeutic effects and micro-structural influence of rTMS on esophageal cancer patients with depression by using DTI

作　　者：胡凯[1] 杨健筌 郭志伟 李光明 母其文 HU Kai;YANG Jianquan;GUO Zhiwei;LI Guangming;MU Qiwen(De partment of Radiology,Nanbu People's Hos pital,Nanchong,Sichuan Province 637300,China;De partment of Oncology,Nanchong Central Hospital,Nanchong,Sichuan Province 637000,China;Department of Medical Imaging,Nanchong Central Hospital,Nanchong,Sichuan Prorince 637000,Chima)

机构地区：[1]南部县人民医院放射科,四川南充637300 [2]南充市中心医院肿瘤分院肿瘤科,四川南充637000 [3]南充市中心医院医学影像科,四川南充637000

出　　处：《实用放射学杂志》2019年第11期1719-1722,1773,共5页Journal of Practical Radiology

基　　金：四川省科技厅应用基础研究项目(2011HH0017,2012JY0044).

摘　　要：目的采用DTI探讨重复经颅磁刺激(rTMS)治疗食管癌相关抑郁患者的疗效及对大脑组织微结构的影响.方法纳入符合标准的食管癌相关抑郁患者10例(男6例,女4例).所有入组患者均给予连续10 d的rTMS治疗(刺激频率10 Hz,刺激左侧背外侧前额叶皮层,刺激强度110%静息运动阈值).入组前及rTMS治疗后,所有患者均接受DTI图像采集及汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评估.对比rTMS治疗前后抑郁相关脑区的FA值,计算rTMS治疗后上述脑区内FA值改变量与临床抑郁评分改变量之间的相关系数.结果rTMS治疗后HAMD、SAS及SDS评分较治疗前均显著降低(t=7.69,P=0.000;t=12.86,P=0.000;t=10.51,P=0.000).FA值图像对比结果显示,rTMS治疗后食管癌相关抑郁患者在双侧海马、左侧苍白球、双侧丘脑、右侧额中叶、双侧前扣带回、双侧颞上回皮层的FA值显著升高.且左侧苍白球、右侧丘脑的FA值改变量分别与SAS值(r=-0.646,P=0.044)、HAMD值(r=-0.712,P=0.021)的改变量显著负相关.结论高频rTMS对食管癌相关性抑郁患者具有明显的抗抑郁疗效,其作用可能与rTMS对左侧苍白球、右侧丘脑白质微结构的影响有关.Objective To investigate the therapeutic effects of repetitive transcranial magnetic stimulation(rTMS)on esophageal cancer patients with depression and the influence on the brain micro-structure by using the DTI technology.Methods Ten esophageal cancer patients with depression(6 male,4 female)were enrolled in this study according to the inclusion criteria.All patients received 10 days of rTMS treatment(stimulation frequency:10 Hz;stimulation site left:dorsolateral prefrontal cortex(DLPFC);stimulation intensity:110%rest motor threshold).Before the first time and after the last time of the rTMS treatment,the DTI image acquisition and the coefficient assessment of hamilton depression scale(HAMD),self-rating depression scale(SDS),and self-rating anxiety scale(SAS)were conducted.Comparison of the mean fractional anisotropy(FA)of the depression related brain regions between pre-and post-rTMS was performed.Pearson correlation coefficient was calculated between the changes of FA value and the depression scale changes as well to understand their relationship.Results The HAMD,SAS and SDS were significantly decreased after pos-t rTMS(t=7.69,P=0.000;t=12.86,P=0.000;t=10.51,P=0.000)compared with pre-rTMS.Also,after rTMS depression patients showed significantly increased FA value in the bilateral hippocampus,left pallidum,bilateral thalamus,left middle frontal cortex,bilateral anterior cingulate cortex,and bilateral superior temporal cortex.Significant negative correlation was observed between the FA changes of the left pallidum and SAS(r=-0.646,P=0.044),and between the FA changes of right thalamus and HAMD(r=-0.712,P=0.021).Conclusion High frequency rTMS over the left DLPFC has significant antidepressant effect on esophageal cancer patients with depression.This may be related to the modulation of rTMS on the micro-structure of the left pallidum and right thalamus.

关 键 词：食管癌 抑郁 重复经颅磁刺激 扩散张量成像 

分 类 号：R735.1[医药卫生—肿瘤] R749.4[医药卫生—临床医学]