高频rTMS联合度洛西汀对青年首发广泛性焦虑障碍的疗效及认知功能的影响  

Clinical efficacy of high-frequency rTMS combined with duloxetine for adolescents with first-episode generalized anxiety disorder and its effect on cognitive function

作　　者：徐彩霞[1] 汤超华 俞洋[1] 黎润仪[1] 邓丹文 谢国军[1] Xu Caixia;Tang Chaohua;Yu Yang;Li Runyi;Deng Danwen;Xie Guojun(The Third People’s Hospital of Foshan,Foshan 528041,China)

机构地区：[1]广东省佛山市第三人民医院,广东佛山528041

出　　处：《四川精神卫生》2020年第4期326-329,共4页Sichuan Mental Health

基　　金：佛山市医学类科技攻关项目(项目名称:青年期广泛性焦虑障碍的认知缺陷、内分泌变化的关联影响及干预研究,项目编号:2018AB002871);佛山市十三五医学重点专科和特色专科建设(项目编号:FSTSZK002)。

摘　　要：目的探讨高频重复经颅磁刺激(rTMS)联合度洛西汀对青年首发广泛性焦虑障碍(GAD)的临床疗效、安全性及对认知功能的影响。方法将符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的90例首发青年患者分为研究组和对照组,研究组接受高频rTMS(10 Hz)联合度洛西汀治疗,对照组接受伪经颅磁刺激联合度洛西汀治疗,观察期4周。于治疗前采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁状况,治疗前和治疗第1、2、4周末采用汉密尔顿焦虑量表(HAMA)评定疗效,治疗前和治疗第4周末使用MATRICS共识认知成套测验(MCCB)评定认知功能,治疗第4周末采用副反应量表(TESS)评定不良反应。结果治疗后各时点,两组HAMA评分均较同组治疗前低(P均<0.01)。治疗4周末,研究组治疗总有效率高于对照组(88.89%vs.73.81%,χ^2=2.100,P=0.040),研究组推理及问题解决、社会认知领域评分均高于对照组(P均<0.05)。治疗后,两组TESS评分比较差异无统计学意义[(2.48±0.86)分vs.(2.14±0.78)分,χ^2=0.640,P=0.420]。结论高频rTMS联合度洛西汀对GAD的疗效更好,且有助于改善推理及问题解决、社会认知等认知功能。Objective To investigate the clinical efficacy and safety of high-frequency repetitive transcranial magnetic stimulation(r TMS)combined with duloxetine for adolescents with first-episode generalized anxiety disorder(GAD),and to analyze its effect on cognitive function.Methods A total of 90 adolescents who met the diagnostic criteria of the International Classification of Diseases,tenth edition(ICD-10)for first-episode GAD were included,and divided into two groups.Study group received highfrequency rTMS(10 Hz)combined with duloxetine,whereas control group received pseudo r TMS combined with duloxetine for 4 weeks.Hamilton Depression Scale-17 item(HAMD-17)was used to assess the depressive symptoms before the treatment.Hamilton Anxiety Scale(HAMA)was used to evaluate efficacy at the baseline and the 1 st,2 ndand 4 thweekend of the treatment.MATRICS Consensus Cognitive Battery(MCCB)was used to evaluate cognitive function at the baseline and the 4 thweekend of treatment,and TESS was used to evaluate adverse reactions at the 4 thweekend of treatment.Results Compared with baseline data,HAMA scores were decreased in both groups after treatment(P<0.01).At the 4 thweekend of treatment,the total response rate of study group was higher than that of control group(88.89%vs.73.81%,χ^2=2.100,P=0.040),and the scores of reasoning,problem solving and social cognition of study group were higher than those of control group(P<0.05).After treatment,TESS score showed no significant difference between groups[(2.48±0.86)vs.(2.14±0.78),χ^2=0.640,P=0.420].Conclusion High-frequency rTMS combined with duloxetine has a better efficacy on GAD,and it can effectively improve cognitive functions such as reasoning,problem solving and social cognition.

关 键 词：高频重复经颅磁刺激 广泛性焦虑障碍 认知功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]