高频重复经颅磁刺激治疗脑卒中后抑郁的疗效及其脑事件相关电位康复评价  

The effects of repetitive high-frequency magnetic stimulation in treating post-stroke depression and their evaluation using event-related potentials

作　　者：王绍昌 张惠芳 陈兴时[2] 陈冲[2] 劳成明 彭滔 Wang Shaochang;Zhang Huifang;Chen Xingshi;Chen Chong;Lao Chengming;Peng Tao(Department of Psychiatry,Yiwu Mental Health Center,Zhejiang 322000,China;Department of Electrophysiology,Shanghai Mental Health Center,Shanghai 200030,China)

机构地区：[1]浙江义乌市精神卫生中心康复医学科,浙江义乌322000 [2]上海交通大学附属精神卫生中心神经生理室,上海200030

出　　处：《中华物理医学与康复杂志》2020年第8期705-709,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金委员会面上项目资助(81471357)。

摘　　要：目的:探讨事件相关电位(ERP)用于高频重复经颅磁刺激(rTMS)治疗脑卒中后抑郁的价值。方法:将入选的义乌市精神卫生中心64例卒中后抑郁患者根据随机数表法分为观察组和对照组,每组32例,另选取35例健康志愿者作为健康组。对照组给予文拉法辛(Venlafaxine)药物治疗,150 mg/d缓释顿服,治疗6周;观察组在给予文拉法辛药物治疗基础上给予高频rTMS治疗,共治疗6周30次。分别于治疗前及治疗3周和治疗6周后(治疗后),对2组患者采用汉密尔顿抑郁量表第17版(HAMD-17)评分进行疗效评定,并采用视觉P300检测方法评定和比较2组患者治疗前后的失配性负波(MMN)、视觉P300指标的变化及其与健康组的差异。结果:治疗后,2组患者的HAMD-17评分均明显降低,且观察组改善更显著(P<0.05)。治疗后,观察组总有效率(87.5%)明显优于对照组(62.5%),组间差异有统计学意义(P<0.05)。治疗前,2组患者MMN中的中央点(Cz)和头皮额点(Fz)的潜伏期均明显延迟,波幅明显低于健康组,且差异均有统计学意义(P<0.05),但2组患者间比较,差异无统计学意义(P>0.05)。治疗后,观察组Fz脑区波幅升高潜伏期前移,与治疗前及对照组比较,差异均有统计学意义(P<0.05)。对照组治疗前后的MMN比较,差异无统计学意义(P>0.05)。治疗前,2组患者的枕区(Oz)视觉P300的P2、P3潜伏期均明显长于健康组,波幅明显低于健康组(P<0.05)。观察组治疗后的靶潜伏期P2、靶潜伏期P3、靶波幅P3分别为(180.2±22.2)ms、(329.3±39.1)ms、(6.1±2.2)μV,分别与组内治疗前[(190.1±25.2)ms、(355.1±44.2)ms、(2.9±1.5)μV]比较,差异有统计学意义(P<0.05)。对照组的视觉P300治疗前后比较,差异无统计学意义(P>0.05)。结论:高频rTMS治疗脑卒中后抑郁有一定疗效,MMN和视觉P300可用于脑卒中后抑郁的康复评价。Objective To investigate the value of event-related brain potentials(ERPs)for evaluating the effect of repeated high-frequency transcranial magnetic stimulation(rTMS)in treating post-stroke depression.Methods Sixty-four depressed stroke survivors were divided at random into an observation group and a control group,each of 32.Thirty-five healthy volunteers constituted a healthy control group.All of the patients were treated with 150mg/d of venlafaxine for 6 weeks.The observation group was additionally given rTMS five times a week for 6 weeks.Before and after the treatment,both patient groups were evaluated using the Hamilton depression scale(HAMD-17)as well as the visual P300.Results After the treatment the average HAMD-17 scores of the two patient groups had decreased significantly,but with significantly greater improvement in the observation group.The total effective rate of the observation group after treatment(87.5%)was significantly higher than the control group′s rate(62.5%).Before the treatment the latency and amplitude of Cz and Fz in both patient groups was significantly delayed and lower than in the healthy group.After the treatment the average Fz amplitude in the observation group had risen and the latency had moved forward significantly compared with the other two groups.No significant differences were observed among the control group before and after the treatment.Before the treatment the average P2 and P3 latencies of the two patient groups were significantly longer than in the healthy group,while the amplitudes were significantly lower.After the treatment the average latency of P2 and the average P3 latency and amplitude of the observation group were significantly better than before the treatment.No significant differences were observed in the healthy control group.Conclusions High-frequency rTMS can affect post-stroke depression.The MMN and visual P300 instruments can be used for rehabilitation evaluation.

关 键 词：经颅磁刺激 脑卒中后抑郁 视觉P300 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]