对帕金森病伴抑郁患者行重复经颅磁刺激疗效的探讨及其磁共振波谱分析研究  

Clinical efficacy of repetitive transcranial magnetic stimulation in treatment of depres­sion in Parkinson's disease and the study of magnetic resonance spectroscopy analysis

作　　者：汤俊芬[1] 郑伟坤[2] 张瑾[3] 敖娟[1] 欧阳樱君[1] 陈杰[1] 罗晓丽 TANG Junfen;ZHENG Weikun;ZHANG jin(Department of Neurology,Guangzhou First People's Hospital,Guangzhou(511457),Guangdong China)

机构地区：[1]广州市第一人民医院神经内科,广东广州511457 [2]广州市第一人民医院骨科,广东广州511457 [3]广州市第一人民医院康复科,广东广州511457

出　　处：《癫痫与神经电生理学杂志》2020年第6期333-337,共5页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：的:探讨低频重复经颅磁刺激(rTMS)治疗帕金森病伴抑郁(DPD)的临床效果,并研究磁共振波谱分析(MRS)对病情、转归判断的作用。方法:将DPD患者随机分为两组,对照组接受传统抗抑郁药物治疗,观察组在药物治疗基础上,加用低频rTMS治疗。治疗前及治疗3周后,所有患者均行汉密尔顿抑郁量表17项(HAMD-17)评价,同时行MRS检测所有患者脑内Cho/Cr含量,计算Cho/Cr的比值,并作Cho/Cr与HAMD-17的相关性分析。结果:治疗前,两组DPD患者HAMD-17评分和Cho/Cr比值的组间差异均无统计学意义(P>0.05)。治疗后.两组患者的HAMD-17评分和Cho/Cr比值均下降,且观察组低于对照组,差异有统计学意义(P<0.05)。同时,治疗后Cho/Cr与HAMD-17评分呈正相关(r=0.849,P<0.001)。结论:低频rTMS与抗抑郁药物联用能有效减轻DPD的临床症状,同时经治疗后的Cho/Cr比值与HAMD-17评分呈正相关。Objective:To explore the clinical effect of low frequency repetitive transcranial mag­netic stimulation(rTMS)in the treatment of depression in Parkinson's disease(DPD),and to study the effect of magnetic resonance spectroscopy(MRS)on the judgment of disease condition and progno­sis.Methods:The patients were randomly divided into the study group(with combined treatment of antidepressant drugs and low frequent rTMS)and the control group(with antidepressant drugs).Be­fore and three weeks after treatment,all cases were examined by Hamilton Depression Scale 17(HAMD17)and MRS,which choline-congtaining compounds(Cho)and creatine compounds(Cr)were measured.Meanwhile,the ratio of Cho/Cr was calculated and the correlation between Cho/Cr and the scale was analyzed.Results:There was no significant difference between the two groups in the scores of H AMD17 and the ratio of Cho/Cr before treatment(P>0.05).After treatment,the scores of HAMD17 and the ratio of Cho/Cr were reduced in both groups.There was significant difference before and after treatment in each group(P<0.05).However,the scores of HAMD17 and the ratio of Cho/Cr in the study group were lower than those in the control group.There was significant differ­ence between two groups after treatment(P<0.05).The scores of HAMD17 were positively correla­ted with the ratio of Cho/Cr(r=0.849,P<0.001).Conclusion:The combined therapy of low fre­quent rTMS and antidepressant drugs can effectively reduce the clinical symptoms of DPD.The Cho/Cr ratio measured by MRS has a positive correlation with HAMD17.The Cho/Cr ratio is expected to be one of the objective indicators of DPD evaluation.

关 键 词：重复经颅磁刺激(rTMS) 帕金森病伴抑郁(DPD) 磁共振波谱分析(MRS) 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]