舍曲林联合重复经颅磁刺激治疗对持续性躯体形式疼痛障碍患者神经电生理的影响  

Effects of sertraline combined with repetitive transcranial magnetic stimulation on neuroelectrophysiology in patients with persistent somatoform pain disorder

作　　者：黄佳茜 白新刚 郭鸿[3] 李涓[4] 金荣疆[4] 郑重[1] HUANG Jiaxi;BAI Xingang;GUO Hong(West China Hospital of Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院,四川成都610041 [2]西部战区总医院 [3]成都中医药大学附属医院 [4]成都中医药大学

出　　处：《精神医学杂志》2021年第5期391-395,共5页Journal of Psychiatry

基　　金：国家自然科学基金面上项目(编号:81873354);四川省科技厅重点研发项目(编号:2020YFS0284)。

摘　　要：目的探索舍曲林联合重复经颅磁刺激(rTMS)治疗对持续性躯体形式疼痛障碍(PSPD)患者神经电生理的影响。方法选取PSPD患者70例,随机分为35例药物组和35例联合组,药物组给予舍曲林单一药物治疗,联合组在舍曲林药物治疗基础上给予3周rTMS治疗。另选取35名健康志愿者作为对照组。于治疗前及治疗后第3周末采用数字评分法(NRS)评估疼痛程度,汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估情绪状况,感觉门控电位P50(SG-P50)和接触性热痛诱发电位(CHEPs)检测技术评估神经电生理功能。结果治疗后,药物组和联合组HAMD、HAMA、NRS评分均较治疗前下降(P<0.05),且联合组治疗后HAMD、HAMA、NRS评分均低于药物组(P<0.05)。治疗前,药物组和联合组S2-P50波幅、S2/S1均高于对照组(P<0.05),N2、P2潜伏期均较对照组提前(P<0.05);治疗后,联合组S2-P50波幅、S2/S1均较治疗前降低(P<0.05),N2、P2潜伏期均较治疗前延长(P<0.05)。结论PSPD患者的神经可塑性受损,表现为大脑感觉门控受损和疼痛敏感性增强,舍曲林联合rTMS治疗能够改善PSPD患者的神经可塑性,增强感觉门控功能,降低疼痛敏感性。Objective Persistent somatoform pain disorder(PSPD)is characterized by the predominant complaint of persistent and distressing pain,which could not be sufficiently explained by a physiological process or a physical disorder.Patients with PSPD usually suffer from lasting pain and emotional distress that often respond unsatisfactorily to pharmacological and psychological treatments.Furthermore,its underlying neural mechanisms are not yet fully understood.Repetitive transcranial magnetic stimulation(rTMS)is a non-invasive technique of brain stimulation.It is found that rTMS delivered over the dorsolateral prefrontal cortex(DLPFC)is effective for psychiatric disorders and chronic pain.Contact heat evoked potentials(CHEPs)and P50 sensory gating(SG-P50)can reflect the electrophysiological activities of the central nervous system in response to external sensation.Therefore,this study aims to explore the effects of sertraline with rTMS on neuroelectrophysiology in patients with PSPD by using CHEPs and SG-P50 measurements.Methods 70 patients with PSPD according to DSM-V criteria,who had not used antidepressants for at least one month before enrollment,were recruited from October 2017 to September 2020 in West China Hospital of Sichuan University.They were randomly assigned to drug group and combined group in a 1∶1 allocation ratio.During the three-week treatment period,the patients in drug group received sertraline monotherapy(75mg/d),while the patients in combined group received the same dose of sertraline combined with rTMS.1 Hz rTMS(90%of rest motor threshold,640 pulses per session)over the right DLPFC and iTBS(90%of rest motor threshold,660 pulses per session)on the left DLPFC for 15 daily sessions in total(on weekdays,five sessions a week)were applied.35 age and gender matched healthy volunteers were enrolled as control group.The severity of pain was measured by Numerical Rating Scale(NRS).Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were utilized to assess the severity of emotional symptoms.SG-P5

关 键 词：持续性躯体形式疼痛障碍 重复经颅磁刺激 感觉门控电位P50 接触性热痛诱发电位 

分 类 号：R749.7[医药卫生—神经病学与精神病学]