脑源性神经营养因子对经颅磁刺激治疗难治性抑郁症的疗效预测作用  

Brain derived neurotrophic factor as the predictor of efficacy for repetitive transcranial magnetic stimulation in the treatment of refractory depression

作　　者：孙丛丛[1,2] 吴涵 周丹娜 姜玮[1,2] 王雯 杨春林[1,2] 马辛[1,2] 任艳萍[1,2] Sun Congcong;Wu Han;Zhou Danna;Jiang Wei;Wang Wen;Yang Chunlin;Ma Xin;Ren Yanping(Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing Key Laboratory of Mental Disorders & The National Clinical Research Center for Mental Disorders, Beijing 100088, China;Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京安定医院精神科精神疾病诊断与治疗北京市重点实验室&国家精神心理疾病临床医学研究中心,北京100088 [2]首都医科大学人脑保护高精尖创新中心,北京100069

出　　处：《首都医科大学学报》2022年第2期227-232,共6页Journal of Capital Medical University

基　　金：国家重点研发计划(2017YFC131110);北京市科学技术委员会科技重大专项(D171100007017001)。

摘　　要：目的探讨脑源性神经营养因子(brain derived neurotrophic factor,BDNF)对重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗难治性抑郁症疗效的预测作用。方法将59例难治性抑郁症患者分为治疗组和对照组,其中治疗组34例,对照组25例。治疗组接受2周的高频(10 Hz)rTMS治疗,对照组接受2周伪刺激治疗。采用汉密尔顿抑郁量表-17项(Hamilton Depression Scale-17 Item,HAMD-17)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估临床症状;采用酶联免疫法测定血清BDNF浓度。评估时间点为基线、治疗(2周)末、随访(6周)末。结果治疗组和对照组HAMD-17评分和HAMA评分均随治疗时间延长而逐渐降低(P时间<0.05),组间比较差异无统计学意义(P组间>0.05);治疗2周后,治疗组有效率(70.59%)高于对照组有效率(44%),差异有统计学意义(P=0.04)。治疗后,治疗组BDNF降低程度与对照组比较差异有统计学意义(P组间<0.05)。基线BDNF浓度与疗效呈正相关(P<0.05)。治疗中无严重不良事件发生。结论rTMS治疗难治性抑郁症有效;血清BDNF基线浓度高的抑郁症患者rTMS治疗效果更好,BDNF可以作为rTMS治疗抑郁症疗效的预测指标。Objective To investigate the predictive effect of brain-derived neurotrophic factor(BDNF)on the efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of refractory depression.Methods Fifty-nine patients with refractory depression were randomly divided into treatment group(34 patients)and control group(25 patients).The treatment group received high frequency(10 Hz)rTMS for 2 weeks,while the control group was treated with sham rTMS stimulation.Hamilton Depression Scale-17 Item(HAMD-17)and Hamilton Anxiety Scale(HAMA)were used to evaluate clinical symptoms.Enzyme linked immunosorbent assay(ELISA)was used to examine the level of serum BDNF.The evaluation time point was baseline,2 weeks after treatment,and 6 weeks follow-up.Results The scores of HAMD-17 and HAMA in the treatment and control groups decreased with the treatment time(Ptime<0.05).There was no significant difference between the two groups(P group>0.05).The response rate of the treatment group(70.59%)was higher than that of the control group(44%)after 2 weeks,with a statistically significant difference(P group=0.04).After treatment,the change of BDNF level in the treatment group was significantly more than that in the control group(P group<0.05).There was a positive correlation between baseline BDNF level and efficacy(P<0.05).No serious adverse events occurred during the treatment.Conclusion rTMS was effective in the treatment of refractory depression.The treatment effect of rTMS was better in patients with high baseline level of serum BDNF than that with low baseline level.BDNF could be used as a predictor of the antidepressant effect of rTMS.

关 键 词：重复经颅磁刺激 抑郁症 脑源性神经营养因子 

分 类 号：R749[医药卫生—神经病学与精神病学]