rTMS联合CBT治疗对酒依赖患者饮酒渴求和认知功能的影响  

Effect of rTMS combined with CBT on alcohol craving and cognitive function in patients with alcohol dependence

作　　者：程畅 王鸿轩[2] 杨卫边 王晓红[1] 康传依 胡晓蕊 卢佳[1] 王怀志[1] 赵娜[1] 范小荷 杨梅 杨建中[5] 贾延劼[6] 张莹洁[7] 周旭辉[8] 刘蕾[1] 迟勇[7] 彭英[2] 胡建[1] Cheng Chang;Wang Hongxuan;Yang Weibian;Wang Xiaohong;Kang Chuanyi;Hu Xiaorui;Lu Jia;Wang Huaizhi;Zhao Na;Fan Xiaohe;Yang Mei;Yang Jianzhong;Jia Yanjie;Zhang Yingjie;Zhou Xuhui;Liu Lei;Chi Yong;Peng Ying;Hu Jian(Department of Psychiatry,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Neurology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Psychiatry,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157011,China;Department of Addiction Medicine,Shenzhen Kangning Hospital,Shenzhen 518000,China;Department of Psychiatry,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Addiction Medicine,Beijing Anding Hospital Affiliated to Capital Medical University,Beijing 100088,China;Department of Psychiatry,Hunan Provincial Brain Hospital,Changsha 410007,China)

机构地区：[1]哈尔滨医科大学附属第一医院精神科,哈尔滨150001 [2]中山大学孙逸仙纪念医院神经科,广州510120 [3]牡丹江医学院附属红旗医院精神心理科,牡丹江157011 [4]深圳市康宁医院成瘾医学科,深圳518000 [5]昆明医科大学第二附属医院精神科,昆明650101 [6]郑州大学第一附属医院神经科,郑州450052 [7]首都医科大学附属北京安定医院成瘾医学科,北京100088 [8]湖南省脑科医院精神科,长沙410007

出　　处：《中华行为医学与脑科学杂志》2022年第8期685-691,共7页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家重点研发计划"重大慢性非传染性疾病防控研究"专项(2018YFC1314400,2018YFC1314402)。

摘　　要：目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合认知行为疗法(cognitive behavioral therapies,CBT)对酒依赖患者的饮酒渴求和认知功能的影响。方法2019年3月至2021年9月纳入酒依赖患者150例。对入组者进行计算机算法自动随机分配,分为rTMS治疗组(rTMS+假CBT,n=41)、CBT治疗组(CBT+假rTMS,n=34)、rTMS+CBT治疗组(n=36)和对照组(假rTMS+假CBT,n=39)。在基线期(治疗前,W0)与治疗2周(W2)、8周(W8)、12周(W12)、24周(W24),分别采用饮酒问卷(alcohol dependence scale,ADS)评估患者酒精依赖程度;强制饮酒量表(obsessive compulsive drinking scale,OCDS)评估患者饮酒渴求程度;蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评估患者认知功能。采用SPSS 23.0软件进行统计分析,使用重复测量方差分析及简单效应分析比较4组的ADS、OCDS、MoCA量表评分差异。结果(1)四组患者分别在W0、W12、W24进行ADS量表的评估,组别×时间的交互作用(F=1.279,P=0.279)和组别主效应不显著(F=0.882,P=0.454),时间主效应显著(F=12.925,P<0.001);进一步简单效应分析,rTMS+CBT组在随访第24周时,ADS量表评分低于基线期[(14.48±5.70)分,(10.00±6.51)分](P=0.01)。(2)四组受试者分别在W0、W2、W8、W12、W24进行OCDS量表的评估,组别×时间交互作用显著(F=2.015,P=0.042);进一步简单效应分析,rTMS组、rTMS+CBT组在各随访时间节点,OCDS量表评分均低于基线期(均P<0.05)。(3)四组受试者分别在W0、W8、W12、W24进行MoCA量表的评估,组别×时间的交互作用不显著(F=1.660,P=0.106),组别主效应及时间主效应均显著(F=2.964,P=0.038;F=14.239,P<0.001)。进一步简单效应分析,CBT组在第24周时,MoCA量表评分高于基线期[(21.73±5.81)分,(24.60±3.98)分](P=0.029);rTMS+CBT组在第24周时,MoCA量表评分高于第8周时[(23.50±6.01)分,(25.95±2.87)分](P=0.006);在随访第12周时,rTMS组MoCA量表评分高于对照组[(22.08±6.64)分,(26.64±2.Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS)combined with cognitive behavioral therapies(CBT)on the cognitive function and alcohol craving in patients with alcohol dependence.Methods From March 2019 to September 2021,a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group(rTMS+sham CBT,n=41),CBT treatment group(CBT+sham rTMS,n=34),rTMS+CBT treatment group(n=36)and control group(sham rTMS+sham CBT,n=39).At baseline(before treatment),2nd week,8th week,12th week and 24th week,alcohol dependence scale(ADS)was used to evaluate the degree of alcohol dependence,the obsessive compulsive drinking scale(OCDS)was used to assess patients'drinking craving,and Montreal cognitive assessment scale(MoCA)was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS,OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis.Results(1)The patients in the four groups were evaluated with ADS scale at baseline,12th week and 24th week respectively.The interaction of group×time(F=1.279,P=0.279)and the main effect of group were not significant(F=0.882,P=0.454),and the main effect of time was significant(F=12.925,P<0.001).Further simple effect analysis showed that the ADS score of rTMS+CBT group was lower than that of baseline(14.48±5.70,10.00±6.51)(P=0.01)at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline,2nd week,8th week,12th week and 24th week,and the interaction of group×time was significant(F=2.015,P=0.042).Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+CBT group at each follow-up time node were lower than those at baseline period(all P<0.05).(3)Patients in the four groups were assessed with MoCA scale at baseline,8th week,12th week and 24th week,and the interaction of group×time was not significant(F=1.660,P=0.106),and the main effect of group and the main e

关 键 词：酒精依赖 重复经颅磁刺激 认知行为治疗 饮酒渴求 认知功能 

分 类 号：R749.62[医药卫生—神经病学与精神病学]