基于磁共振波谱探讨靳三针联合低频rTMS治疗帕金森病合并抑郁的临床疗效  

Clinical efficacy of Jin’s three-needle therapy combined with low frequency rTMS on depression in Parkinson’s disease based on magnetic resonance spectroscopy

作　　者：汤俊芬[1] 郑伟坤[2] 敖娟[1] 陆高平 罗晓丽 张娥铿 TANG Junfen;ZHENG Weikun;AO Juan(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南沙医院神经内科,广东广州511457 [2]广州市第一人民医院南沙医院骨科,广东广州511457 [3]广州市第一人民医院南沙医院康复科,广东广州511457

出　　处：《癫痫与神经电生理学杂志》2023年第1期31-36,共6页Journal of Epileptology and Electroneurophysiology(China)

基　　金：广东省中医药局科研项目(20232126);广州市中医药和中西医结合科技项目(20212A011001)。

摘　　要：目的基于磁共振波谱(MRS)探讨靳三针联合低频重复经颅磁刺激(rTMS)干预帕金森病伴抑郁(DPD)的临床疗效。方法选取2021年5月至2022年8月广州市第一人民医院神经内科收治的DPD患者,根据治疗方式不同分为观察组和对照组,对照组给予常规药物治疗,观察组在对照组基础上,联用靳三针+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(HAMD17)及Beck抑郁量表(BDI)评分,同时行MRS检测所有患者脑内NAA、Cho及Cr含量,计算NAA/Cr及Cho/Cr的比值,并作NAA/Cr及Cho/Cr与量表的相关性分析。结果观察组与对照组DPD患者治疗前HAMD17评分、BDI评分比较差异均无统计学意义。经治疗后,两组患者HAMD17及BDI评分均明显下降,组内治疗前后评分比较差异均有统计学意义(P<0.05),治疗后,观察组HAMD17及BDI评分均明显低于对照组(P<0.05)。两组DPD患者治疗前MRS扫描所得NAA/Cr、Cho/Cr比较差异均无统计学意义。经治疗后,两组DPD患者Cho/Cr均明显下降(P<0.05),而NAA/Cr均有上升趋势,但组内治疗前后该比值差异无统计学意义。治疗后,观察组Cho/Cr明显低于对照组(P<0.05),NAA/Cr与对照组比较差异无统计学意义。NAA/Cr与HAMD17评分、BDI评分呈负相关(r=-0.516,P<0.001,r=-0.530,P<0.001),但相关性较弱,Cho/Cr与HAMD17评分、BDI评分呈正相关(r=0.833,P<0.001,r=0.831,P<0.001),相关性较强。结论靳三针联合低频rTMS能有效改善DPD患者的抑郁量表评分,提高患者的生活质量和社会功能。Cho/Cr比值与HAMD17、BDI拟合良好,与患者病情转归有良好的耦合度。Objective To explore the clinical efficacy of Jin’s three-needle therapy(JTNT) combined with low frequency repetitive transcranial magnetic stimulation(rTMS) on depression in Parkinson’s disease(DPD) by magnetic resonance spectroscopy(MRS). Methods DPD patients admitted to the Department of Neurology, Guangzhou First People’s Hospital from May 2021 to August 2022 were selected and divided into observation and control groups according to different treatment approaches. Control group was given routine drug treatment, while observation group was treated with JTNT combined with low frequency rTMS on the basis of control group. Before and at 3 weeks after treatment, all patients were scored with Hamilton Depression Rating Scale 17(HAMD17) and Beck Depression Inventory(BDI). At the same time, MRS was performed to detect the contents of NAA, Cho and Cr in the brains of all patients. The ratios of NAA/Cr and Cho/Cr were calculated. The associations of NAA/Cr and Cho/Cr with HAMD17 and BDI were analyzed. Results There were no significant differences in HAMD17 score and BDI score between observation and control groups before treatment. After treatment, HAMD17 and BDI scores of two groups were significantly decreased. There were significant differences between before and after treatment in both groups(P<0.05). After treatment, the scores of HAMD17 and BDI were significantly lower in observation group than those in control group(P<0.05). There were no statistically significant differences in NAA/Cr and Cho/Cr obtained from MRS scanning before treatment between two groups. After treatment, Cho/Cr were significantly decreased in both groups(P<0.05), while NAA/Cr had an upward trend, but there was no significant difference between before and after treatment in both groups. After treatment, Cho/Cr was significantly lower in observation group than that in control group(P<0.05), while NAA/Cr had no significant difference between observation and control groups. NAA/Cr was negatively correlated with HAMD17 score and BDI score(

关 键 词：靳三针 重复经颅磁刺激 磁共振波谱分析 

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