不同部位重复经颅磁刺激对脑卒中后抑郁患者的抑郁状态ATP酶活性及P300的影响  

Effects of repeated transcranial magnetic stimulation at different sites on depressive state,ATPase activity and P300 in post-stroke depression

作　　者：剡军 王永正[1] 赖彩琼 SHAN Jun;WANG Yongzheng;LAI Caiqiong(Deyang People’s Hospital,Deyang 618000,Sichuan)

机构地区：[1]德阳市人民医院,四川德阳618000

出　　处：《中国实用神经疾病杂志》2022年第11期1395-1400,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省卫生与计划生育委员会2018年科研课题(编号:18PJ522)。

摘　　要：目的探讨不同部位的重复经颅磁刺激(rTMS)治疗脑卒中后抑郁(PSD)患者的临床疗效及其机制。方法选取124例符合纳入、排除标准的PSD患者作为研究对象,随机分为左侧组、右侧组和双侧组。左侧组采用10 Hz高频刺激左侧背外侧前额叶(DLPFC);右侧组采用1 Hz低频刺激右侧DLPFC;双侧组联用左侧组和右侧组的治疗方案。3组连续治疗6周。治疗前后,评估HAMD-17、NIHSS评估患者的抑郁状态和神经功能;检测患者S100β、NSE、TRPC1以及Na^(+)-k^(-)-ATP、Ca^(2+)-Mg^(2+)-ATP的酶活性;采集事件相关电位P300电位。结果在量表评估,治疗后3组HADM-17、NIHSS、SS-QOL均优于治疗前,差异有统计学意义(P<0.05);而双侧组在HADM-17、NIHSS两项评分优于其余2组(P<0.05),在SS-QOL评分3组间差异无统计学意义(P>0.05);在实验室指标,治疗后除右侧组Na^(+)-k^(-)-ATP酶活性一项指标外,3组各项指标均优于治疗前,差异有统计学意义(P<0.05);而双侧组在S100β、TRPC1、Na^(+)-k^(-)-ATP、Ca^(2+)-Mg^(2+)-ATP优于其余2组(P<0.05),在NSE指标双侧组仅优于右侧组(P<0.05),与左侧组无差异(P>0.05);在视觉P300检查,治疗后除右侧组波幅外,3组两项指标均优于治疗前,差异有统计学意义(P<0.05);而双侧组在潜伏期和波幅均优于其余2组(P<0.05)。结论10 Hz高频刺激左侧DLPFC配合1 Hz低频刺激右侧DLPFC的联用方案能更有效改善PSD患者的抑郁状态及神经功能,值得进一步推广。Objective The purpose of this study is to investigate the clinical efficacy and mechanism of repeated transcranial magnetic stimulation(rTMS)in different parts in the treatment of post-stroke depression(PSD).Methods One hundred and twenty-four PSD patients who met the inclusion and exclusion criteria were randomly divided into left group,right group and bilateral group.In the left group,the left dorsolateral prefrontal lobe(DLPFC)was stimulated with 10 Hz high frequency.The right DLPFC was stimulated with 1 Hz low frequency in the right group.The bilateral group was combined with the treatment scheme of the left group and the right group.The three groups were treated for 6 weeks.Before and after treatment,HAMD-17 and NIHSS were evaluated to evaluate the depressive state and neurological function of the patients;Test patient S100β,NSE,TRPC1,Na^(+)-k^(-)-ATP,Ca^(2+)-Mg^(2+)-ATP;Collect event-related potential P300 potential.Results In the evaluation of the scale,HADM-17,NIHSS and SS-QOL in the three groups after treatment were better than those before treatment,and the difference was statistically significant(P<0.05).The scores of HADM-17 and NIHSS in bilateral group were better than those in the other two groups(P<0.05),and there was no significant difference in SS-QOL score among the three groups(P>0.05).In laboratory indexes,after treatment,except for the activity of Na^(+)-K^(-)ATPase in the right group,all indexes of the three groups were better than those before treatment,and the difference was statistically significant(P<0.05).The bilateral group was at S100β.TRPC1,Na^(+)-K^(-)-ATP and Ca^(2+)-Mg^(2+)-ATP were better than the other two groups(P<0.05),and the NSE index in the bilateral group was only better than that in the right group(P<0.05),which was not different from that in the left group(P>0.05).In visual P300 examination,after treatment,except for the amplitude of the right group,the two indexes of the three groups were better than those before treatment,and the difference was statistically signific

关 键 词：脑卒中后抑郁 重复经颅磁刺激 不同部位 ATP酶活性 P300 

分 类 号：R743.3[医药卫生—神经病学与精神病学]