深部经颅磁刺激联合草酸艾司西酞普兰治疗抑郁症的疗效:一项随机对照试验  

Deep Transcranial Magnetic Stimulation Combined with Escitalopram Oxalate in the Treatment of Depression:a Randomized Controlled Trial

作　　者：庞兰 李佩璠 朱晓岗 杨再红 郑蕾 PANG Lan;LI Peifan;ZHU Xiaogang;YANG Zaihong;ZHENG Lei(Department of Psychiatry,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Center for Neuroelectrophysiology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院精神科,贵州省贵阳市550004 [2]贵州医科大学附属医院神经电生理中心,贵州省贵阳市550004

出　　处：《中国全科医学》2024年第17期2098-2103,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(82060651);贵州医科大学附属医院博士研究基金(GYFYBSKY-2021-67)。

摘　　要：背景抑郁症是一种常见精神疾病,目前治疗手段有限,深部经颅磁刺激(dTMS)作为一种新型非侵入性神经调控技术,已经被运用于重度抑郁症(MDD)的治疗,但临床研究证据较少。目的探究dTMS联合草酸艾司西酞普兰(Esc)治疗抑郁症的临床疗效,为dTMS治疗抑郁症患者进一步提供可靠的数据参考。方法选取2021年12月—2023年1月就诊于贵州医科大学附属医院精神科的73例抑郁症患者为研究对象,按随机数字表法分为药物对照组35例、联合治疗组38例。药物对照组患者给予Esc(第1周10 mg/d,第2周起20 mg/d,连续2周),联合治疗组患者在药物对照组治疗基础上给予dTMS治疗[左侧背外侧前额叶(DLPFC)为刺激靶点,18 Hz,120%MT,1980次/d,一共2周,总计10次]。分别于治疗开始前及治疗2周后应用汉密尔顿抑郁量表(HAMD)、贝克自杀意念量表(BSS)、蒙特利尔认知评估量表(MoCA)及基于言语流畅性任务(VFT)期间的功能性近红外光谱成像仪(fNIRS)测量的前额叶平均氧合血红蛋白(oxy-Hb)浓度变化对两组患者的抑郁症状及认知功能改善情况进行评定。结果实际完成试验的药物对照组30例、联合治疗组31例。联合治疗组患者治疗后HAMD、BSS评分低于药物对照组,MoCA评分高于药物对照组(P<0.05)。两组患者治疗后HAMD、BSS评分低于组内治疗前,MoCA评分高于组内治疗前(P<0.05)。两组患者治疗后前额叶皮质未见明显激活。联合治疗组患者治疗后抑郁症状及认知功能改善情况优于药物对照组。结论dTMS联合Esc治疗较单独Esc治疗能更好地改善抑郁症患者抑郁症状及认知功能。Background Depression is a common psychiatric disorder with limited treatment options.Deep transcranial magnetic stimulation(dTMS),as a new non-invasive neuromodulation technique,has been utilized in the treatment of major depressive disorder(MDD),but there is less evidence from clinical studies.Objective To explore the clinical efficacy of dTMS combined with escitalopram oxalate(Esc) in the treatment of depression,and provide further reliable data reference for dTMS in the treatment of depression patients.Methods A total of 73 patients with depression who attended Department of Psychiatry,Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group(n=35) and combined treatment group(n=38) according to the random number table.Patients in the control group were given Esc( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks).The combined treatment group received the treatment of dTMS(left DLPFC as the stimulation target,18 Hz,120%MT,1 980 times per day for 2 weeks,10 times in total) based on the same treatment for the control group.The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale(HAMD),Beck Scale for Suicide Ideation(BSS),Montreal Cognitive Assessment Scale(Mo CA) and the mean oxygenated hemoglobin(oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy(f NIRS) based on the verbal fluency text(VFT) task.Results The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group.After treatment,the HAMD and BSS scores of the combined treatment group were lower than those of the control group,and the Mo CA score was higher than that of the control group(P<0.05).After treatment,the HAMD and BSS scores of patients in the two groups were lower than those before treatment,and the Mo

关 键 词：抑郁症 深部经颅磁刺激 近红外光谱成像 认知功能 治疗结果 

分 类 号：R749.41[医药卫生—神经病学与精神病学]