联合电休克治疗对抑郁症患者复发及认知功能影响的5年随访研究  

A 5-year follow-up study of effects of combined electroconvulsive therapy on relapse and cognitive function in patients with major depressive disorder

作　　者：姚姣 徐康健 高月 杜洋 徐小童 黄悦勤[3] 季益富 YAO Jiao;XU Kangjan;GAO Yue;DU Yang;XU Xiaotong;HUANG Yueqin;JI Yifu(Department of Mental Health and Psychological Science,Anhui Medical University,Hefei 230032,China;Affiliated Psychological Hospital of Anhui Medical University,Anhui Mental Health Center,the Fourth People's Hospital of Hefei,Hefei 230032,China;Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100083,China)

机构地区：[1]安徽医科大学精神卫生与心理科学学院,合肥230032 [2]安徽医科大学附属心理医院安徽省精神卫生中心合肥市第四人民医院,合肥230032 [3]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100083

出　　处：《中国心理卫生杂志》2024年第8期641-647,共7页Chinese Mental Health Journal

基　　金：2023年度安徽省高校科学研究项目-重点项目(2023AH050531);安徽省哲学社会科学重点实验室依托项目(GXXT-2022-101);安徽省哲学社会科学重点实验室开放基金重大项目(SYS2023A05)。

摘　　要：目的:探讨改良电休克疗法(MECT)联合药物和单用药物对抑郁症患者复发及认知功能的影响。方法:选取符合精神障碍诊断与统计手册第5版(DSM-5)抑郁症诊断标准的324例患者为研究对象,包括联合MECT组(n=117)和未联合MECT组(n=207)。在基线和随访5年,两组均完成一般情况调查表、蒙特利尔认知评估量表(MoCA)以及汉密顿抑郁量表(HAMD),分析认知功能与多种变量间的联系。结果:基线时,两组一般资料、MoCA以及HAMD评分差异无统计学意义(均P>0.05)。随访5年后,联合MECT组复发率低于未联合MECT组[(37.6%)vs(72.0%),P<0.001],MECT是抑郁症复发的保护因素;[RR(95%CI)=0.52(0.40~0.66)],联合MECT组的MoCA得分低于未联合MECT组[(20.9±3.5)VS.(23.6±4.2),P<0.001]。结论:联合MECT是抑郁症复发的保护因素,对抑郁症患者认知功能的影响可能有长期性。Objective:To investigate the effects of modified electroconvulsive therapy(MECT)in combination with medication and medication alone on relapse and cognitive functioning in patients with major depressive disorder(MDD).Methods:Totally 324 patients meeting the diagnostic criteria ofthe DSM-5 for MDD were selected and divided into combined MECT group(n=117)and non-combined MECT group(n=207).At baseline and 5 years of follow-up,both groups completed the General Information Questionnaire,Montreal Cognitive Assessment(MoCA),and Hamilton Depression Scale(HAMD)to analyze associations between cognitive functioning and multiple variables.Results:At baseline,there were no significant differences between the two groups on general information,MoCA,and HAMD scores(Ps>0.05).After 5 years of follow-up,the relapse rate was lower in the combined MECT group than in the un-combined MECT group[(37.6%vs.72.0%),P<0.001].MECT was a protective factor against recurrence of MDD[RR(95%CI)=0.52(0.40-0.66)],and the MoCA scores were lower in the combined MECT group than in the un-combined MECT group[(20.9±3.5)vs.(23.6±4.2),β=-1.93,P<0.001].Conclusion:Combined MECT is a protective factor against MDD recurrence.Its effects on the cognitive functioning of MDD patients may have long-term effects.

关 键 词：抑郁症 改良电休克疗法 认知功能 复发 

分 类 号：R749.41[医药卫生—神经病学与精神病学] R749.054[医药卫生—临床医学]