磁休克治疗与改良电休克治疗重度抑郁发作疗效的随机对照研究  

A randomized controlled study of magnetic seizure therapy and modified electroconvulsive therapy in the treatment of major depressive episodes

作　　者：杨乔 陈舒弋 李春波[1] 王继军[1] 贾玉萍[1] 王文政[1] 唐莺莹[1] 盛建华[1] Yang Qiao;Chen Shuyi;Li Chunbo;Wang Jijun;Jia Yuping;Wang Wenzheng;Tang Yingying;Sheng Jianhua(Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,National Center for Mental Disorder,Shanghai200030,China;Shanghai Xuhui District Mental Health Center,Shanghai200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,国家精神疾病医学中心,上海200030 [2]上海市徐汇区精神卫生中心,上海200030

出　　处：《中华精神科杂志》2025年第1期30-36,共7页Chinese Journal of Psychiatry

基　　金：上海市卫生和计划生育委员会卫生行业临床研究专项(201840269)。

摘　　要：目的比较磁休克治疗(magnetic seizure therapy,MST)与改良电休克治疗(modified electro-convulsive therapy,MECT)重度抑郁发作(major depressive episode,MDE)的临床疗效及对认知功能的影响。方法选取2019年1月1日至2021年12月31日上海交通大学医学院附属精神卫生中心符合美国精神障碍诊断与统计手册第5版(Diagnostic and Statistical Manual of Mental Disorders,fifth edition,DSM-5)中MDE(抑郁症或双相障碍)诊断的住院患者40例,采用随机数字表法随机分为MECT组(n=20)和MST组(n=20)。2组均在接受选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors,SSRIs)治疗的基础上使用MECT或MST,每周3次,共治疗4周。2组治疗前和治疗后分别进行17项汉密尔顿抑郁量表(17-items Hamilton Depression Rating Scale,HAMD 17)和可重复神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评估,治疗前和治疗后比较采用两因素重复测量方差分析。以HAMD 17减分率及有效率为主要评估指标,RBANS总分及因子分为次要评估指标,2组HAMD 17减分率比较采用t检验,治疗有效率比较采用校正卡方检验或Fisher精确概率法。结果2组治疗前HAMD 17评分及RBANS评分差异均无统计学意义(t=0.29,P=0.773;t=0.67,P=0.509);MECT组治疗有效率90%(18/20),HAMD 17减分率平均为67.9%;MST组治疗有效率75%(15/20),HAMD 17减分率平均为60.9%,2组HAMD 17减分率及有效率差异无统计学意义(t=0.69,P=0.493;χ^(2)=0.16,P=0.693)。MECT组治疗后RBANS认知测验总分及因子分(即刻记忆评分、言语功能评分、注意评分、延时记忆评分)均小于治疗前,差异均有统计学意义(F=19.29、6.22、9.13、5.23、35.90,均P<0.05);而MST组治疗前与治疗后的RBANS认知测验总分及因子分差异均无统计学意义(F=0.49、2.25、1.22、0.23、0.02,均P>0.05)。结论MST与MECT治疗MDE患者疗效相当,MST相较于MECT对认知功能影响较小。ObjectiveTo compare the clinical efficacy and effects on cognitive function of magnetic seizure therapy(MST)and modified electroconvulsive therapy(MECT)in the treatment of major depressive episode(MDE).MethodsFrom January 1,2019 to December 31,2021,40 patients who met the MDE diagnostic criteria in the fifth edition of the Diagnostic Statistical Manual of Mental Disorders(DSM-5)were selected in Shanghai Mental Health Center.Participants were randomly assigned to MECT therapy group(20 patients)and MST therapy group(20 patients)using the random number table method.Both groups received MECT or MST while using serotonin reuptake inhibitors(SSRIs),3 times a week for 4 weeks.The 17-items Hamilton Depression Rating Scale(HAMD 17)and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)were performed before and after treatment.HAMD 17 reduction rate and effective rate were the main assessment indicators,while RBANS total score and factor scores were considered as the secondary assessment indicators.T-test was used to compare the reduction rate of HAMD 17 between the two groups,and corrected Chi-square test or Fisher′s exact probability method was used to compare the effective rate of treatment between the two groups.HAMD 17 scores and RBANS scores before and after treatment were compared using two-factor repeated measure ANOVA.ResultsThere were no significant differences in baseline HAMD 17 scores and RBANS scores between 2 groups(t=0.29,P=0.773;t=0.67,P=0.509).The treatment effective rate in the MECT group was 90%(18/20),and the average reduction rate of HAMD 17 was 67.9%.Meanwhile,the effective rate of MST group was 75%(15/20),and the average reduction rate of HAMD 17 was 60.9%.There was no significant difference in the reduction rate and effective rate of HAMD 17 between the two groups(t=0.69,P=0.493;χ^(2)=0.16,P=0.693).The total scores and factor scores of RBANS after treatment were lower than those before treatment,with statistical significance(total scores:F=19.29,P<0.001;immediate memory

关 键 词：抑郁 物理治疗技术 磁休克治疗 改良电休克治疗 

分 类 号：R749.4[医药卫生—神经病学与精神病学]