密集型经颅磁刺激对难治性抑郁症患者认知功能与系统免疫炎性指数的影响  

Effect of intensive transcranial magnetic stimulation on cognitive function and systemic immune-inflammation index in patients with treatment-resistant depression

作　　者：王奇 成文文 董晓梅 耿忠丽 崔刚 范琳 徐天朝 Wang Qi;Cheng Wenwen;Dong Xiaomei;Geng Zhongli;Cui Gang;Fan Lin;Xu Tianchao(Department of Psychiatry and Psychology,General Hospital of the Northern Theater Command,Shenyang 110016,China;Liaoning Normal College,Shenyang 110032,China;Department of Mental Health Prevention and Treatment,Shenyang Mental Health Center,Shenyang 110168,China)

机构地区：[1]北部战区总医院精神心理科,沈阳110016 [2]辽宁师范高等专科学校,沈阳110032 [3]沈阳市精神卫生中心精防科,沈阳110168

出　　处：《中华行为医学与脑科学杂志》2025年第1期30-35,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：军队后勤科研重点项目(BLB19J012);辽宁省应用基础研究计划项目(2022JH2/101500040)。

摘　　要：目的探讨密集型经颅磁刺激(irTMS)治疗难治性抑郁症(TRD)的效果及其对认知功能与系统免疫炎性指数(SII)的影响。方法用随机数字表法将48例TRD患者分为观察组和对照组,每组24例。观察组采用irTMS治疗,刺激部位为左背外侧前额叶,刺激强度为110%运动阈值,刺激频率为15 Hz,刺激间隔26 s,每次刺激3000个脉冲;每日刺激5次,每次间隔50 min,连续治疗5 d;5 d的总刺激量为75000个脉冲。对照组进行伪刺激。治疗前(T0)、治疗5 d后(T1)、治疗后1个月(T2)时采用17项汉密尔顿抑郁量表(HAMD-17)评估抑郁情绪;用威斯康辛卡片分类测验评估认知功能;用全自动血细胞分析仪检测血小板计数(PLT)、中性粒细胞计数(NC)、淋巴细胞计数(LC),计算系统免疫炎性指数(SII),SII=PLT×NC/LC。采用SPSS 20.0软件进行统计学分析。两组重复测量数据之间的比较用重复测量方差分析,若交互效应显著则进行简单效应分析;相关性检验用Pearson相关分析。结果HAMD-17评分的时间和组别的交互效应显著(F=121.784,P<0.05),简单效应分析结果显示,观察组T1和T2时的HAMD-17评分分别为(12.07±4.08)分和(14.78±4.99)分,均低于对照组[(23.78±5.87)分、(24.67±7.00)分,P<0.05]。观察组T1时治疗应答率和缓解率均高于对照组(χ^(2)=4.090,7.378,均P<0.05);观察组T2时治疗应答率和缓解率均高于对照组(χ^(2)=4.463,4.547,均P<0.05)。威斯康辛卡片分类测验正确应答百分比和概念化水平百分数的时间和组别的交互效应均显著(F=36.087、20.004,均P<0.05),简单效应分析结果显示,观察组T1、T2时正确应答百分比和概念化水平百分数均高于对照组(均P<0.05)。SII的时间和组别交互效应显著(F=8.173,P<0.05),简单效应分析结果显示,两组T0时SII的比较差异无统计学意义(P>0.05),观察组T1、T2时的SII均低于对照组(P<0.05)。在观察组中,T2至T0的SII变化值与HAMD-17评分变化值呈正相关(r=0.527,P<0.05ObjectiveTo explore the efficacy of intensive repetitive transcranial magnetic stimulation(irTMS)in treatment-resistant depression(TRD)and its impact on cognitive function and systemic immune-inflammation index(SII).MethodsForty-eight TRD patients were divided into observation group and control group using random number table method,with 24 patients in each group.The observation group was treated with irTMS,and the stimulation site was the left dorsolateral prefrontal lobe.The stimulation intensity was 110%of the motor threshold,and the stimulation frequency was 15 Hz.The stimulation interval was 26 s,and 3000 pulses were stimulated each time.Stimulating 5 times per day,with an interval of 50 min,and continuous treatment for 5 days.The total stimulation amount for 5 days was 75000 pulses.The control group was treated with pseudo stimulation.Before treatment(T0),5 days after treatment(T1),and 1 month after treatment(T2),17-item Hamilton depression scale(HAMD-17)was used to assess depressive mood.Evaluating cognitive function using the Wisconsin card sorting test.A fully automated blood cell analyzer was used to detect platelet count(PLT),neutrophil count(NC),and lymphocyte count(LC),calculate the systemic immune inflammation index(SII),SII=PLT×NC/LC.Statistical analysis was conducted using SPSS 20.0 software.The comparison between two sets of repeated measurement data was performed using repeated measurement analysis of variance.Simple effect analysis was performed if the interaction effect was significant.Pearson analysis was used for correlation testing.ResultsThe interaction effect between the time and group of HAMD-17 scores was significant(F=121.784,P<0.05).The results of simple effects analysis showed that the HAMD-17 scores of the observation group at T1 and T2((12.07±4.08)and(14.78±4.99),respectively)were lower than those of the control group((23.78±5.87)and(24.67±7.00),P<0.05).The treatment response rate and remission rate of the observation group at T1 were higher than those of the control group(χ^

关 键 词：密集型经颅磁刺激 难治性抑郁症 认知功能 系统免疫炎性指数 

分 类 号：R749.4[医药卫生—神经病学与精神病学]