重复经颅磁刺激治疗帕金森病抑郁患者的疗效及机制  

Role and potential mechanism of repetitive transcranial magnetic stimulation on depressive disorder in patients with Parkinson's disease

作　　者：郭紫瑄 许丽娜 董慧芳 GUO Zixuan;XU Lina;DONG Huifang(Jincheng People's Hospital,Jincheng 048000,China;Jincheng Hospital Affiliated to Changzhi Medical College,Jincheng 048000,China)

机构地区：[1]晋城市人民医院,山西晋城048000 [2]长治医学院附属晋城医院,山西晋城048000

出　　处：《临床医药实践》2025年第3期179-184,194,共7页Proceeding of Clinical Medicine

摘　　要：目的:探讨重复经颅磁刺激(rTMS)治疗帕金森病(PD)抑郁患者的疗效及可能的机制。方法:选取2021年12月-2023年6月于晋城市人民医院门诊及住院部就诊的PD抑郁患者120例,随机分为假刺激组、低频rTMS组(0.5 Hz)和高频rTMS组(5 Hz),每组40例。连续治疗2周后,分别于治疗前、治疗后即刻及治疗后4周采用汉密顿抑郁量表(HAMD)、统一帕金森病评定量表第Ⅲ部分(UPDRS-Ⅲ)、PD患者生活质量问卷(PDQ-39)对患者情况进行评分,通过统计学分析比较得出治疗PD抑郁障碍的最优治疗参数。通过对疗效最佳患者进行炎症因子检测,得出rTMS治疗PD抑郁的可能机制。结果:与假刺激组相比,高频rTMS组和低频rTMS组患者的HAMD评分、UPDRS-Ⅲ评分、PDQ-39评分在治疗后均有所下降,差异有统计学意义(P<0.05);高频rTMS组疗效优于低频rTMS组(P<0.05)。与治疗前相比,高频rTMS组治疗后即刻、治疗后4周血清白细胞介素-6(IL-6)水平均有所下降,差异有统计学意义(P<0.05)。结论:高频rTMS治疗可明显改善PD患者抑郁症状,且疗效可持续至治疗后4周,其可能通过降低患者血清IL-6水平发挥治疗作用。Objective:To investigate the effect and possible mechanism of repetitive transcranial magnetic stimulation(rTMS)on depressive disorder in patients with Parkinson’s disease(PD).Methods:All 120 patients with PD depression in outpatient and inpatient departments of Jincheng People's Hospital from December 2021 to June 2023 were prospectively selected,which were randomly divided into sham stimulation group,low-frequency rTMS group(0.5 Hz)and high-frequency rTMS group(5 Hz).After continuous treatment for 2 weeks,all participants underwent examinations of Hamilton Rating Scale(HAMD),the motor part of the Unified Parkinson Disease Rating Scale(UPDRS-Ⅲ)and Parkinson's disease Quality of Life questionnaire(PDQ-39)after treatment immediately and 4 weeks after treatment respectively,and the optimal treatment parameters for PD depressive disorder were obtained by statistical analysis.By detection of inflammatory cytokines which was performed in the patients of optimal treatment group,we may conclude the possible mechanism of rTMS.Results:Compared with the sham stimulation group,the HAMD score,UPDRS-Ⅲscore and PDQ-39 score of the high-frequency and low-frequency rTMS groups were decreased after treatment,and the differences were statistically significant(P<0.05).The therapeutic effect of high-frequency rTMS group and low-frequency rTMS group was statistically different in the treatment of Parkinson's depression(P<0.05).The serum IL-6 level in the high-frequency rTMS group decreased immediately after treatment and 4 weeks after treatment,and the differences were statistically significant(P<0.05).Conclusion:The group of high-frequency rTMS can significantly improve the depressive symptoms of patients with PD,and the curative effect can be sustained until 4 weeks after treatment,which is mediated by reducing the serum IL-6 level of patients.

关 键 词：重复经颅磁刺激 帕金森病 抑郁障碍 炎性因子 

分 类 号：R749.05[医药卫生—神经病学与精神病学]