低频重复经颅磁刺激联合治疗卒中后抑郁患者疗效研究

Efficacy Evaluation of Low Frequency Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-stroke Depression

目的探讨低频重复经颅磁刺激联合治疗卒中后抑郁(PSD)患者的疗效。方法选取大兴区人民医院2017年5月到2019年9月收治的100例PSD患者为研究对象,采用随机数表法分为观察组、对照组,各50例,对照组口服帕罗西汀治疗,观察组在对照组的基础上采用低频重复经颅磁刺激治疗,对比两组患者治疗前、治疗2个月时汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)评分及血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)水平和不良反应发生情况。结果治疗2个月时,两组患者HAMD、SDS、NIHSS评分水平均较治疗前低(P<0.05),且观察组HAMD、SDS、NIHSS评分低于对照组(P<0.05);治疗后,两组患者NSE、TNF-α、IL-6水平均较治疗前低(P<0.05),且观察组NSE、TNF-α、IL-6水平低于对照组(P<0.05);对照组不良反应发生率高于观察组(χ^(2)=4.000,P=0.046)。结论在帕罗西汀的基础上联合低频rTMS治疗PSD患者,可有效改善其抑郁状态及神经功能,降低炎性反应,且具有较高的安全性。

Objective To investigate the efficacy of low frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke depression.Methods 100 patients with PSD in Daxing District People’s Hospital from May 2017 to September 2019 were selected and randomly divided into observation group and control group,50 cases in each group.The control group was treated with paroxetine,and the observation group was treated with low frequency repetitive transcranial magnetic stimulation on the basis of the control group.Compared two groups before treatment and 2 months after treatment HAMD,SDS,NIHSS scores,NSE,TNF-α,IL-6 levels and the incidence of adverse reactions.Results After 2 months of treatment,the scores of HAMD,SDS and NIHSS in the two groups were lower than those before treatment(P<0.05),and the scores of HAMD、SDS and NIHSS in the observation group were lower than those in the control group(P<0.05).After 2 months of treatment,the levels of NSE,TNF-αand IL-6 in 2 groups were lower than before treatment(P<0.05),and the levels of NSE,TNF-αand IL-6 in observation group were lower than those in control group(P<0.05).After 2 months of treatment,the incidence of adverse reactions in the control group was higher than that in the observation group(χ^(2)=4.000,P=0.046).Conclusion The combination of paroxetine and low frequency rTMS can effectively improve the depression and nerve function of PSD patients and reduce the inflammatory response.