低频重复经颅磁刺激联合氟西汀对卒中后抑郁患者血清NPY、BDNF、CRF水平的影响

Effects of Low Frequency Repeated Transcranial Magnetic Stimulation Combined with Fluoxetine on Serum NPY, BDNF and CRF Levels in Patients with Post-Stroke Depression

目的探讨低频重复经颅磁刺激(rTMS)联合氟西汀治疗卒中后抑郁的效果.方法选取2019年9月—2021年9月本院收治的72例卒中后抑郁患者,按随机数字表法分为两组,各36例.对照组给予氟西汀治疗,观察组在对照组基础上给予低频rTMS,连续治疗4周.对比两组临床疗效、汉密尔顿抑郁量表(HAMD)评分、神经肽Y(NPY)、促肾上腺皮质激素释放因子(CRF)、脑源性神经营养因子(BDNF)水平、不良反应.结果观察组治疗总有效率94.44%高于对照组的77.78%,差异有统计学意义(P<0.05).治疗后,观察组HAMD评分(11.21±1.34)分、CRF水平(45.79±3.08)μg/L均低于对照组的(16.45±1.65)分、(56.25±3.48)μg/L,NPY水平(181.67±9.45)ng/L、BDNF水平(12.49±2.31)μg/L均高于对照组的(145.36±8.21)ng/L、(9.41±1.76)μg/L,组间差异有统计学意义(P<0.05).两组不良反应发生率比较,差异无统计学意义(P>0.05).结论低频rTMS联合氟西汀能够减轻卒中后抑郁患者的抑郁症状,改善血清NPY、BDNF、CRF水平,且不会增加不良反应,值得临床大力推行.

Objective To investigate the efficacy of low frequency repeated transcranial magnetic stimulation(rTMS)combined with fluoxetine in the treatment of post-stroke depression.Methods A total of 72 patients with post-stroke depression admitted to the hospital from September 2019 to September 2021 were selected and divided into two groups according to random number table method,with 36 cases in each group.The control group was treated with fluoxetine,and the observation group was treated with low frequency rTMS on the basis of the control group.The two groups were treated continuously for 4 weeks.Clinical efficacy,Hamilton depression scale(HAMD)score,neuropeptide Y(NPY),corticotropinreleasing factor(CRF),brain-derived neurotrophic factor(BDNF)levels,and adverse reactions were compared between the two groups.Results The total effective rate in the observation group was 94.44%,which was higher than 77.78%in the control group,and the difference was statistically significant(P<0.05).After treatment,HAMD score(11.21±1.34)points and CRF level(45.79±3.08)μg/L in the observation group were lower than(16.45±1.65)points,(56.25±3.48)μg/L in the control group,and the NPY level(181.67±9.45)ng/L and BDNF level(12.49±2.31)μg/L were higher than(145.36±8.21)ng/L,(9.41±1.76)μg/L in the control group,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion Low frequency rTMS combined with fluoxetine can reduce depressive symptoms in patients with post-stroke depression,improve serum NPY,BDNF and CRF levels,without increasing adverse reactions,which is worthy of clinical efforts.