重复经颅磁刺激对抑郁症患者血清脑源性神经营养因子水平影响的研究

Effect of repetitive transcranial magnetic stimulation on serum brain derived neurotrophic factor in depressive patients

目的探讨重复经颅磁刺激（rTMS）治疗对抑郁症患者的血清脑源性神经营养因子（BDNF）水平的影响。方法68例接受文拉法辛治疗的单相抑郁症患者以随机数字表法分组，真刺激组（n=34）同时给予左侧背外侧前额叶rTMS治疗，伪刺激组（n=34）给予相应部位伪刺激治疗。治疗前及治疗4周末分别测定两组血清BDNF水平及评定汉密尔顿抑郁量表（HAMD）。结果1）治疗4周末，两组血清BD—NF水平[（12．2±1．3）μg/L、（11．4±1．5）μg/L]均较治疗前[（5．6±0．8）μg/L、（6．0±1．0）μg/L]显著升高（t=-9．167，P=0．000；t=-7．421，P=0．000）。而两组HAMD评分[（11．6±1．7）分、（4．2±2．8）分]均较治疗前[（32．6±2．5）分、（31．8±3．2）分]显著降低（t=14．654，P=0．000；t=12．089，P=0．000）。且真刺激组血清BDNF水平增加值[（6．7±0．8）μg/L]及HAMD评分减分值[（21．0±2．1）分]变化均较伪刺激组[（5．1±1．2）μg/L、（17．6±2．6）分]更加显著（t=2．690，P=0．009；t=2．693，P=0．000）。2）治疗前真、伪刺激组血清BDNF水平与HAMD评分均呈负相关（r=-0．530，P=0．003；r=-0．490，P=0．004），治疗前后两组血清BDNF水平增加值与HAMD评分减分值均呈正相关（r=0．439，P=0．006；r=0．454，P=0．005）。结论rTMS治疗可升高抑郁症患者血清BDNF水平。

Objective To explore the effect of repetitive transcranial magnetic stimulation （rTMS） treatment on the brain derived neurotrophic factor（ BDNF） serum levels in depressive patients. Methods Sixty-eight unipolar depressions treated with venlafaxine were randomly assigned to the real rTMS group （ n = 34）and the sham rTMS group（ n = 34 ） ,which were accepted the real or the shame rTMS treatment on the left dorsolateral prefrontal lobes respectively. The Hamihon Ratiug Scale for Depression （HAMD） and BDNF serum was assayed before and after 4 weeks＇ treatment. Results 1 ） A significant increase of serum BDNF（ （ 12.2 ± 1.3 ） μg/L vs （ 5.6 ± 0.8 ） μg/L, t= -9. 167, P=0.000;（11.4± 1.5）μg/L vs （6.0 ± 1.0）μg/L, t= -7.421, P= 0. 000 ） and a significant decline of HAMD（ （ 11.6 ± 1.7 ） score vs （ 32.6 ± 2.5 ） score, t = 14. 654, P = 0. 000 ; （ 4.2 ± 2.8 ） score vs （31.8 ± 3.2） score, t = 12. 089, P = 0. 000） were found after the treatment in the real and the shame group, and the real group changed more significantly than the shame group （ （ 6.7 ± 0.8 ） μg/L vs （ 5. 1 ± 1.2 ） μg/L, t = 2. 690, P = 0. 009 ; （ 21.0 ± 2.1 ） score vs （ 17.6± 2.6 ） score, t = 2. 693, P = 0. 000 ）. 2 ） A negative correlation was found between the serum BDNF levels and the HAMD scores before the treatment（ r= -0.530, P=0. 003; r = -0. 490, P = 0. 004） , and a positive correlation between changes of BDNF levels and HAMD scores changes（ r = 0. 439, P = 0. 006 ; r = 0. 454, P = 0. 005 ）. Conclusion The rTMS treatment can increase serum BDNF levels in depressive patients.