低频重复经颅磁刺激对卒中后抑郁的远期疗效及血浆5-羟色胺表达的影响

The effect of low-frequency repetitive transcranial magnetic stimulation on post-stroke depression and the expression of plasma 5-hydroxytryptamine

目的探讨低频重复经颅磁刺激（rTMS）对卒中后抑郁的远期效应及血浆5-羟色胺（5-HT）表达的影响。方法选取74例符合本研究标准的脑卒中后抑郁（PSD）患者，按随机数字表法分成对照组（35例）和治疗组（39例）。最终资料完整纳入本研究患者65例，对照组31例，治疗组34例。对照组给予舍曲林及基础治疗，治疗组给予低频rTMS及基础治疗，疗程8周。分别于入组前（治疗前）和治疗8周后（治疗后），采用汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）及改良Barthel指数（MBI）等指标来评定患者的临床抑郁状态、临床神经功能缺损程度及日常生活活动（ADL）能力；以高效液相色谱法检测2组患者治疗前后血浆5-HT浓度。并于12个月后追踪随访（随访时），复测上述指标，进行统计学分析比较。结果治疗后，2组患者HAMD评分和CSS评分均较治疗前明显下降（P〈0．05），MBI评分则较治疗前明显提高（P〈0．05）；但2组间比较，差异无统计学意义（P〉0．05）；对照组血浆5-HT浓度较治疗前明显升高（P〈0．05），但治疗组变化不明显（P〉0．05）。12个月后随访时，2组患者HAMD评分和CSS评分均较治疗后进一步下降（P〈0．05），MBI评分亦进一步提高（P〈0．05）；2组问比较，治疗组较对照组HAMD评分下降及MBI评分提高更为显著（P〈0．05）；2组患者血浆5-HT浓度较治疗后稍高，但差异无统计学意义（P〉0．05）。治疗后，对照组和治疗组脱离抑郁状态患者分别有10例（32．26％）和12例（35．29％），差异无统计学意义（χ^2=0．067，P=0．796），但12个月后随访时，2组脱离抑郁状态患者分别有22例（70．97％）和31例（91．18％），组间差异有统计学意义（χ^2=4．399，P=0．036）。结论rTMS治疗可以改善脑卒中后抑郁患者的远期效应，提高患者ADL能力，且其作用机制可能与血浆5-HT表达变化无关。

Objective To explore any effect of low-frequency transcranial magnetic stimulation （rTMS） on post-stroke depression and the expression of plasma 5-hydroxytryptamine （5-HT）. Methods Seventy-four pa- tients suffering from post-stroke depression （PSD） were divided into a control group （31 cases） which received basic therapy and sertraline and a therapy group （34 cases） which received basic therapy and 8 weeks of low-frequency rTMS. Scores on the Hamilton depression （HAMD） scale and the Chinese stroke scale （CSS） and the modified Barthel index （MBI） were used to evaluate depression, neurological impairment, and ability in the activities of daily living （ADL） before and after the experiment. Levels of plasma 5-HT in the two groups were also detected with high performance liquid chromatography before and after the experiment. The patients were then followed up I year later, when these indexes were reassessed. Results After 8 weeks of treatment the HAMD and CSS scores in both groups had decreased significantly, and their MBI scores had increased significantly compared with prior to treatment, but there was no significant difference between the groups. The average plasma 5-HT concentration in the control group had increased significantly, but there was little change in the therapy group. One year later, the HAMD and CSS scores of both groups had declined significantly and their MBI scores had increased further. The average decrease in HAMD scores and rise in MBI scores in the therapy group was significantly greater than in the control group. There had been no significant change in plasma 5-HT concentration in either group. After 8 weeks of treatment, 10 controls and 12 therapy group patients had escaped depression. A year later the numbers were 22 and 31 cases, a significant inter-group difference. Conclusion Low-frequency rTMS can help alleviate post-stroke depression, and enhance ADL ability. The mechanism might have nothing to do with any change in 5-HT expression.