重复经颅磁刺激联合舍曲林对精神分裂症后抑郁影响的随机对照研究

Repetitive transcranial magnetic stimulation combined sertraline effects on post-schizophrenia depression patients

目的探讨重复经颅磁刺激(r TMS)联合舍曲林对精神分裂症后抑郁的疗效及认知功能的影响。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)精神分裂症后抑郁诊断标准的78例患者分为观察组和对照组各39例,对照组采用舍曲林治疗,观察组在对照组治疗方案的基础上辅用r TMS治疗,两组均于治疗前及治疗6周后采用汉密尔顿抑郁量表(HRSD)、Herth希望指数量表(HHI)、威斯康辛卡片分类测验(WCST)进行测评。结果治疗后,两组HRSD评分均低于治疗前(t=34.212,26.631,P<0.01),且观察组低于对照组(t=6.705,P<0.01);治疗后两组HHI总分及各项因子评分高于治疗前(t=6.737,6.245,11.008,6.403,P<0.01),两组HHI总分及各项因子评分比较差异均有统计学意义(t=3.184,2.799,4.265,2.855,P<0.01);治疗后观察组WCST评分较治疗前差异有统计学意义(t=20.399,18.558,5.101,5.894,15.385,P<0.01),观察组WCST评分较对照组差异有统计学意义(t=11.900,10.614,3.739,3.573,6.229,P<0.01)。结论重复经颅磁刺激合并舍曲林可能提高精神分裂症后抑郁的疗效及心理希望水平,改善患者的认知功能。

Objective To explore the influence of repetitive transcranial magnetic stimulation（ rTMS）combined sertraline on the curative effect and cognitive function of post-schizophrenia depression patients. Methods 78 cases of post-schizophrenia depression patients conform to the International Classification of Diseases,tenth edition（ICD-10）were randomized divided into observation group （39 cases）and control group（39 cases）,The control group treated with sertraline,patients were given rTMS treatment in observation group on the basis of control group. Two groups of patients were assessed by using Hamilton Rating Scale for Depression（ HRSD）,The Herth hope index scale（HHI）and Wisconsin card sorting test（WCST）to evaluate before and after 6 weeks treatment. Results The scores of the HRSD in the two patients was significantly lower than before after 6 weeks treatment（t=34. 212,P﹤0. 01）. The scores of HRSD in the observation group were significantly lower than those in the control group（t=6. 705,P﹤0. 01）. The scores of the HHI total score and each factor score in the two groups were higher than before treatment（t=3. 184,2. 799,4. 265,2. 855,P﹤0. 01）. The scores of HHI in the observation group were significantly higher than those in the control group（ t=3. 184,2. 799,4. 265,2. 855,P﹤0. 01）. The WCST scores of the observation group is improved than before（t=20. 399,18. 558,5. 101,5. 894,15. 385,P﹤0. 01）. Compered with the control group,the WCST scores of the observation group is improved,the difference was statistically significant（ t=11. 900,10. 614,3. 739,3. 573,6. 229,P﹤0. 01）. Conclusion rTMS combined with sertraline can improve the efficacy,the level of the hope and cognitive function in post-schizophrenia depression.