深部经颅磁刺激对难治性抑郁症患者的疗效及对血清脑源性神经营养因子的影响

Effects of deep-brain magnetic stimulation on brain derived neurotropic factor in treatment-resistant depression

目的：探讨深部经颅磁刺激（DMS）对难治性抑郁症患者的疗效以及对血清脑源性神经营养因子（BDNF）浓度的影响。方法：15例难治性抑郁症患者给予DMS治疗,频率8～12 Hz（alpha节律）,每周5次,每次20 min,连续6周共30次。采用汉密尔顿抑郁量表（HAMD-17）及HAMD-17的睡眠和Apathy亚量表中情感淡漠和睡眠障碍的特定条目、汉密尔顿焦虑量表（HAMA）分别在治疗前、治疗后2、4和6周对患者的症状进行评估;同时间检测血清BDNF浓度,分析比较疗效及与BDNF浓度的相关性。结果：治疗6周,治疗有效率53.5%;完全缓解率33.3%。HAMD总分（F=31.75,P〈0.001）、HAMA总分（F=10.62,P=0.001）、情感淡漠（F=24.10,P〈0.01）及睡眠障碍（F=8.79,P〈0.01）评分均较治疗前显著降低。血清BDNF浓度在治疗6周时明显增高（F=5.72,P=0.002）。Spearman相关分析显示HAMD减分值与BDNF浓度增加呈正相关（r=0.56,P=0.028）。结论：DMS在有效改善难治性抑郁症患者症状的同时可提高血清BDNF的浓度,且BDNF浓度与疗效具有相关性。

Objective：To explore the effectiveness of deep-brain magnetic stimulation（ DMS） on treatment-resistant depression and the effect on brain derived neurotropic factor（ BDNF）.Method：Fifteen treatment-resistant depressive patients were enrolled.Antidepressant medications were withdrawn and active DMS treatment was administered at 8 ～ 12 Hz（ alpha burst）,20 minutes for each session,5 days a week for consecutive 6 weeks,30 sessions in all.The subjects were evaluated with the 17 items Hamilton rating scale for depression（ HAMD-17） and Hamilton rating scale for anxiety（ HAMA） at baseline,2,4,6 week after treatment.Apathy and sleep scores were derived from the specific items of HAMD-17.Serum BDNF was also assayed at each visitto analyze the correlation between efficacy and BDNF level.Results：At endpoint（ week 6） 53.5% patients responded to the treatment and 33.3% obtained remission.Significant decreases were observed in HAMD-17 total score（ F = 31.75,P〈0.001） and HAMA total score（ F = 10.62,P = 0.001）.Apathy and sleep disturbance after treatment were also significantly improved（ F = 24.10,F = 8.79;both P〈0.01）.The level of BDNF gradually increased after the treatment,especially at week 6（ F = 5.72,P = 0.002）.At endpoint,the decrease of HAMD-17 and the increase of serum BDNF were positively correlated（ r = 0.56,P = 0.028）.Conclusion：DMS is effective intervention for treatment-resistant depression and enhanced serum BDNF accordingly.The increase of BDNF level is correlated with the improvement of depression.