高频或低频重复经颅磁刺激治疗对抑郁障碍患者局部脑内代谢物质的影响

Influence of high or low frequency repetitive transcranial magnetic stimulation therapy on local brain metabolism substance in patients with depressive disorder

目的:探讨高频或低频重复经颅磁刺激(rTMS)治疗对抑郁障碍患者局部脑内代谢物质的影响。方法:随机将40例抑郁障碍患者分成高频和低频r TMS组并进行相应的r TMS治疗4周。治疗前后应用汉密尔顿抑郁量表(HAMD)评定患者的病情,应用氢质子磁共振波普成像(1H-MRS)检测前额叶皮质N-22乙酰天门冬氨酸(NAA)、谷氨酸(Glx)、胆碱复合物(Cho)及肌酸(Cr)代谢物水平,并与20名正常对照者(对照组)比较。结果:两r TMS组分别有12例患者完成治疗,治疗后两组HAMD评分显著低于治疗前(P均<0.01)。与对照组比较,治疗前两r TMS组左侧前额叶皮质NAA/Cr、Glx/Cr、右侧前额叶皮质NAA/Cr显著降低(P均<0.01),治疗后都有明显升高(P均<0.05)。结论:抑郁障碍患者双侧前额叶NAA及左侧前额叶Glx水平降低;高、低频r TMS治疗后患者双侧前额叶NAA及左侧前额叶Glx水平提高,可能是r TMS治疗抑郁障碍的机制之一。

Objective： To explorer the influence of high or low frequency repetitive transcranial magnetic stimulation （rTMS） therapy on local brain metabolism substance in patients with depressive disorder. Method：Fourty patients with depressive disorder were randomly divided into high frequency rTMS （HF-rTMS） group and the low frequency rTMS（LF-rTMS） group,20 cases in each group; and received the corresponding rTMS treatment for 4 weeks. The condition of the patients were assessed by Hamilton rating scale for depression （ HAMD）, and the levels of N-acetylaspartate （ NAA）, glutamine ＋ glutamate （ Glx）, choline （Cho） were measured and their ratios of metabolite to Cr levels were determined in bilateral frontal lobe by proton magnetic reso- nance spectroscopy （ 1 H-MRS） before and after the treatment. The result of i H-MRS was compared with 20 normal controls （control group）. Results：Twelve patients in each rTMS group completed the treatment;and the HAMD scores of the two rTMS groups were significantly decresed than before treatment （ all P 〈 0.01 ）. Compared with the control group, the levels of NAA/Cr, Glx/Cr on left side of the prefrontal cortex （PFC）, and NAA/Cr on right PFC were lower significantly in the two rTMS groups before treatment （all P 〈0.01 ） ;but all of them had increased significantly after treatment （all P 〈 0.05）. Conclusion ： There are reductions of levels of NAA in bilateral PFC and Glx in left PFC in patients with depressive disorder. After high and low frequency rTMS treatment, the levels of NAA in bilateral PFC and Glx in left PFC obviously increase. This may be one of the mechanism of rTMS treatment for depressive disorder.