无抽搐电休克合并重复经颅磁刺激治疗抑郁障碍患者的对照研究

Control study of modified electroconvulsive therapy combined with repetitive transcranial magnetic stimulation in patients with major depressive disorder

目的:探讨抑郁障碍患者应用无抽搐电休克治疗(MECT)合并重复经颅磁刺激(r TMS)对抗抑郁作用及对认知功能的影响。方法:将54例接受MECT治疗的抑郁障碍患者随机分成两组,两组患者在接受MECT基础上,研究组(26例)联合r TMS治疗,对照组(28例)联合伪r TMS治疗;分别于MECT治疗前、第6次MECT次日进行汉密尔顿抑郁量表-17项(HAMD)评定、威斯康辛卡片分类测试(WCST)以及事件相关电位P300检测。结果:治疗前两组HAMD评分、WCST中持续性错误应答数(PE)、完成第一个分类所需应答数(TFC)、以及P300波幅与潜伏期比较差异无统计学意义。治疗后两组HAMD评分较治疗前显著降低(P均<0.01),且研究组HAMD评分显著低于对照组,HAMD减分率显著高于对照组(P均<0.05);协方差分析显示,研究组WCST中PE、P300潜伏期延长幅度及P300波幅降低幅度显著低于对照组(F=6.155、6.761、7.138;P均<0.05)。结论:应用MECT的抑郁障碍患者联用r TMS可增强抗抑郁效果,并减轻MECT所致认知功能损害。

Objective： To explore the antidepressant effect and its influence on cognitive function of modified electroconvulsive therapy（ MECT） combined with repetitive transcranial magnetic stimulation（ r TMS） in patients with major depressive disorder（ MDD）. Method： Fifty-four MDD patients were randomly divided into two groups. Based on MECT,the study group（ 26 cases） and the control group（ 28 cases） combined with r TMS or sham r TMS treatment,respectively. The Hamilton dcpression rating scale for depression 17-item version（ HAMD）,Wisconsin card sorting test（ WCST） and the event related potential P300 were assessed and tested at the baseline and the day after the sixth MECT,respectively. Results： At the baseline,there were no significant differences between groups within HAMD score,WCST indicators including the perseverative errors（ PE）and trials to compete first category（ TFC）,as well as the amplitude and latency of P300. After 6 times of MECT,the average HAMD score was significantly lower,and its reduction rate was significantly higher in the study group than that in the control group. Covariance analysis showed that the increases of PE,P300 latency and the decrease of P300 amplitude in the study group were significantly lower than those in the control group（ F = 6. 155,6. 761,7. 138; all P〈0. 05）. Conclusion： The antidepressant effect of MECT combine with r TMS in MDD patients can be increased,and the cognitive impairment caused by MECT can be reduced.