重复经颅磁刺激治疗首发未服药抑郁症患者的疗效及家庭功能对疗效的影响

Efficacy of repeated transcranial magnetic stimulation in the treatment of patients with first-episode depression without medication and the effect of family function on the efficacy

目的探讨重复经颅磁刺激（rTMs）对首发未服药抑郁症患者的疗效，并分析家庭功能对治疗效果的影响。方法于2015年10月-2017年10月对我院门诊就诊，诊断为抑郁症且为首次发作、未服用药物治疗的100例患者进行研究，单纯采用rTMS对患者进行治疗，治疗4周，5次／周，共20次，于治疗前应用汉密尔顿抑郁量表（HAMD）及家庭亲密度与适应性量表（FACESII—CV）对患者抑郁程度及家庭功能进行调查，治疗4周末再次应用HAMD评估治疗效果，并分析家庭功能对治疗效果的影响，最终完成本次研究患者89例。结果（1）治疗前患者HAMD评分为（27．08±5．32）分，治疗后为（14．52±4．76）分，治疗前后比较差异有统计学意义（t=16．593，P〈0．01）；（2）按照FACESⅡ-CV评分标准，本研究中极端型34例，中间型31例，平衡型24例，3种家庭HAMD评分在治疗前、治疗4周末及差值变化比较差异有统计学意义（P〈0．01），其中极端型家庭在治疗前后HAMD评分均高于中间型及平衡型家庭，治疗前后差值变化低于中间型及平衡型家庭，中间型与平衡型家庭之间比较差异无统计学意义；（3）治疗前HAMD评分与家庭亲密度（r=-0．230，P〈0．05）及家庭适应性呈负相关（r=-0．220，P〈0．05），治疗前后HAMD差值与家庭亲密度（r=0．230，P〈0．05）呈正相关；多元线性回归显示，家庭亲密度及治疗前HAMD评分是治疗前后HAMD差值的影响因素。结论单纯rTMS治疗可以改善首次发作且未服药患者的抑郁程度，但可能仅限于轻中度抑郁症患者，而对于抑郁情绪严重的患者，单纯的rTMS治疗效果可能并不理想；抑郁症患者的家庭功能影响抑郁发作时的严重程度，极端型家庭患者抑郁发作时抑郁程度更重，家庭亲密度低影响治疗效果。

Objective To investigate the effects of repetitive transcranial magnetic stimulation （rTMS） on the first episode and not taking drugs depressive patients, and to analyze the effects of family function in the treatment. Methods From October 2015 to October 2017, a total of 100 cases of first-episode depression patients who had never received medication treatment in the outpatient department of Xinjiang Uygur Autonomous Region People＇s Hospital were recruited in the research. All the patients were simply treated with rTMS for 4 weeks, 5 times per week, 20 times in total. We used Hamilton Depression Scale （HAMD） and Family Adaptability and Cohesion Scale, Second Edition （FACESⅡ-CV） to investigate the degree of depression and family function before treatment, and after four weeks of treatment, we used the HAMD scale to evaluate the therapeutic effect again, and analyzed the influence of family function on the treatment effects. Finally, 89 cases completed the study. Results The scores of HAMD before and after treatment were （27.08 ± 5.32） and （14.52 ± 4.76）, and the difference was statistically significant （t=16.593, P 〈0.01）. In accordance with the FACESII-CV standard for evaluation, there were 34 intermediate, 31 extreme and 24 balance family in this study. There was a significant difference seen in HAMD scores in the three type families before and after treatment （P 〈 0.01）. The score of HAMD in extreme family was higher than intermediate and balance family and the variation of HAMD after treatment in extreme fmnily was lower than intermediate and balance family. There was no significant difference between intermediate and balance family. The score of HAMD before treatment was negatively correlated with family adaptability and cohesion （r=-0.230, -0.220 ; P 〈 0.05）, and the variation of HAMD after treatment was positively correlated with family cohesion （r=0.230, P 〈 0.05）. The multiple linear regression showed that family cohesion and the score of HAMD before treatment has speculated significance to the variation of HAMD. Conclusions Simple rTMS therapy can improve the degree of depression in patients with first episode and not taking drugs, but may be limited to patients with mild and moderate depression. Whereas for patients with severe depression, simple rTMS may not be ideal. The family function of depression patients affects the severity of depression attack. The depression degree of extreme family patients is more serious, and low family cohesion affected the therapeutic effects.