重复经颅磁刺激对脑卒中后癫痫合并焦虑抑郁共病病人去甲肾上腺素及5-羟色胺的调节作用

The Regulation of Repetitive Transcranial Magnetic Stimulation on Norepinephrine and 5-hydroxytryptamine in Post-stroke Epilepsy Patients with Comorbid Anxiety and Depression

目的探讨重复经颅磁刺激(rTMS)对脑卒中后癫痫合并焦虑抑郁共病(CAD)病人去甲肾上腺素(NE)及5-羟色胺(5-HT)的调节作用。方法选择2014年3月—2016年8月廊坊市第四人民医院神经内科收治的脑卒中后继发性癫痫合并CAD病人92例,按照数字列表法分为rTMS组与对照组,每组46例。对照组常规药物治疗及抗癫痫治疗,rTMS组在此基础上加用rTMS治疗。于治疗前及治疗后进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、临床神经功能缺损程度(NFDS)评分及高切黏度(HSV)、低切黏度(LSV)、血浆比黏度(ηs)、血小板聚集指数(PAI)、纤维蛋白原(Fib)等血液流变学指标测定。采用酶联免疫吸附法测定两组治疗前后血浆NE及5-HT含量。结果 (1)与治疗前比较,两组治疗后HAMA、HAMD及NFDS评分明显下降(P <0.05),但rTMS组下降程度高于对照组(P <0.05)。(2)与治疗前比较,两组治疗后Fib水平明显下降(P <0.05),rTMS组治疗后HSV、LSV、ηs、PAI等显著下降(P <0.05),且明显低于对照组(P <0.05)。(3)与治疗前比较,两组治疗后血浆NE水平明显升高(P <0.05),5-HT水平明显下降(P <0.05),rTMS组改善程度优于对照组。结论常规药物基础上予rTMS治疗有助于改善脑卒中后癫痫合并焦虑抑郁共病病人的焦虑抑郁症状,其机制可能与其对NE及5-HT的调节作用有关。

Objective To investigate the regulation of repetitive transcranial magnetic stimulation(rTMS)on norepinephrine(NE)and 5 hydroxytryptamine(5-HT)in post stroke epilepsy patients with comorbid anxiety and depression(CAD).Methods Ninety two patients with post stroke epilepsy and CAD from March 2014 to August 2016 were randomly divided into two groups:control group(n=46)treated with routine treatment,and treatment group(n=46)treated with rTMS plus routine treatment.Hamilton Anxiety Scale(HAMA),Hamilton Depression Rating Scale(HAMD),and Neurological Function Defect Scale(NFDS)scores were evaluated before and after treatment.The hemorheological parameters such as high shear viscosity(HSV),low shear viscosity(LSV),specific shear viscosity(ηs),platelet aggregation index(PAI),fibrinogen(Fib)were determinated.The plasma NE and 5-HT levels were determinated by enzyme linked immunosorbent assay before and after treatment.Results Compared with eata before treatment,the scores of HAMA,HAMD,and NFDS were significantly decreased in the two groups(P<0.05),which were lower in the treatment group than that in the control group(P<0.05).Fib levels were significantly decreased in the two groups after treatment(P<0.05).The levels of HSV,LSV,ηs,PAI were significantly decreased in the treatment group(P<0.05),which were lower than that in the control group(P<0.05).Compared with that before treatment,plasma NE levels were significantly increased in the two groups after treatment(P<0.05),which were higher in the treatment group than that in the control group(P<0.05).Compared with that before treatment,plasma 5-HT levels were significantly decreased in the two group(P<0.05),which were lower in the treatment group than that in the control group(P<0.05).Conclusion The rTMS can improve the symptoms of CAD in patients with post stroke epilepsy,and its mechanism may be related to the regulation of NE and 5-HT.