rTMS治疗食管癌患者抑郁疗效的功能磁共振评估

Therapeutic effects of rTMS on esophageal cancer patients with depression: Assessed with functional magnetic resonance imaging

目的探讨重复经颅磁刺激(rTMS)对食管癌患者抑郁的临床疗效及对大脑神经活动的影响。方法选取南充市中心医院2015年11月～2016年12月住院的22例食管癌抑郁患者,按入院顺序分为单次rTMS治疗组(s-rTMS组,12例)和多次rTMS治疗组(m-rTMS组,10例)。s-rTMS组只接受1次rTMS治疗(10Hz,110%静息运动阈值强度,左侧背外侧前额叶皮层);m-rTMS组接受连续5d rTMS治疗(两组参数完全相同)。比较两组治疗前后及组间汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评分及低频振幅(ALFF)的变化和差异,并计算HAMD、SDS评分改变量与ALFF改变量的相关性。结果 rTMS治疗后,s-rTMS组和m-rTMS组两组HAMD及SDS评分均有明显改善(P<0.05),且m-rTMS组比s-rTMS组改善更明显(P<0.05);治疗后s-rTMS组ALFF明显增高的脑区包括双侧前额叶(PFC)、双侧前扣带回(ACC)、右侧丘脑(THA)、右侧海马HIP(HIP);m-rTMS组ALFF明显增高的脑区包括在双侧PFC、双侧ACC、右侧苍白球、右侧HIP;与s-rTMS组比较,m-rTMS组治疗后双侧PFC、双侧ACC、右侧尾状核头的ALFF增加更明显(P<0.05)。两组治疗前后ACC的ALFF改变量与HAMD评分改变量均呈显著负相关;m-rTMS组治疗前后右侧HIP的ALFF改变量与HAMD评分改变量呈显著负相关(P<0.05)。结论高频rTMS治疗为食管癌抑郁提供了一种安全、有效的治疗方法,且多次rTMS刺激比单次rTMS刺激具有更好的疗效,其抗抑郁疗效可能与rTMS对大脑神经活动的调节尤其是对ACC及右侧HIP神经活动的调节有关。

Objective To investigate the clinical therapeutic effects and the influence on the neural activity of esophageal cancer patients with depression after repetitive transcranial magnetic stimulation(rTMS). Methods Twenty-two identified esophageal cancer patients with depression were recruited in this study and divided into single rTMS(s-rTMS) group(12 patients), and multiple rTMS(m-rTMS) group(10 patients). Patients in the s-rTMS group received one session of high-frequency rTMS(10.0 Hz, 110 % of resting motor threshold) treatment over the left dorsolateral prefrontal cortex. The m-rTMS group received rTMS in five consecutive days, with the same parameters. Comparisons of the HAMD, SDS and amplitude of low frequency fluctuation(ALFF) were carried out before and after the treatment in each group as well as between s-rTMS and m-rTMS groups after the treatment. Furthermore, correlation between the change of behavioral scores(HAMD and SDS) and the change of ALFF were also calculated. Results HAMD and SDS scores were significantly increased both in s-rTMS and m-rTMS groups after treatment(P< 0.05) and the m-rTMS group improved more than s-rTMS group. Comparison of the ALFF between baseline and after treatment, ALFF was significantly increased in the bilateral prefrontal cortices(PFC), bilateral anterior cingulate cortex(ACC), right thalamus(THA), and the right hippocampus(HIP) in s-rTMS group. The ALFF was significantly increased in the bilateral PFC, bilateral ACC, right pallidum, and the right HIP in m-rTMS group after the rTMS treatment. The m-rTMS group also achieved more significant improved ALFF in the bilateral PFC, bilateral ACC, and the head of the right caudate nucleus compared to the s-rTMS group(P< 0.05). The significantly negative correlation between the ALFF changes in the ACC and the HAMD score changes were observed in both groups. In addition, the significant negative correlation was found between the ALFF changes in the right HIP and the HAMD score changes in m-rTMS group(P< 0.05).Conclusion High frequency rTMS which is a safe method might have a positive antidepressant effect on esophageal cancer patients with depression, and the treatment using m-rTMS is more effective than s-rTMS. This may be associated with the regulation of rTMS on neural physiological activities in the related brain areas, especially on the ACC and the right HIP.