低频重复经颅磁刺激联合尼麦角林治疗脑卒中后抑郁患者的临床疗效

Clinical Effect of Low-frequency Repetitive Transcranial Magnetic Stimulation Combined with Nicergoline in Treating Patients with Post-stroke Depression

目的 观察低频重复经颅磁刺激(rTMS)联合尼麦角林治疗脑卒中后抑郁(PSD)患者的临床疗效。方法 选取2015—2017年武汉市普仁医院收治的PSD患者92例,采用随机数字表法分为对照组和观察组,每组46例。对照组患者在常规治疗基础上给予尼麦角林片治疗,观察组患者在对照组基础上给予低频rTMS治疗。比较两组患者临床疗效、治疗前后实验室检查指标〔包括5-羟色胺(5-HT)、去甲肾上腺素(NE)、神经生长因子(NGF)、脑源性神经营养因子(BDNF)〕、汉密尔顿抑郁量表(HAMD)评分、健康调查简表(SF-36)评分,并观察两组患者治疗期间不良反应发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)两组患者治疗前5-HT、NE、NGF、BDNF比较,差异无统计学意义(P>0.05);观察组患者治疗后5-HT、NE、NGF、BDNF高于对照组(P<0.05)。(3)两组患者治疗前HAMD评分和SF-36评分比较,差异无统计学意义(P>0.05);观察组患者治疗后HAMD评分低于对照组,SF-36评分高于对照组(P<0.05)。(4)两组患者治疗期间未出现明显不适,无一例出现疼痛、头晕或癫痫症状。结论 低频rTMS联合尼麦角林治疗PSD患者的临床疗效确切,可有效改善患者神经功能,减轻患者抑郁程度,提高患者生存质量,且安全性较高。

Objective To observe the clinical effect of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with nicergoline in treating patients with post-stroke depression(PSD).Methods A total of 92 patients with PSD were selected in Puren Hospital of Wuhan from 2015 to 2017,and they were divided into control group and observation group according to random number table,with 46 cases in each group.Patients in control group received nicergoline tablets based on conventional treatment,while patients in observation group received low-frequency rTMS based on that of control group.Clinical effect,pre-and post-treatment laboratory examination results(including 5-HT,NE,NGF and BDNF),HAMD score and SF-36 score were compared between the two groups,and incidence of adverse reactions was observed during treatment.Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)No statistically significant difference of 5-HT,NE,NGF or BDNF was found between the two groups before treatment(P>0.05),while 5-HT,NE,NGF and BDNF in observation group were statistically significantly higher than those in control group after treatment(P<0.05).(3)No statistically significant difference of HAMD score or SF-36 score was found between the two groups before treatment(P>0.05);after treatment,HAMD score in observation group was statistically significantly lower than that in control group,while SF-36 score in observation group was statistically significantly higher than that in control group(P<0.05).(4)No one in the two groups occurred any obvious discomfort,pain,dizziness or epilepsy.Conclusion Low-frequency rTMS combined with nicergoline has certain clinical effect in treating patients with PSD,which can effectively improve the neurological function and quality of life,reduce the depression degree,and is relatively safe.