重复经颅磁刺激对躯体形式障碍患者的临床疗效研究

Clinical efficacy of repeated transcranial magnetic stimulation in patients with somatoform disorder

目的:探讨重复经颅磁刺激(rTMS)联合度洛西汀治疗躯体形式障碍的疗效及安全性。 方法:将45例躯体形式障碍患者按就诊顺序分为研究组(22例)和对照组(23例);给予两组患者口服度洛西汀(40~60mg/d),疗程4周;在此基础上研究组联合rTMS每日1次、每周5次、共3周。治疗前及治疗后1、2、3、4周应用汉密尔顿抑郁量表(HAMD-17)减分率评定疗效,应用治疗中出现的症状量表(TESS)评定不良反应。结果:治疗后两组HAMD-17评分随时间进展明显下降,第3、4周末研究组HAMD-17评分明显低于对照组(P均<0.05);研究组显效率(80.95%)明显高于对照组(56.52%)(P<0.05);研究组不良反应发生率(27.3%)与对照组(43.5%)比较差异无统计学意义。 结论:与单用度洛西汀治疗相比,rTMS结合度洛西汀治疗躯体形式障碍起效快、疗效优、不良反应相似。

Objective: To investigate the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) combined with duloxetine in patients with somatoform disorders (SD). Method: Forty-five SD patients were divided into study group (22 cases) and control group (23 cases) according to the order of visiting time.Both the two groups were treated by duloxetine dose 40-60 mg/d for 4 weeks.On this basis,the study group was added rTMS treatment once a day and 5 times a week for 3 weeks.Hamilton depression rating scale (HAMD-17) was used to assess the condition of patients before and 1,2,3 and 4 weeks after the treatment,respectively.Meanwhile treatment emergent symptom scale (TESS) was used to assess the adverse reactions. Results: The HAMD scores were decreased significantly with time after treatment in the two groups;and the HAMD scores at the end of the 3rd and 4th week after treatment in the study group were significantly lower than those in the control group (all P <0.05).The efficiency of the study group (80.95 %) was significantly higher than that in the control group (56.52 %)( P <0.05).The difference of incidence of adverse reactions between the study group (27.3 %) and the control group (43.5 %) was not statistically significant. Conclusion: Compared to the single treatment with duroxetine on SD,rTMS combined with duloxetine has a better therapeutic effect and similar adverse reactions.