重复经颅磁刺激与艾司西酞普兰治疗帕金森伴抑郁状态的疗效及机制研究

A research of repetitive transcranial magnetic stimulation and escitalopram in the treatment of patients with Parkinson’s disease and depression

目的比较重复经颅磁刺激(repetitive transcranial magnetic stimulate,rTMS)与SSRI类抗抑郁药物艾司西酞普兰治疗帕金森(Parkinson’s disease,PD)伴抑郁患者的疗效,进一步通过检测外周血脑源性神经生长因子(brain-derived neurotrophic factor,BDNF)mRNA表达的变化,探讨rTMS与艾司西酞普兰治疗PD伴抑郁的可能机制。方法将PD伴抑郁患者按照治疗手段分为3组,即rTMS组、艾司西酞普兰组、rTMS+艾司西酞普兰组,另设健康对照组。治疗前采用统一帕金森病评价量表(unified Parkinson’s disease rating scale,UPDRS)及汉密尔顿抑郁量表(Hamilton depression scale,HAMD)进行评价,同时检测外周血BDNF mRNA表达水平;在给予为期4周的相应治疗后,再次进行UPDRS及HAMD评分及外周血BDNF mRNA表达水平的检测。结果治疗前3组的UPDRS及HAMD评分明显高于正常对照组,差异有统计学意义(P<0.05);且治疗前3组外周血BDNF mRNA表达水平低于正常对照组,差异有统计学意义(P<0.05);治疗后,3组UPDRS及HAMD评分均明显下降,与治疗前相比差异有统计学意义(P<0.05),但与正常对照组相比仍较高,差异有统计学意义(P<0.05);治疗后3组外周血BDNF mRNA表达水平与治疗前相比明显增加,但是与正常对照组相比仍较低,差异有统计学意义(P<0.05)。结论rTMS治疗可作为一种重要的辅助治疗手段来治疗帕金森伴抑郁状态,且可改变外周血BDNF mRNA表达水平,BDNF可能参与帕金森伴抑郁的发生、发展,可作为帕金森伴抑郁治疗的潜在靶点。

Objective To compared the clinical efficacy of repetitive transcranial magnetic stimulate(rTMS)and escitalopram in the treatment of patients with Parkinson’s disease(PD)with depression,and investigated whether the treatments affects expression pattern of brain-derived neurotrophic factor(BDNF)mRNA in peripheral blood leukocytes.Methods There were healthy control group and PD with depression patients.The patients were divided into three groups:the rTMS group,the escitalopram group and the rTMS+escitalopram group.We compared the mean unified Parkinson’s disease rating scale(UPDRS)and the Hamilton depression scale(HAMD)scores of patients before and after treatment.Meanwhile,we measured the BDNF mRNA expression before and after 4 weeks treatment.Results Compared with the control group,the UPDRS and the HAMD scores significantly increased in the three groups of patients before the treatments(P<0.05).There was a significant reduction of the UPDRS and the HAMD scores after treatment,but it was still higher than the control group(P<0.05).And compared with the control group,BDNF mRNA expression were significantly decreased in the three groups of patients before and after treatments(P<0.05).BDNF mRNA expression were significantly increased in the three groups of patients after treatments(P<0.05).Conclusion rTMS can be used as an important means of adjuvant therapy for treatment the patients with PD with depression,and the BDNF possesses important role in PD with depression and it is possible to search a new therapeutic target for PD with depression.