重复经颅磁刺激联合运动疗法对抑郁症患者认知功能和血清炎症细胞因子水平的影响

Effect of repetitive transcranial magnetic stimulation combined with exercise therapy on cognitive function and serum inflammatory cytokine levels in patients with depression

目的探讨重复经颅磁刺激(rTMS)联合运动疗法对抑郁症患者认知功能和血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)及肿瘤坏死因子α(TNF-α)水平的影响。方法选取2017年1月—2018年12月于杭州市第七人民医院精神科就诊的抑郁症患者300例,根据随机数字法将患者分为rTMS组和联合组,各150例。根据汉密顿抑郁量表(HAMD)评价疗效。采用威斯康星卡片分类测验(WCST)测定认知功能。采用酶联免疫吸附试验测定血清IL-1β、IL-6及TNF-α水平。结果联合组治疗后HAMD评分低于rTMS组(P<0.05),两组治疗后HAMD评分均低于治疗前(P<0.05)。联合组总有效率高于rTMS组(P<0.05)。联合组治疗后WCST随机错误数、WCST持续错误数及WCST总错误数均高于rTMS组(P<0.05),WCST完成分类数低于rTMS组(P<0.05)。两组治疗后WCST随机错误数、WCST持续错误数及WCST总错误数均高于治疗前(P<0.05),WCST完成分类数低于治疗前(P<0.05)。联合组治疗后血清IL-1β、IL-6及TNF-α水平低于rTMS组(P<0.05)。两组治疗后血清IL-1β、IL-6及TNF-α水平均低于治疗前(P<0.05)。结论rTMS联合运动疗法可能通过抑制炎症反应改善抑郁症患者的认知功能。

Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)combined with exercise therapy on cognitive function and serum levels of interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)in patients with depression.Methods Totally 300 patients with depression from the Department of Psychiatry,Hangzhou Seventh People’s Hospital,from January 2017 to December 2018 were selected,and were divided into repetitive transcranial magnetic stimulation group(group A)and repetitive transcranial magnetic stimulation combined with exercise therapy group(Group B)accorded to the random number method,150 cases in each group.Efficacy was evaluated according to the HAMD rating scale.Cognitive function was measured by WCST.Serum levels of IL-1β,IL-6 and TNF-αwere measured by enzyme-linked immunosorbent assay(ELISA).Results After treatment,the HAMD scores of group B was higher than that of group A,and the HAMD scores of the two groups were lower than those before treatment(P<0.05).The total effective rate of group B was higher than that of group A(P<0.05).The number of WCST random errors,WCST persistent errors and WCST total errors in group B were higher than those in group A(P<0.05),WCST completed classifications was lower than in group A(P<0.05).After treatment,the number of WCST random errors,the number of WCST persistent errors and the total number of WCST errors were higher than those before treatment(P<0.05),and the number of WCST completed classification was lower than that before treatment(P<0.05).The levels of IL-1β,IL-6 and TNF-αin the combined group were lower than those in the repetitive transcranial magnetic stimulation group(P<0.05).The serum levels of IL-1β,IL-6 and TNF-αin the two groups were lower than those before treatment(P<0.05).Conclusion Repetitive transcranial magnetic stimulation combined with exercise therapy may improve cognitive function in patients with depression by inhibiting inflammatory response.