氟西汀联合重复经颅磁刺激对急性脑卒中后抑郁患者的认知功能、神经功能及血清BDNF、CRP的影响

Effects of fluoxetine combined with repetitive transcranial magnetic stimulation on cognitive function,neurological function,serum BDNF,and CRP in acute stroke patients with post-stroke depression

目的探讨氟西汀联合重复经颅磁刺激对急性脑卒中后抑郁患者的认知功能、神经功能及血清脑源性神经营养因子(BDNF)、C反应蛋白(CRP)的影响。方法选择2016年2月至2018年11月空军军医大学第二附属医院神经内科收治的110例急性脑卒中后抑郁患者进行研究,采用随机数表法将患者分为观察组和对照组,每组55例。对照组给予氟西汀治疗,观察组在此基础上联合重复经颅磁刺激治疗,均连续治疗8周。比较两组患者治疗前后的汉密尔顿抑郁量表(HAMD)、蒙特利尔认知评估量表(MoCA)、美国国立卫生研究院卒中量表(NIHSS)的评分,以及血清BDNF、CRP水平和不良反应。结果治疗后,观察组患者的HAMD评分和NIHSS评分分别为(9.05±1.86)分、(9.33±1.75)分,明显低于对照组的(13.07±2.21)分、(11.28±2.04)分,MoCA评分为(26.74±1.49)分,明显高于对照组的(24.05±1.52)分,差异均具有统计学意义(P<0.05);治疗后,观察组患者的血清BDNF为(13.12±2.49)μg/L,明显高于对照组的(10.06±2.08)μg/L,CRP为(10.06±2.08)mg/L,明显低于对照组的(9.86±1.73)mg/L,差异均具有统计学意义(P<0.05);观察组和对照组患者的不良反应总发生率分别为1.82%和3.64%,差异无统计学意义(P>0.05)。结论氟西汀联合重复经颅磁刺激治疗急性脑卒中后抑郁患者疗效显著,其不仅能明显改善患者的认知功能和神经功能,还可提高患者的血清BDNF,降低CRP水平,且安全性好。

Objective To study the effects of fluoxetine combined with repetitive transcranial magnetic stimulation(rTMS)on cognitive function,neurological function,serum brain derived neurotrophic factor(BDNF)and C reactive protein(CRP)in acute stroke patients with post-stroke depression(PSD).Methods A total of 110 acute stroke patients with PSD,who admitted to Department of Neurology in the Second Affiliated Hospital of Air Force Medical University from February 2016 to November 2018 were selected and divided into the observation group and control group according to random number table method,with 55 patients in each group.The control group was treated with fluoxetine,while the observation group received rTMS,in addition to fluoxetine.The treatment course was 8 weeks.The changes of Hamilton Depression Scale(HAMD),Montreal Cognitive Assessment(MoCA),National Institutes of Health Stroke Scale(NIHSS),and serum BDNF and CRP levels before and after treatment and adverse reactions of the two groups were compared.Results After treatment,the HAMD score and NIHSS score in the observation group were(9.05±1.86)points and(9.33±1.75)points respectively,which were significantly lower than corresponding(13.07±2.21)points and(11.28±2.04)points in the control group(P<0.05);the MoCA score was(26.74±1.49)points,which were significantly higher than(24.05±1.52)points in the control group(P<0.05);the serum BDNF in the observation group were(13.12±2.49)μg/L,which was significantly higher than(10.06±2.08)μg/L in the control group(P<0.05);the CRP were(8.04±1.59)mg/L,which were significantly lower than(9.86±1.73)mg/L in the control group(P<0.05);the total incidence rates of adverse reactions in the observation group was 1.82%versus 3.64%in the control group(P>0.05).Conclusion Fluoxetine combined with r TMS is well for acute stroke patients with,which can not only improve the cognitive function and neurological function of patients,but also improve the serum BDNF and reduce the CRP level,with good safety.