间歇性θ短阵快速脉冲经颅磁刺激对脑卒中患者抑郁情绪及认知功能的影响

EFFECTS OF INTERMITTENT THETA BURST TRANSCRANIAL MAGNETIC STIMULATION ON DEPRESSED MOOD AND COGNITIVE FUNCTION IN PATIENTS WITH STROKE

目的探讨间歇性θ短阵快速脉冲经颅磁刺激(iTBS)对脑卒中后抑郁(PSD)伴脑卒中后认知障碍(PSCI)患者抑郁情绪及认知功能的影响。方法采用随机数字表法将40例符合纳入标准的PSD伴PSCI患者分为iTBS组及对照组,每组20例,对照组患者给予常规药物治疗(如控制血压、血糖、调节脂代谢、营养脑神经及改善微循环等)、常规康复训练、认知训练及抗抑郁药物草酸艾司西酞普兰治疗。iTBS组在对照组的基础上,每日认知训练后辅以iTBS治疗。于治疗前、治疗4周后采用汉密尔顿抑郁量表17项(HAMD-17)、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、事件相关诱发电位P300测定指标及改良Barthel指数(MBI)评定两组患者的抑郁程度、认知功能及日常生活活动能力(ADL)。结果治疗前2组患者一般情况、HAMD-17评分、P300潜伏期、P300波幅及MMSE、MoCA、MBI评分比较差异均无显著性(P>0.05)。治疗后,两组患者的HAMD-17评分降低,MMSE、MoCA、MBI评分均有不同程度提高,P300潜伏期缩短、波幅增高(t=-11.94~17.09,P<0.05);两组患者治疗前后MBI、HAMD-17、MMSE、MoCA评分差值及P300潜伏期、P300波幅差值比较,差异均具有显著性(t=-4.18~5.47,P<0.05)。结论与常规康复训练及服用抗抑郁药物相比较,iTBS联合康复训练及抗抑郁药物有望进一步改善脑卒中患者抑郁情绪及认知功能。

Objective To investigate the effects of intermittent theta burst transcranial magnetic stimulation(iTBS)on the depressed mood and cognitive function of patients with poststroke depression(PSD)and poststroke cognitive impairment(PSCI).Methods Forty patients with PSD and PSCI,who met the inclusion criteria,were divided into iTBS group and control group using a random number table,with 20 patients in each group.Patients in the control group were subjected to conventional pharmacotherapy(e.g.,blood pressure and blood glucose control,lipid metabolism regulation,cerebral nerve nourishment,and microcirculation improvement),conventional rehabilitation training,cognitive training,and treatment with the antidepressant drug escitalopram oxalate.Patients in the iTBS group received iTBS treatment after daily cognitive training in addition to the treatments for the control group.Before and four weeks after treatment,the 17-item Hamilton Depression Rating Scale(HAMD-17),Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),event-related evoked potential P300,and modified Barthel Index(MBI)were used to assess the degree of depression,cognitive function,and activities of daily living of patients in the two groups.Results Before treatment,there were no significant differences between the two groups in general condition,latency and amplitude of P300,and HAMD-17,MMSE,MoCA,and MBI scores(P>0.05).After treatment,the two groups had decreased HAMD-17 scores,varying degrees of increases in MMSE,MoCA,and MBI scores,and shortened latency and elevated amplitude of P300(t=-11.94-17.09,P<0.05).There were significant differences between the two groups in the changes in MBI,HAMD-17,MMSE,and MoCA scores as well as latency and amplitude of P300 after treatment(t=-4.18-5.47,P<0.05).Conclusion\Compared with conventional rehabilitation training and administration of antidepressant drugs,iTBS in combination with rehabilitation training and antidepressant drugs can further improve the depressed mood and cognitive function of patients with stroke.