早期症状改善预测焦虑患者rTMS治疗的疗效

Early improvement predicts efficacy with rTMS treatment in patients with anxiety

目的探讨重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗焦虑障碍患者早期症状的改善能否预测最终的临床疗效。方法选择40例2017年7月-2019年11月本院焦虑障碍患者进行rTMS治疗,早期症状改善的界限值定义为治疗1或2周后汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)减分率15%~40%,分别计算其预测治疗4周后最终临床疗效的灵敏度、特异度、阳性预报值、阴性预报值,并通过受试者工作特征曲线(Receiver operating characteristic curve,ROC曲线)评估其预测效应。结果治疗总有效率为62.5%;以rTMS治疗1周后HAMA减分率15%及20%或治疗2周后HAMA减分率15%、20%、25%、30%及35%为界限值预测临床疗效有相对较高的灵敏度和阴性预报值;以rTMS治疗1周后HAMA减分率30%、35%及40%或治疗2周后HAMA减分率35%及40%为界限值预测临床疗效有相对较高的特异度和阳性预报值;以治疗1和2周后HAMA减分率预测治疗4周后临床疗效的ROC曲线下面积分别为0.712(P<0.05)和0.856(P<0.01)。结论 rTMS治疗焦虑障碍早期症状改善可有效预测最终临床疗效。

Objective To investigate if early improvement predicts the final clinical efficacy with repetitive transcranial magnetic stimulation(rTMS) treatment in patients with anxiety disorders. Methods Forty patients with anxiety disorders accepted rTMS treatment from July 2017 to December 2019. Improvement cut off value was defined as Hamilton Anxiety Scale(HAMA) score reduction of 15%~40% after 1 or 2 weeks of treatment. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict the final clinical efficacy after 4 weeks of treatment. Receiver operating characteristic(ROC) curve was used to assess the prediction effect. Results The total effective rate of the treatment was 62.5%. The cut off value of HAMA score reduction of 15% and 20% for predicting the clinical efficacy after 1 week of rTMS treatment or 15%, 20%, 25, 30% and 35% after 2 weeks of rTMS treatment had comparatively high sensitivity and negative predictive value. The cut off value of HAMA score reduction of 30%, 35% and 40% for predicting the clinical efficacy after 1 week of rTMS treatment or 35% and 40% after 2 weeks of rTMS treatment had comparatively high specificity and positive predictive value. The areas under ROC curve with HAMA score reduction after 1 week and 2 weeks of treatment for predicting the clinical efficacy after 4 weeks of treatment were 0.712(P<0.05) and 0.856(P<0.01). Conclusion This study provided the preliminary evidence to support the perspective that early improvement with rTMS treatment in anxiety disorders could predict the final clinical efficacy effectively.