高频重复经颅磁刺激联合氟哌噻吨美利曲辛治疗脑卒中后抑郁的疗效及安全性

Clinical Efficacy and Safety of High-frequency Repetitive Transcranial Magnetic Stimulation Combined with Flupentixol Melitracen on Post-stroke depression

目的:探讨高频重复经颅磁刺激(rTMS)联合氟哌噻吨美利曲辛治疗脑卒中后抑郁(PSD)的疗效及安全性。方法:120例PSD患者,随机分为药物组(n=60)和联合组(n=60)。药物组患者接受氟哌噻吨美利曲辛和伪刺激,联合组患者接受氟哌噻吨美利曲辛和高频rTMS。对比观察两组抗PSD有效率、汉密尔顿抑郁量表(HAMD)评分、中国脑卒中量表(CSS)评分、健康调查简表(SF-36)评分、负性认知调查问卷评分及血清5-羟色胺(5-HT)、去甲肾上腺素(NE)、神经肽Y(NPY)、脑源性神经营养因子(BDNF)水平的差异。结果:治疗前,两组各指标差异均无统计学意义(P>0.05);治疗后,联合组抗PSD有效率高于药物组(93.33%vs 71.67%,P<0.01);两组HAMD评分、CSS评分较治疗前降低,SF-36评分较治疗前增高,且联合组改善情况优于药物组(P<0.01);两组负性注意、负性记忆、负性解释、负性反复思考等评分均较治疗前降低,且联合组较药物组降低更明显(P<0.01);两组血清5-HT、NE、NPY及BDNF水平均较治疗前增高,且联合组较药物组升高更明显(P<0.01);两组不良反应差异无统计学意义(P>0.05)。结论:高频rTMS联合氟哌噻吨美利曲辛治疗PSD临床效果显著,值得临床推广应用。

Objective: To explore the clinical efficacy and safety of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with flupentixol melitracen on post-stroke depression(PSD). Method: One hundred and twenty PSD patients were randomly divided into drug group(n=60) and combination group(n=60). The drug group received flupentixol melitracen and sham-stimulation, while the combined group received flupentixol melitracen and high-frequency rTMS. The differences in Anti-PSD effective rate, Hamilton depression scale(HAMD) score, Chinese stroke scale(CSS) score, SF-36 score and the serum levels of serotonin(5-HT), norepinephrine(NE), neuropeptide Y(NPY) and brain-derived neurotrophic factor(BDNF) between the two groups were observed and compared. Results: Before treatment, there was no statistical significance in each index between the two groups(P>0.05).The effective rate of anti-PSD in the combination group was higher than that in the drug group,and the difference was statistically significant(93.33% vs 71.67%,P<0.01).After treatment,HAMD score and CSS score decreased and SF-36 score increased in both groups,but the improvement in combination group was better than that in drug group(P<0.01).After treatment,the scores of negative attention,negative memory,negative interpretation and negative ruminating decreased in both groups,and the decrease was more obvious in the combination group than in the drug group(P<0.01).The serum levels of 5-HT,NE,NPY and BDNF in both groups after treatment were higher than before treatment,and the increase was more obvious in combination group than in drug group(P<0.01).There were no statistical significance in the adverse reactions between the two groups(P>0.05).Conclusion:High frequency rTMS combined with flupentixol meritracine in the treatment of PSD has a significant clinical effect,which is worthy of clinical application.