高频重复经颅磁刺激对帕金森合并抑郁患者的临床疗效分析

Clinical efficacy of high-frequency repetitive transcranial magnetic stimulation in patients with Parkinson's disease complicated with depression

目的研究探讨高频重复经颅磁刺激(rTMS)治疗帕金森合并抑郁患者的临床疗效及脑血流灌注参数变化情况。方法选取我院2018年4月~2020年4月期间收治的88例帕金森病合并抑郁症患者,采用随机数字表法分为对照组和观察组,每组各44例。对照组患者采取常规治疗,观察组患者在对照组基础上接受高频rTMS治疗,疗程均为4 w。比较两组患者治疗前后双侧额叶、顶叶、颞叶及基底节区的脑血流量(CBF)变化情况,17项汉密尔顿抑郁量表(HAMD-17)评分、统一帕金森病评分量表(UPDRS)评分及血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果(1)治疗前,两组患者双侧颞叶、顶叶、额叶及基底节区的CBF差异无统计学意义(P>0.05),但两组左侧顶叶、额叶的CBF均低于右侧(P<0.05);治疗后,观察组患者双侧额叶、顶叶、颞叶及基底节区的CBF改善情况优于对照组(P<0.05)。(2)治疗后,观察组患者HAMD-17评分、UPDRS评分及血清IL-1β、IL-6、TNF-α水平均低于对照组(P<0.05)。结论高频rTMS治疗可有效改善帕金森合并抑郁患者脑血流低灌注,抑制炎症反应,缓解其抑郁症状。

Objective To investigate the clinical efficacy of high-frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of Parkinson's disease with depression and the changes of cerebral blood perfusion parameters.Methods A total of 88 patients with Parkinson's disease combined with depression admitted to our hospital from April 2018 to April 2020 were selected and divided into control group and observation group by random number table method,with 44 patients in each group.The control group received conventional treatment,and the observation group received high-frequency rTMS treatment on the basis of the control group.The cerebral blood flow(CBF)in bilateral frontal,parietal lobe,temporal lobe and basal ganglia region and 17 Hamilton depression rating scale(HAMD-17)score,unified Parkinson disease rating scale(UPDRS)score and serum interleukin 1 beta(IL-1 beta),interleukin 6(IL-6),tumor necrosis factor alpha(TNF alpha)level between the two groups before and after treatment were compared.Results(1)Before treatment,there was no statistically significant difference in CBF in bilateral temporal lobe,parietal lobe,frontal lobe and basal joint region between the two groups(P>0.05),but the CBF in the left parietal lobe and frontal lobe was significantly lower than that in the right lobe(P<0.05).After treatment,the improvement of CBF in bilateral frontal,parietal,temporal and basal ganglia regions in the observation group was better than those in the control group(P<0.05).(2)After treatment,the HAMD-17 score,UPDRS score and serum IL-1,IL-6 and TNF-in the observation group were significantly lower than those in the control group(P<0.05).Conclusion High-frequency rTMS therapy can effectively improve cerebral blood flow hypoperfusion in patients with Parkinson's disease complicated with depression,inhibit inflammatory response,and relieve their depressive symptoms.