经颅磁刺激联合阿戈美拉汀治疗抑郁症伴失眠的疗效及机制研究

Efficacy and mechanism of repetitive transcranial magnetic stimulation combined with agomelatine in the treatment of depression with insomnia

目的:探讨经颅磁刺激(rTMS)联合阿戈美拉汀治疗抑郁症伴失眠的疗效及机制。方法:选取110例抑郁症伴失眠患者为研究对象,按照疗方案不同分为观察组和对照组,每组各55例。观察组予以阿戈美拉汀+rTMS治疗,对照组予以阿戈美拉汀+伪刺激治疗,疗程12周。比较两组患者临床疗效、治疗前后汉密顿抑郁量表-17(HAMD-17)、匹兹堡睡眠质量指数(PSQI)、疲劳量表(FS-14)、重复性成套神经心理状态测验(RBANS)评分及血清肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)、IL-1β水平及不良反应发生情况。结果:观察组患者临床总有效率高于对照组(P<0.05)。治疗后,观察组HAMD-17、PSQI、FS-14评分低于对照组(P<0.05);RBANS中即刻记忆、视觉广度、言语功能、注意力、延时记忆等评分升高(P<0.05);血清TNF-α、IL-2、IL-1β水平低于对照组(P<0.05)。两组患者头晕、头痛、嗜睡、消化道不适、转氨酶升高等不良反应发生率比较,差异无统计学意义(P>0.05)。结论:rTMS联合阿戈美拉汀治疗抑郁症伴失眠的疗效显著,且安全性好,血清炎性细胞因子水平降低可能是机制之一。

Objective:To explore the efficacy and mechanism of repetitive transcranial magnetic stimulation(rTMS)combined with agomelatine in the treatment of depression with insomnia.Methods:A total of 110 patients with depression complicated with insomnia were selected as the research subjects,and they were divided into the observation group and the control group according to different treatment plan,with 55 cases in each group.The observation group was treated with agomelatine+rTMS while the control group was given agomelatine+pseudo-stimulation therapy.The clinical efficacy of the two groups was compared,and the scores of Hamilton Depression Scale-17(HAMD-17),Pittsburgh Sleep Quality Index(PSQI),Fatigue SeverityScale(FS-14)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)and levels of serum tumor necrosis factor-α(TNF-α),interleukin-2(IL-2)and IL-1βwere compared between the two groups before and after treatment.Results:The total clinical effective rate of the observation group was significantly higher than that of the control group(P<0.05).The scores of HAMD-17,PSQI and FS-14 in the observation group were lower than those in the control group after treatment(P<0.05).The scores of factors such as immediate memory,visual span,speech function,attention and delayed memory increased in RBANS(P<0.05).The levels of serum TNF-α,IL-2 and IL-1βin the observation group were significantly lower than those in the control group after treatment(P<0.05).There were no significant differences in the incidence rates of adverse reactions such as dizziness,headache,drowsiness,gastrointestinal discomfort and elevated transaminase between the two groups(P>0.05).Conclusion:rTMS combined with agomelatine has a significant efficacy and good safety in the treatment of depression with insomnia.The decrease of serum inflammatory cytokines may be one of the mechanisms.