功能磁共振引导下的重复经颅磁刺激对抑郁症短期疗效和执行功能的影响

Effects of repetitive transcranial magnetic stimulation guided by magnetic resonance imaging on the short-trem efficacy and executive function of patients with depression

目的探讨功能磁共振(MRI)引导下的重复经颅磁刺激(rTMS)对抑郁症短期疗效和执行功能的影响。方法选取2019年11月至2020年3月收治的18~50岁的抑郁症患者59例,按随机数字表法随机分为MRI组、常规组和对照组,3组受试者均接受5-羟色胺再摄取抑制剂(SSRIs)类药物治疗,在此基础上,MRI引导的重复经颅磁刺激组采用静息态磁共振扫描进行个体化定位(MRI组,19例),常规重复经颅磁刺激组采用传统的“5 cm定位法”(常规组,20例),rTMS刺激频率为10 Hz,刺激强度为100%运动阈值,每次均刺激40个序列,每个刺激序列中刺激时间为5 s,间隔时间为20 s,每次共计接受1500个刺激脉冲。每周5次,连续2周共20次,对照组为仅单纯应用SSRIs类药物治疗(20例)。受试者于基线期、治疗2周末进行汉密尔顿抑郁量表17项版本(HAMD-17)、连线测试(TMT-A)和stroop色词测验(SCWT)的评估。结果3组受试者在性别比、年龄、文化程度、抑郁症家族史、首发年龄上均无统计学意义(P>0.05)。在治疗2周末,3组治疗总有效率分别是:MRI组:53.64%;常规组:20.00%;对照组:15.00%;MRI组的疗效要优于常规组和对照组(P=0.020)。MRI组、常规组和对照组在基线期的TMT-A、Stroop Word、Stroop Color、Stroop interference的评分比较差异均无统计学意义(P>0.05),重复测量方差分析发现,在TMT-A、Stroop Word、Stroop Color、Stroop interference评分上,时间效应均显著(P<0.05),时间和组间的交互作用也显著(P<0.05)。Bronfenni分析显示,在治疗2周末,MRI组和常规组的TMT-A评分明显高于对照组,差异有统计学意义(P<0.05);MRI组和常规组的Stroop Color评分明显高于对照组,差异有统计学意义(P<0.05);MRI组和常规组的Stroop Color评分均高于对照组,差异有统计学意义(P<0.05),同时,MRI组的评分也高于常规组,差异有统计学意义(P<0.01);MRI组与常规组的Stroop interference评分均高于对照组,差异有统计学意义(P<0.05),同时,MRI组的评分也高于常规组,差异有统计学意义(P=0.002)。结论重复经颅磁刺激治疗对抑郁症的早期疗效和执行功能有改善作用,尤其是MRI引导下的重复经颅磁刺激治疗改善效果更明显。

Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)guided by magnetic resonance imaging(MRI)on the short-trem efficacy and executive function of patients with depression.Methods A total of 59 patients with depression aged 18~50 years who were treated in our hospital from November 2019 to March 2020 were enrolled in the study,who were randomly divided into MRI group(n=19),routine group(n=20)and control group(n=20).The patients in the three groups were treated by SSRIs-like drugs.On this basis,the patients in MRI group were individually localized by using resting-state MRI scans.The patients in routine group were treated by the conventional“5-cm localization method”,and rTMS stimulation frequency was 10Hz,and the stimulation intensity was 100%of the motor threshold,total of 1,500 stimulus pulses,5 times a wek,for 20 times(2 weeks).The patientsin control group were treated by SSRIs only.After 2-wwek treatment the therapeutic effects were assessed by the Hamilton Depression Inventory version 17(HAMD-17),the Connectedness Test(TMT-A)and Stroop Color Word Test(SCWT).Results There were no significant differences in gender,age,education level,family history of depression,and age at first onset among the three groups(P>0.05).After 2-wwek treatment,the total effective rates in MRI group,routine group and control group were 53.64%,20.00%,15.00%,respectively.The therapeutic effects in MRI group were superior to those in routine group and control group(P<0.05).There were no significant differences in TMT-A at baseline,Stroop Word,Stroop Color and Stroop interference among the three groups(P>0.05).Repeated measures ANOVA showed that there were significant time effects in TMT-A,Stroop Word,Stroop Color,and Stroop interference scores(P<0.05).Bronfenni analysis showed that at the end of treatment,the scores of TMT-A,Stroop Word,Stroop Color,Stroop interference in MRI group and routine group were significantly higher than those in control group(P<0.05),moreover,which in MRI group and routine group were significantly higher than those in routine group(P<0.05).Conclusion The repeated transcranial magnetic stimulation treatment can improve the short-trem efficacy and executive function of patients with depression,moreover,the improvement effects of MRI-guided repeated transcranial magnetic stimulation are more obvious.