经颅直流电刺激治疗广泛性焦虑障碍的疗效观察

目的 分析广泛性焦虑障碍患者经颅直流电刺激(tDCS)治疗前后外周血中C反应蛋白(CRP),肿瘤坏死因子α(TNF-α)水平和临床症状的变化.方法 纳入符合标准的60例GAD患者(观察组)和60名匹配的健康对照者(对照组),并按照随机数字表将60例患者分为tDCS真刺激组和伪刺激组,每组各30例.观察组治疗前及治疗4周末及健康对照组检测血清CRP、TNF-α水平,并评定汉密尔顿焦虑量表(HAMA).结果 ①观察组HAMA总分、精神焦虑因子分、躯体焦虑因子分、CRP血清水平高于对照组,差异有统计学意义(P<0.001);②tDCS真刺激组治疗后HAMA总分差值 、精神焦虑因子分差值 、CRP差值明显高于伪刺激组(P<0.05);③tDCS真刺激组治疗后HAMA总分、精神焦虑因子分、躯体焦虑因子分、CRP、TNF-α均低于治疗前,差异有统计学意义(P<0.001);④tDCS真刺激组治疗前后CRP差值与HAMA总分差值、躯体焦虑因子分呈显著正相关(P<0.05).结论 GAD患者体内炎症因子CRP水平高于健康人群,tDCS可以调节GAD患者的免疫炎症反应和改善临床症状.

Objective To analyze the changes of serum levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and clinical symptoms in patients with generalized anxiety disorder before and after transcranial direct current stimulation(tDCS).Methods 60 patients with GAD(the study group)who met the criteria and 60 matched healthy controls were included,and 60 patients were assigned to the real tDCS group and the sham tDCS group according to a random number table,with 30 patients in each group.The levels of serum CRP,TNF-α and Hamiton Anxiety Scale(HAMA)were measured in the study group before treatment and at the end of 4 weeks of treatment,and in the healthy control group.Results①The total score of HAMA,the scores of mental anxiety factor,the scores of somatic anxiety factor and the serum levels of CRP in the study group were higher than those in the control group,and the differences were statistically significant(P<0.001),②HAMA total score difference,mental anxiety factor score difference and the serum levels of CRP dfference in real tDCS group were significantly higher than those in sham tDCS group(P<0.05),③HAMA total score,mental anxiety factor score,somatic anxiety factor score,the serum levels of CRP and TNF-α in real tDCS group after treatment were lower than before treatment,and the differences were statistically significant(P<0.001),④In real tDCS group,the difference of serum levels of CRP before and after treatment was positively correlated with the difference of total score of HAMA and the score of somatic anxiety factor(P<0.05).Conclusion The serum level of CRP in patients with GAD is higher than that in healthy people.tDCS can regulate the immune infammatory response and improve the clinical symptoms in patients with GAD.