经颅直流电刺激联合盐酸氟西汀治疗抑郁症伴焦虑症状疗效及对患者认知功能的影响

Efficacy of transcranial direct current stimulation combined with fluoxetine hydrochloride in treatment of depression with anxiety symptoms and its effect on cognitive function

目的:探讨经颅直流电刺激(tDCS)联合盐酸氟西汀治疗抑郁症伴焦虑症状的临床疗效及对患者认知功能的影响。方法:选择首发、未用药、伴焦虑症状的抑郁症患者112例为研究对象,随机分为治疗组(55例)和对照组(57例)。治疗组采用tDCS联合盐酸氟西汀治疗,而对照组采用伪刺激联合盐酸氟西汀治疗,疗程共8周。采用汉密尔顿焦虑量表(HAMA)和17项汉密尔顿抑郁量表(HAMD_(17))评估临床疗效。采用威斯康星卡片分类测验(WCST)评估认知功能。采用酶联免疫吸附技术检测患者血清脑源性神经营养因子(BDNF)、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及诱导型一氧化氮合酶(iNOS)]及抗炎因子[IL-4、IL-10及转化生子因子-β(TGF-β)]水平。结果:在治疗8周后,治疗组总有效率高于对照组(P<0.05)。两组治疗前HAMA和HAMD_(17)评分比较差异无统计学意义(均P>0.05),治疗第2、4、8周治疗组HAMA和HAMD_(17)评分较对照组低(均P<0.05)。经过8周治疗后,两组总反应数、正确反应数以及完成分类数评分较治疗前高,错误应答数、持续性错误数评分较治疗前低,且治疗组各项评分优于对照组(均P<0.05)。治疗后,两组血清BDNF、IL-4、IL-10及TGF-β水平升高,而IL-6、TNF-α、iNOS水平降低,且治疗组各项指标优于对照组(均P<0.05)。结论:相对于单纯盐酸氟西汀治疗,tDCS联合盐酸氟西汀能更有效地缓解抑郁症伴焦虑症状患者的焦虑和抑郁症状,改善患者认知功能。

Objective:To explore the efficacy of transcranial direct current stimulation(tDCS)combined with fluoxetine hydrochloride in the treatment of depression with anxiety symptoms and its effect on cognitive function.Methods:A total of 112 depression patients with first episode,no medication and anxiety symptoms were randomly divided into treatment group(55 cases)and control group(57 cases).The treatment group was treated with tDCS combined with fluoxetine hydrochloride,while the control group was treated with pseudo-stimulation combined with fluoxetine hydrochloride for 8 weeks.Clinical efficacy was assessed with HAMA and HAMD_(17).Cognitive function was assessed by using WCST.Serum levels of BDNF,inflammatory factors(IL-6,TNF-αand iNOS),and anti-inflammatory factors(IL-4,IL-10 andTGF-β)were measured by enzyme-linked immunosorbent assay.Results:After 8 weeks of treatment,the total effective rate of the treatment group was higher than that of the control group(P<0.05).There was no significant difference in HAMA and HAMD_(17) scores between the two groups before treatment(all P>0.05).The HAMA and HAMD_(17) scores in the treatment group were significantly lower than those in the control group at the 2nd,4th and 8th week of treatment(all P<0.05).After 8 weeks of treatment,the scores of total number of reactions,number of correct reactions and number of completed categories were significantly higher than those before treatment,while the scores of number of error reactions and preservative errors were significantly lower than those before treatment,and all scores in the treatment group were better than those in the control group(all P<0.05).After treatment,the levels of BDNF,IL-4,IL-10 and TGF-βin serum of the two groups increased significantly,while the levels of IL-6,TNF-αand iNOS decreased significantly,and all indexes of the treatment group were better than those of the control group(all P<0.05).Conclusion:Compared with fluoxetine hydrochloride alone,tDCS combined with fluoxetine hydrochloride can effectively relieve anxiety and depressive symptoms of depression patients with anxiety symptoms,and improve patients’cognitive function.