从血清瘦素与BDNF水平探讨经颅磁刺激治疗卒中后抑郁的机理

Exploring the Mechanism of Transcranial Magnetic Stimulation in the Treatment of Post-stroke Depression from Serum Leptin and BDNF Levels

目的 探讨经颅磁刺激治疗卒中后抑郁对血清瘦素与脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平的影响。方法 选取2020年1—12月湘雅博爱康复医院收治的60例脑卒中后抑郁患者,依据随机数字法分为两组,每组30例。对照组采用常规治疗,观察组在此基础上采用低频重复经颅磁刺激治疗,连续治疗4周后,比较两组抑郁评分、血清瘦素及BDNF水平、氨基酸类神经递质[γ-氨基丁酸(GABA)、甘氨酸(Gly)、天冬氨酸(Asp)、谷氨酸(Glu)]、单胺类神经递质[多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)]水平。结果 治疗后,观察组HAMD评分、血清瘦素水平分别为(7.28±2.11)分、(8.11±4.26)μg/L,低于对照组的(13.26±2.47)分、(14.86±5.02)μg/L,BDNF水平为(42.19±3.84)ng/mL,高于对照组(30.17±4.05)ng/mL,差异有统计学意义(t=10.083、5.615、11.796,P<0.001);治疗后,观察组GABA、Gly水平较对照组高,Asp、Glu水平较对照组低,差异有统计学意义(t=12.724、4.371、12.307、7.916,P<0.001);治疗后,观察组DA、5-HT、NE水平较对照组高,差异有统计学意义(t=6.671、7.964、9.196,P<0.001)。结论 卒中后抑郁患者采用经颅磁刺激治疗可刺激单胺类神经递质分泌,改善氨基酸类神经递质水平,调节血清瘦素及BDNF水平,改善患者抑郁情绪。

Objective To investigate the effect of transcranial magnetic stimulation on the levels of serum leptin and brain-derived neurotrophic factor(BDNF) in the treatment of post-stroke depression.Methods A total of 60 patients with post-stroke depression who were admitted to Xiangya Bo’ai Rehabilitation Hospital from January to December2020 were selected. According to the random number method, they were divided into two groups, 30 cases in each group. The control group received conventional treatment, and the observation group received low-frequency repetitive transcranial magnetic stimulation on this basis. After 4 weeks of continuous treatment, the depression scores, serum leptin and BDNF levels, amino acid neurotransmitters [γ-aminobutyric acid(GABA), glycine(Gly), aspartic acid(Asp), and glutamic acid(Glu)], monoamine neurotransmitters [dopamine(DA), serotonin(5-HT), norepinephrine(NE)]levels were compared between the two groups.Results After treatment, the HAMD score and serum leptin level in the observation group were(7.28±2.11) points and(8.11±4.26) μg/L, respectively, lower than the control group(13.26±2.47) points,(14.86±5.02) μg/L, the level of BDNF was(42.19±3.84) ng/mL, which was higher than that of the control group(30.17±4.05) ng/mL, and the difference was statistically significant(t=10.083, 5.615, 11.796, P<0.001). After treatment, the levels of GABA and Gly in the observation group were higher than those in the control group, while the levels of Asp and Glu were lower than those in the control group, and the differences were statistically significant(t=12.724, 4.371, 12.307, 7.916, P<0.001). After treatment, the levels of DA, 5-HT and NE in the observation group were higher than those in the control group, and the difference was statistically significant(t=6.671, 7.964, 9.196, P<0.001).Conclusion Transcranial magnetic stimulation in post-stroke depression patients can stimulate the secretion of monoamine neurotransmitters, improve the levels of amino acid neurotransmitters, regulate serum leptin and BDNF levels, and improve patients’ depression.