rTMS联合盐酸帕罗西汀对NSSI青少年抑郁障碍执行功能的影响

Effects of repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride on executive function in depressed adolescents with non-suicidal self-injury

目的探讨重复经颅磁刺激(rTMS)联合盐酸帕罗西汀对非自杀性自伤行为(NSSI)青少年抑郁障碍患者执行功能的改善作用。方法回顾性分析金华市第二医院2021年8月至2022年7月收治的NSSI青少年抑郁障碍患者120例的临床资料,按照治疗方法不同分为对照组、观察组各60例。对照组给予盐酸帕罗西汀治疗,观察组给予rTMS联合盐酸帕罗西汀治疗,均治疗2个月。观察两组汉密顿抑郁量表-24(HAMD-24)评分、青少年非自杀性自伤行为和功能量表(ANSSIQ)评分、执行功能、脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)的变化及临床疗效。结果治疗后,观察组HAMD-24评分为(15.85±1.08)分,低于对照组的(18.72±1.21)分(t=13.71,P<0.001);观察组ANSSIQ量表中2周内自伤次数、自伤冲动次数、自伤想法强烈程度评分均低于对照组(t=3.42、3.03、1.92,均P<0.05);观察组连线测验、Stroop Word测试、Stroop Color测试、Stroop interference测试评分均高于对照组(t=2.66、3.33、3.97、4.64,均P<0.01);观察组BDNF、5-HT分别为(11.45±1.79)μg/L、(136.68±11.90)μg/L,均高于对照组的(9.06±2.21)μg/L、(124.82±10.34)μg/L(t=6.51、5.83,均P<0.001)。观察组总有效率为91.7%,高于对照组的78.3%(Z=2.73,P=0.006)。结论rTMS联合盐酸帕罗西汀治疗NSSI青少年抑郁障碍的效果较好,可减轻患者症状,提高执行功能、认知功能,改善血清学指标,值得推广。

Objective To investigate the effects of repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride on executive function in depressed adolescents with non-suicidal self-injury.Methods The clinical data of 120 depressed adolescents with depressive disorders who were admitted to The Second Hospital of Jinhua from August 2021 to July 2022 were retrospectively analyzed.They were randomly assigned to undergo treatment either with paroxetine hydrochloride(control group,n=60)or repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride(observation group,n=60).All patients were treated for 2 months.Hamilton Depression Rating Scale-24(HAMD-24)score,Non-suicidal Self-injury Behavior and Function Scale for Adolescents(ANSSIQ)score,executive function,brain-derived neurotrophic factor,5-hydroxytryptamine,and clinical efficacy were determined in each group.Results After treatment,the Hamilton Depression Rating Scale-24 score in the observation group was significantly lower than that in the control group[(15.85±1.08)points)vs.(18.72±1.21)points,t=13.71,P<0.001).After treatment,the number of self-injury attacks,number of self-injury impulsions,and the intensity of self-injury thought within 2 weeks in the observation group were significantly lower than those in the control group(t=3.42,3.03,1.92,all P<0.05).The scores of the Trail Making Test,Stroop Word test,Stroop Color test,and Stroop Color-Word Interference Test were significantly higher in the observation group than those in the control group(t=2.66,3.33,3.97,4.64,all P<0.01).Brain-derived neurotrophic factor and 5-hydroxytryptamine levels in the observation group were(11.45±1.79)μg/L and(136.68±11.90)μg/L,respectively,which were significantly higher than(9.06±2.21)μg/L and(124.82±10.34)μg/L in the control group(t=6.51,5.83,both P<0.001).The total response rate in the observation group was significantly higher than that in the control group(91.7%vs.78.3%,Z=2.73,P=0.006).Conclusion Repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride is highly effective on depressive disorders in adolescents with non-suicidal self-injury.The combined therapy can reduce symptoms,improve executive function and cognitive function,and optimize serological indicators,and thereby deserves the clinical promotion.