无抽搐电休克治疗联合药物对双相情感障碍躁狂相治疗效果及炎性因子的影响

The influence of modified electroconvulsive therapy combined with drug therapy on therapeutic effect and inflammatory factors of manic phase of bipolar disorder

目的探讨无抽搐电休克治疗联合碳酸锂与单纯碳酸锂治疗相比,对双相情感障碍躁狂相治疗效果及炎性因子改变差异。方法回顾性分析2019年1月—2021年12月哈尔滨市第一专科医院收治的80例双相情感障碍躁狂相发作患者作为研究对象,根据治疗方案不同,将口服碳酸锂的40例患者入组为对照组,将联合应用无抽搐电休克治疗和口服碳酸锂的40例患者入组为实验组。分析治疗前与治疗1周、2周、1个月后患者杨氏躁狂评定量表评分,以及治疗前与治疗1个月后患者血清炎性因子IL-6、IL-10、TNF-α水平,对比两组患者治疗前后疗效差异。结果治疗一个月后,实验组治疗总有效率为87.5%,高于对照组的65.0%,差异有统计学意义(P<0.05)。实验组患者治疗前、治疗1周、2周、1个月后的YMRS评分分别为(31.75±6.89)、(19.25±6.36)、(14.65±6.45)、(12.38±7.13)分;对照组患者治疗前、治疗1周、2周、1个月后的YMRS评分分别为(31.38±6.89)、(29.35±6.53)、(21.83±6.60)、(17.98±7.22)分。与对照组相比,实验组患者在治疗1周时、2周、1个月后YMRS评分降低程度更大,差异具有统计学意义(P<0.05)。实验组患者治疗前、治疗1个月后的血清IL-6水平分别为(13.26±4.96)、(4.59±3.51)pg/ml;对照组患者治疗前、治疗1个月后的血清IL-6水平分别为(13.26±4.34)、(5.72±3.51)pg/ml。实验组治疗前、治疗1个月后的血清IL-10水平分别为(4.91±4.24)、(6.47±2.31)pg/ml;对照组患者治疗前、治疗1个月后的血清IL-10水平分别为(4.64±3.23)、(5.12±2.07)pg/ml。实验组治疗前、治疗1个月后的血清TNF-α水平分别为(2.67±1.11)、(1.32±1.21)pg/ml;对照组患者治疗前、治疗1个月后的血清TNF-α水平分别为(2.69±1.31)、(1.90±1.20)pg/ml。与对照组相比,实验组患者在治疗1个月后的血清IL-6、TNF-α水平降低程度更大,IL-10水平升高程度更大,差异具有统计学意义(P<0.05)。结论采取无抽搐电休克治疗联合碳酸锂对双相情感障碍躁狂相治疗能够迅速改善双相情感障碍躁狂相患者的躁狂状态,血清炎性因子水平降低程度更大。联合治疗能够对患者的临床治疗效果起到非常积极的影响作用,值得广泛推广应用。

Objective To investigate the discrepancy of therapeutic effect and inflammatory factors variation of modified electroconvulsive therapy combined with lithium carbonate or lithium carbonate therapy alone in the treatment of manic phase of bipolar disorder.Methods A retrospective analysis was performed on 80 patients suffered from bipolar disorder(current manic episode)those admitted to Harbin first specialized hospital from January 2019 to December 2021,according to the therapy method,the 40 patients orally administrated lithium carbonate were enrolled in the control group,and 40 patients orally administrated lithium carbonate combined with modified electroconvulsive therapy were enrolled in the experimental group.The differences of therapeutic effect between the two groups were compared.The scores of Young mania rating scale(YMRS)before treatment and that at 1 week,2 weeks and 1 month after treatment were analyzed.And the level of inflammatory factors including IL-6,IL-10 and TNF-αin serum before treatment and at 1 month after treatment were analyzed.Results After one month of treatment,the total effective rate of the experimental group was 87.5%,which was significantly higher than 65.0%of the control group,the difference was statistically significant(P<0.05).The YMRS scores of the experimental group were(31.75±6.89),(19.25±6.36),(14.65±6.45),and(12.38±7.13)points,at the time points before treatment,1 week,2 weeks and 1 month after treatment,respectively.The YMRS scores of the control group were(31.38±6.89),(29.35±6.53),(21.83±6.60)and(17.98±7.22)points,at the time points before treatment,1 week,2 weeks and 1 month after treatment,respectively.Compared with the control group,the reduction of YMRS score was greater in the experimental group at 1 week,2 weeks and 1 month,after treatment with statistically significant difference(P<0.05).The serum IL-6 levels of experimental group were(13.26±4.96)and(4.59±3.51)pg/mL before treatment and at 1 month after treatment,respectively.The serum IL-6 levels of control group were(13.26±4.34)and(5.72±3.51)pg/ml before treatment and 1 month after treatment,respectively.The serum IL-10 levels of the experimental group were(4.91±4.24)and(6.47±2.31)pg/ml before treatment and 1 month after treatment,respectively.The serum IL-10 levels of control group were(4.64±3.23)and(5.12±2.07)pg/ml before treatment and 1 month after treatment,respectively.The serum TNF-αlevels in the experimental group were(2.67±1.11)and(1.32±1.21)pg/ml before treatment and 1 month after treatment,respectively.The serum TNF-αlevels in control group was(2.69±1.31)and(1.90±1.20)pg/ml before treatment and after 1 month treatment,respectively.Compared with the control group,the serum levels of IL-6 and TNF-αin the experimental group were decreased after 1 month of treatment,however,the serum level of IL-10 in the experimental group was increased after 1 month of treatment,the difference was statistically significant(P<0.05).Conclusions The treatment of bipolar disorder(current manic episode)with modified electroconvulsive therapy combined with lithium carbonate can rapidly improve the manic state of bipolar disordermanic phase patients,and the level of serum inflammatory factors changed to a greater extent.Combination therapy could play a very positive role in the clinical treatment effect of patients,it is worth widespread and well-developed.