草酸艾司西酞普兰联合重复经颅磁刺激治疗首发单相抑郁症的疗效及对患者注意功能的影响

Effect of escitalopram combined with repetitive transcranial magnetic stimulation on efficacy and attention function of patients with first-episode unipolar depression

目的:探讨草酸艾司西酞普兰联合重复经颅磁刺激(rTMS)治疗首发单相抑郁症患者的疗效以及该联合治疗方案对患者注意功能的影响。方法:前瞻性选择广州市第一人民医院神经内科自2022年3月至2023年4月收治的52例首次发病且未予任何治疗措施的单相抑郁症患者为研究对象,患者分别在服用草酸艾司西酞普兰抗抑郁治疗的基础上接受长达4周(每周5 d,共20 d)的左侧背外侧前额叶皮质(DLPFC)rTMS真刺激(真刺激组, n=27)或伪刺激(伪刺激组, n=25)。分别于治疗前及治疗第2、4周末,应用汉密尔顿抑郁量表24项(HAMD-24)测评患者的抑郁症状严重程度,以及应用中国伯明翰认知筛查量表(BCoS-C)的听觉注意测试项目评估患者的听觉注意程度。 结果:(1)抑郁症状:真刺激组患者治疗第2、4周末的HAMD-24评分[(20.63±2.73)分、(15.85±2.43)分]均明显低于治疗前[(25.74±2.68)分],伪刺激组患者治疗第4周末的HAMD-24评分亦较治疗前明显降低[(20.48±2.33)分 vs. (25.80±2.57)分],差异均有统计学意义( P<0.05)。治疗第2、4周末时,真刺激组患者的HAMD-24评分均明显低于伪刺激组,差异均有统计学意义( P<0.05)。(2)听觉注意功能:真刺激组患者治疗第4周末的总正确数较治疗前明显升高(51.74±1.38 vs. 47.48±1.60),持续指标较治疗前明显降低(0.74±0.71 vs. 4.37±1.15),差异均有统计学意义( P<0.05)。治疗第4周末时,真刺激组患者的总正确数较伪刺激组(48.00±1.66)明显升高,持续指标较伪刺激组(3.72±1.28)明显降低,差异均有统计学意义( P<0.05)。 结论:草酸艾司西酞普兰联合rTMS能更快速有效地改善单相抑郁症患者的抑郁症状及注意功能,其中抑郁症状较注意功能能更快得到改善。

Objective To observe the effect of escitalopram combined with repetitive transcranial magnetic stimulation(rTMS)on efficacy and attention function in patients with first-episode unipolar depression.Methods Fifty-two first-episode initial-naive unipolar depression patients were enrolled in Department of Neurology of Guangzhou First People's Hospital from March 2022 to April 2023 were chosen.They were randomly allocated to active stimulation group(n=27)and sham stimulation group(n=25);both were treated with escitalopram,and active treatment or sham treatment in the left dorsolateral prefrontal cortex(DLPFC)were given for 4 weeks(5 d per week,20 d totally).Before treatment and 2 and 4 weeks after treatment,Hamilton Depression Rating Scale(HAMD)-24 was used to evaluate depressive symptoms,and Birmingham Cognitive Screening Scale-Chinese(BCoS-C)was used to evaluate the attention function.Results(1)In terms of depressive symptoms:HAMD-24 scores of the active stimulation group 2 and 4 weeks after treatment(20.63±2.73,15.85±2.43)were significantly lower than those before treatment(25.74±2.68,P<0.05);HAMD-24 scores of sham stimulation group 4 weeks after treatment were also significantly lower than those before treatment([20.48±2.33]vs.[25.80±2.57],P<0.05);HAMD-24 scores of the active stimulation group 2 and 4 weeks after treatment were significantly lower than those of sham stimulation group(P<0.05).(2)In terms of auditory attention indicators:total correct number(selective attention)in active stimulation group 4 weeks after treatment was significantly larger than that before treatment(51.74±1.38 vs.47.48±1.60),and the sustained index(sustained attention)was significantly lower than that before treatment(0.74±0.71 vs.4.37±1.15,P<0.05);total correct number in active stimulation group 4 weeks after treatment was significantly larger than that in sham stimulation group(48.00±1.66),and the sustained index was significantly lower than that in sham stimulation group(3.72±1.28,P<0.05).Conclusion Combined with escitalopram,rTMS can more effectively mitigate the depressive symptoms in first-episode unipolar depression patients,and depressive symptoms improve more quickly than attentional function.