高频重复经颅磁刺激联合富马酸喹硫平对改善双相障碍Ⅱ型抑郁发作疗效和认知功能的临床研究

Clinical research of improvement efficacy on bipolar II depression onset and cognitive function by high-frequency repetitive transcranial magnetic stimulation combined with quetiapine

目的探讨高频重复经颅磁刺激(rTMS)与富马酸喹硫平联合治疗对双相障碍Ⅱ型抑郁发作的疗效、认知功能及安全性的影响。方法选择2022年5月—2023年10月本院收治的40例双相障碍Ⅱ型抑郁发作患者作为研究对象,随机数表法将患者分为研究组和对照组两组,每组各20例。两组在为期4周的治疗期间,研究组采用高频重复经颅磁刺激联合富马酸喹硫平治疗,对照组采用伪刺激联合富马酸喹硫平治疗。治疗前和治疗第1、2、3、4周末使用汉密尔顿抑郁评定量表(HMAD-24)评估临床疗效,使用韦克斯勒成人记忆量表第四版中文版(WNS-IV)、韦克斯勒成人智力量表(WAIS)、威斯康辛卡片分类测验(WCST)评估认知功能,并记录治疗中不良事件。结果治疗4周后,两组的总显效率差异无统计学意义(P>0.05)。研究组在第1、2周末的HMAD-24评分明显低于对照组,显示早期优势(P<0.05)。然而,治疗4周后,两组在认知功能测试(如理解记忆、再认等)方面无统计学差异(P>0.05)。同时,两组在治疗期间的不良反应发生率相近,无统计学差异(P>0.05)。这表明,尽管联合疗法在早期表现出较好疗效,但长期对认知功能的改善并不明显,且安全性相当。结论与单纯仅使用富马酸喹硫平治疗比较,高频rTMS联合富马酸喹硫平治疗在双相障碍Ⅱ型抑郁发作在治疗前期可较快改善患者抑郁症状,但在治疗4周后对于提升临床疗效及改善认知功能方面未能显现出明显优势。

Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with quetiapine fumarate on the efficacy,cognitive function,and safety in patients with bipolar disorder type II depression.Methods The study was designed as a single-blind randomized controlled trial,involving 40 patients with bipolar disorder type II depression who were admitted to our hospital from May 2022 to October 2023.Using a random number table,the patients were divided into a study group(n=20)and a control group(n=20)in a 1:1 ratio.During the four-week treatment period,the study group received high-frequency rTMS combined with quetiapine fumarate,while the control group received sham stimulation combined with quetiapine fumarate.The Hamilton Depression Rating Scale(HMAD-24)was used to assess clinical efficacy before treatment and at the end of the 1st,2nd,3rd,and 4th weeks of treatment.Cognitive function was evaluated using the Wechsler Memory Scale for Adults-Fourth Edition(WMS-IV),Wechsler Adult Intelligence Scale(WAIS),and Wisconsin Card Sorting Test(WCST).Additionally,adverse events were recorded during the treatment period.Results After four weeks of treatment,there was no statistically significant difference in the overall response rate between the two groups(P>0.05).However,the HMAD-24 scores in the study group were significantly lower than those in the control group at the end of the 1 st and 2 nd weeks,indicating an early advantage(P<0.05).Nevertheless,there were no significant differences in cognitive function tests,such as understanding memory and recognition,between the two groups after four weeks of treatment(P>0.05).Additionally,the incidence of adverse events was similar in both groups during the treatment period,with no statistical difference(P>0.05).These results suggest that although the combined therapy demonstrated better early efficacy,it did not show significant long-term improvement in cognitive function and had comparable safety.Conclusions Compared to quetiapine fumarate alone,high-frequency rTMS combined with quetiapine fumarate provide faster improvement in depressive symptoms in patients with bipolar disorder type II depression during the early stages of treatment.However,after four weeks of treatment,it does not demonstrate a significant advantage in enhancing clinical efficacy or improving cognitive function.