rTMS仪联合艾司西酞普兰对门诊焦虑障碍患者焦虑症状、睡眠质量及认知功能的疗效研究

Effect of rTMS combined with escitalopram on anxiety symptoms,sleep quality and cognitive function in outpatients with anxiety disorder

目的验证家用便携式重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗仪(PLTK-Home)治疗门诊焦虑障碍患者的有效性与安全性。方法采用开放对照研究,456例焦虑障碍患者分配为rTMS治疗组211例与对照组245例。两组均给予艾司西酞普兰治疗。治疗前后采用汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)、匹茨堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、重复性神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评定临床症状。结果419例患者完成4周随访,rTMS组192例,对照组227例,两组患者治疗4周后HAMA减分值(rTMS组:-19.23±4.19;对照组:-13.60±5.17)PSQI减分值(rTMS组:-11.75±3.11;对照组:-6.73±4.74)评分结果均显著下降;RBANS评分结果显示rTMS组患者经过4周治疗注意评分显著提高(rTMS组:8.51±7.13),而对照组未发现明显变化;组间比较显示采用重复测量资料的方差分析,rTMS组患者经过4周治疗后HAMA、PSQI、RBANS注意评分相比对照组改善更为显著(P<0.05)。结论便携式rTMS治疗仪能改善焦虑障碍患者的焦虑症状与睡眠症状,为焦虑障碍患者提供了新的一种便于普及的家用治疗方式。

Objective To evaluate the efficacy and safety of portable repetitive transcranial magnetic stimulation(rTMS)instrument(PLTK-Home)in the treatment of anxiety disorders in outpatients.Methods 456 patients with anxiety disorder were divided into rTMS group(n=211)and control group(N=245).Both groups were treated with escitalopram.Before and after treatment,the clinical symptoms were assessed with Hamilton Anxiety Scale(HAMA),Pittsburgh Sleep Quality Index(PSQI)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Results A total of 419 patients completed the 4-week study.There were 192 ones in rTMS and 227 ones in control groups,respectively.After 4 weeks of treatment,decreasing scores of HAMA(rTMS group:-19.23±4.19,control group:-13.60±5.17)and decreasing scores of PSQI(rTMS Group:-11.75±3.11,control group:-6.73±4.74)were significantly in both groups.The results of RBANS showed that the attention score of the patients in the rTMS group increased significantly after 4 weeks of treatment(rTMS group:8.51±7.13),while no significant change was found in the control group;after 4 weeks of treatment,the scores of HAMA,PSQI and RBANS in the rTMS group improved more significantly than those in the control group(P<0.05).Conclusion The portable rTMS therapeutic instrument can improve the anxiety and sleep symptoms of the patients with anxiety disorders,and provide a new convenient and popular home therapy for the patients with anxiety disorders.