中西药联合重复经颅磁刺激治疗对心肾阳虚型难治性抑郁症的治疗效果

Therapeutic effect of combined traditional Chinese and western medicine with repetitive transcranial magnetic stimulation in the treatment of treatment resistant depression with heart and kidney yang deficiency type

目的观察中西药联合重复经颅磁刺激(rTMS)治疗对心肾阳虚型难治性抑郁症(TRD)的治疗效果。方法选取2020年1月至2023年8月北京中医医院内蒙古医院收治的120例心肾阳虚型TRD患者作为研究对象,按照随机数字表法将其分为研究组和对照组,各60例。对照组采用四逆汤加味联合盐酸文拉法辛缓释胶囊治疗,研究组在此基础上联合rTMS治疗。两组疗程均为6周。比较两组治疗效果和不良反应发生情况;比较两组治疗前和治疗2、4、6周后汉密尔顿抑郁量表-24项(HAMD-24)评分、脑内神经递质5-羟色胺(5-HT)、去甲肾上腺素(NE)和多巴胺(DA)功率。结果研究组临床疗效优于对照组(P<0.05)。两组HAMD-24评分、5-HT、NE、DA功率各时间点比较,差异均有统计学意义(P<0.05);治疗2、4、6周后,研究组5-HT、NE、DA功率均高于对照组,HAMD-24评分均低于对照组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论四逆汤加味联合盐酸文拉法辛和rTMS可以更加有效地治疗心肾阳虚型TRD,能全面快速调整脑内单胺类脑神经递质功率水平,且不会增加不良反应。

Objective To observe the therapeutic effect of combined Chinese and western medicine with repetitive transcranial magnetic stimulation(rTMS)in the treatment of treatment resistant depression(TRD)with heart and kidney yang deficiency type.Methods A total of 120 patients with heart and kidney yang deficiency TRD treated in Inner Mongolia Hospital of Beijing Hospital of Traditional Chinese Medicine from January 2020 to August 2023 were selected as the research objects,and they were divided into study group and control group according to random number table method,with 60 cases in each group.The control group was treated with Jiawei Sini Decoction combined with Venlafaxine Hydrochloride Sustained-release Capsules,and the study group received rTMS on this basis.The course of treatment for both groups was six weeks.After treatment,the therapeutic effects and occurrence of adverse reactions were compared between the two groups.The Hamilton depression rating scale-24(HAMD-24)scores,the power of neurotransmitters serotonin 5-hydroxytryptamine(5-HT),norepinephrine(NE),and dopamine(DA)in the brain were compared before treatment and at weeks two,four,and six of treatment between the two groups.Results The clinical treatment of the study group was better than that of the control group(P<0.05).There were significant differences in HAMD-24 score,5-HT,NE,and DA power between two groups at each time point(P<0.05);after two,four and six weeks of treatment,5-HT,NE,and DA power of the study group were higher than those of the control group,and HAMD-24 scores were lower than those of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Jiawei Sini Decoction combined with Venlafaxine Hydrochloride Sustained-release Capsules and rTMS can more effectively in the treatment of TRD with heart and kidney yang deficiency type,comprehensively and rapidly adjust the power level of monoamine neurotransmitters in the brain,does not increase adverse reactions.