基于每日症状指数的动态监测预测儿童青少年抑郁症重复经颅磁刺激疗效的回顾性队列研究

Predicting the efficacy of repetitive transcranial magnetic stimulation in children and adolescents with depression using dynamic monitoring of daily symptom index

背景重复经颅磁刺激(rTMS)+抗抑郁药物已成为治疗儿童和青少年抑郁症的新兴疗法,但如何早期预测疗效仍是一大挑战。目的探讨rTMS+抗抑郁药物治疗过程中预测远期疗效的潜在因子。设计回顾性队列研究。方法首次诊断中重度单相或双相抑郁症的年龄<18岁、始于住院时连续≥20次的rTMS治疗且有每日症状指数(DI-5)的评分记录、有rTMS治疗前和第20次时的汉密尔顿抑郁量表(HAMD)评分记录的儿童青少年为队列人群,以rTMS治疗最后1次较基线HAMD评分减少≥50%分为应答组和未应答组,对20次DI-5评估结果与HAMD评估行相关性分析,当存在较好的相关结果时,考察rTMS+抗抑郁药物治疗中的DI-5评估是否能更早预测应答结果。主要结局指标DI-5与HAMD评分相关性。结果符合本文纳入排除标准的中重度单相或双相抑郁症的儿童青少年228例,平均年龄(14.0±3.0)岁,男111例(48.6%),rTMS治疗前和后DI-5分数与HAMD分数Pearson相关系数分别为0.70和0.72,差异均有统计学意义(P均<0.001)。rTMS治疗20次后应答组101例,未应答组127例,两组在性别分布、年龄、单亲家庭比例、留守儿童比例、家族精神病史、症状始发年龄、症状持续时间、学习障碍、语言障碍、运动发育障碍、体重、身高、服药时长、心理咨询次数、甲状腺功能异常、入睡时长、经常做梦比例和饮食习惯-挑食差异均无统计学意义(P>0.05);DI-5和HAMD基线分数应答组较未应答组差异均无统计学意义(P>0.05);第20次rTMS治疗后DI-5分数应答组较未应答组差异有统计学意义(P<0.001);HAMD最后1次评分应答组较未应答组差异有统计学意义(P<0.001)。第11次rTMS治疗时DI-5分数应答组较未应答组DI-5分数差异有统计学意义(P<0.001),应答组较未应答组DI-5中位数分数减少2分并以此作为分层依据,DI-5量表减少分数<2分组107例(46.9%)在第20次rTMS治疗时有98.1%的概率为未应答,DI-5量表减少分数≥2分组64例(87.4%)在第20次TMS治疗时有89.2%的概率为应答。结论第11次rTMS较治疗前DI-5减分≥2分可能是预测儿童青少年抑郁症rTMS+抗抑郁药物疗效的早期预测因子。

Background Repetitive transcranial magnetic stimulation(rTMS)combined with antidepressants has emerged as a novel therapy for treating depression in children and adolescents.However,predicting early treatment efficacy remains a significant challenge.Objective To explore potential factors that could predict long-term efficacy during rTMS combined with antidepressant therapy.Design Retrospective cohort study.Methods The cohort included children and adolescents under 18 years of age who were newly diagnosed with moderate to severe unipolar or bipolar depression,received rTMS treatment continuously for at least 20 sessions during hospitalization,had daily symptom index(DI-5)scores recorded,and had Hamilton Depression Rating Scale(HAMD)scores recorded before and after the 20th rTMS session.Participants were divided into response and non-response groups based on whether their final HAMD score showed a reduction of≥50%from baseline.Correlation analysis was conducted between DI-5 and HAMD scores.If a strong correlation was found,the potential of DI-5 assessments during rTMS treatment to predict early response was evaluated.Main outcome measures Correlation between DI-5 and HAMD scores.Results A total of 228 children and adolescents with moderate to severe unipolar or bipolar depression met the inclusion and exclusion criteria.The mean age was 14.0±3.0 years,and 111(48.6%)were male.The Pearson correlation coefficients between DI-5 and HAMD scores before and after rTMS treatment were 0.70 and 0.72,respectively,with both being statistically significant(P<0.001).After 20 rTMS sessions,there were 101 participants in the response group and 127 in the non-response group.There were no statistically significant differences between the two groups in gender distribution,age,single-parent household proportion,left-behind children proportion,family psychiatric history,age of symptom onset,symptom duration,learning disabilities,language disorders,motor development disorders,weight,height,medication duration,counseling sessions,thyroid dysfunction,time to fall asleep,frequency of dreaming,and picky eating habits(P>0.05).Baseline DI-5 and HAMD scores also showed no statistically significant differences between the response and non-response groups(P>0.05).However,DI-5 scores after the 20th rTMS session were significantly different between the response and non-response groups(P<0.001),as were the final HAMD scores(P<0.001).On the 11th session,the DI-5 scores showed a statistically significant difference between the response and non-response groups(P<0.001).A median reduction of 2 points in DI-5 scores was used as a stratification basis.In the group with a reduction of<2 points on the DI-5 scale,107 participants(46.9%)had a 98.1%probability of being in the non-response group by the 20th rTMS session.In the group with a reduction of≥2 points,64 participants(87.4%)had an 89.2%probability of being in the response group by the 20th rTMS session.Conclusion A reduction of≥2 points on the DI-5 scale by the 11th rTMS session may serve as an early predictor of treatment efficacy for rTMS combined with antidepressants in children and adolescents with depression.