低频重复经颅磁刺激治疗卒中后抑郁的对照研究

Study of low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke depression

目的探讨低频重复经颅磁刺激(r TMS)治疗卒中后抑郁(PSD)的安全性及有效性。方法选取2014年7月至2015年6月东南大学医学院附属江阴医院神经内科收治的PSD患者80例,采用数字表法随机分为观察组(r TMS组)40例和对照组40例。两组患者均予脑梗死常规治疗和度洛西汀抗抑郁治疗,观察组加用低频r TMS治疗。比较两组患者治疗的痊愈率及有效率,以及治疗前后汉密尔顿抑郁量表(HAMD-24)、抑郁自评量表(SDS)以及蒙哥马利抑郁量表(MARDS)的分值变化。结果观察组完成临床治疗36例,对照组为37例;所有患者行r TMS治疗过程中均未出现不良反应;观察组患者治疗后的痊愈率和有效率分别为63.9%(23/36),97.2%(35/36),均高于对照组的37.8%(14/37)、75.7%(28/37),差异均有统计学意义(P<0.05或P<0.01);观察组患者治疗后的HAMD、SDS及MARDS评分均较治疗前显著降低,差异均有统计学意义(P<0.01);对照组患者治疗后的HAMD及MARDS评分均较治疗前显著降低,差异均有统计学意义(P<0.01或0.05),但治疗前后SDS评分差异无统计学意义(P>0.05);两组患者治疗前的HAMD、SDS及MARDS评分比较差异均无统计学意义(P>0.05),而治疗后观察组的上述各项评分均显著低于对照组,差异均有统计学意义(P<0.01)。结论低频r TMS治疗PSD安全有效。

Objective To investigate the effect and safety of low frequency repetitive transcranial magnetic stimulation(r TMS) in the treatment of post-stroke depression(PSD). Methods Eighty patients with PSD in Department of Neurology in Jiangyin Hospital Affiliated to Medical College of Southeast University were selected from July2014 to June 2015. The patients were divided into the control group(n=40) and the observation group(r TMS group, n=40) according to the random number table. Both the two groups were treated with conventional therapy and antidepressant drugs. The patients of observation group were additionally treated by r TMS. The cure rate and effective rate of two groups were compared, and the scores of Hamilton Depression Scale(HAMD-24), Self-rating Depression Scale(SDS)and Montgomerie Depression Scale(MARDS) were compared before and after treatment. Results Clinical trial was completed in 36 patients in the observation group and 37 patients in the control group. All patients had no adverse reactions in the course of r TMS treatment. After treatment, the cure rate and effective rate of observation group were significantly higher than those of control group [63.9%(23/36) vs 37.8%(14/37), 97.2%(35/36) vs 75.7%(28/37), P<0.05 or P<0.01]. After treatment, the scores of HAMD, SDS, MARDS in observation group were significantly decreased, and the differences were statistically significant(P<0.01). After treatment, the scores of HAMD, MARDS in control group were significantly lower than before treatment, and the difference was statistically significant(P<0.01 or 0.05), but there was no significant difference in the SDS score before and after treatment(P>0.05). There was no significant difference in HAMD, SDS and MARDS scores between the two groups before treatment. However, the scores of the observation group after treatment were significantly lower than those of the control group, and the differences were statistically significant(P<0.01). Conclusion Low frequency r TMS combined with antidepressant drugs can significantly improve the depressive symptoms, and there was no obvious adverse reactions.