目的:探讨不同模式重复经颅磁刺激(repetitive Transcranial Magnetic Stimulation, rTMS)对脑卒中后抑郁(Post-stroke depression, PSD)患者的治疗效果,并观察其对血清相关指标的影响。方法:纳入2022年9月到2023年12月确诊的87例患者...目的:探讨不同模式重复经颅磁刺激(repetitive Transcranial Magnetic Stimulation, rTMS)对脑卒中后抑郁(Post-stroke depression, PSD)患者的治疗效果,并观察其对血清相关指标的影响。方法:纳入2022年9月到2023年12月确诊的87例患者。所有患者均接受脑卒中常规治疗、口服度洛西汀抗抑郁药物治疗。按照双盲随机对照试验方案分为三组,高频rTMS组(刺激频率10 HZ,左侧DLPFC + 度洛西汀)、低频rTMS组(刺激频率1 HZ,右侧DLPFC + 度洛西汀)、对照组(假线圈刺激治疗 + 度洛西汀),1次/天,5天/周,共治疗4周。于治疗前、治疗后4周测量汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数量表(PSQI)、血清BDNF及IL-6水平。结果:三组患者治疗后的HAMD评分、PSQI评分均低于本组治疗前,差异有统计学意义(P Objective: To observe the efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) in patients with post stroke depression (PSD), and to observe its influence on serum related indexes. Methods: 87 patients of PSD were enrolled prospectively in the department of rehabilitation from September 2020 to December 2023, and were divided into 3 groups according to the random number table: patients of the 3 groups received routine rehabilitation training, high frequency group (10 Hz rTMS, l-DLPFC + duloxetine), low frequency group (1 Hz rTMS, r-DLPFC + duloxetine) and control group (sham stimulation + duloxetine), 1 time/day, 5 times/week, for 4 consecutive weeks. The Hamilton Depression Scale-17 (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and serum BDNF and IL-6 levels were measured before treatment and 4 weeks after treatment. Results: The HAMD scores and PSQI scores in the three groups after treatment were lower than those before treatment, and the differences were statistically significant (P < 0.05). The levels of IL-6 in the three groups decreased and the levels of BDNF increased after treatment, and the differences were statistically significant (P < 0.05). Through group comparison, it was found that the high-frequency group had significantly better improvement in HAMD scores, serum BDNF levels, and IL-6 levels compared with the other two groups, and the differences were statistically significant (P < 0.05). The low-frequency group showed significantly better improvement in PSQI scores compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions: rTMS has a definite therapeutic effect on post-stroke depression, with a high patient acceptance. High-frequency rTMS on the l-DLPFC has a better therapeutic effect on depression than low-frequency rTMS on the r-DLPFC, and its mechanism may be related to increased levels of BDNF and decreased levels of IL-6 after treatment. Additionally, this study suggests that low-frequency rTMS on the r-DLPFC has a better improvement in sleep quality compared with high-frequency rTMS on the l-DLPFC.展开更多
文摘目的:探讨不同模式重复经颅磁刺激(repetitive Transcranial Magnetic Stimulation, rTMS)对脑卒中后抑郁(Post-stroke depression, PSD)患者的治疗效果,并观察其对血清相关指标的影响。方法:纳入2022年9月到2023年12月确诊的87例患者。所有患者均接受脑卒中常规治疗、口服度洛西汀抗抑郁药物治疗。按照双盲随机对照试验方案分为三组,高频rTMS组(刺激频率10 HZ,左侧DLPFC + 度洛西汀)、低频rTMS组(刺激频率1 HZ,右侧DLPFC + 度洛西汀)、对照组(假线圈刺激治疗 + 度洛西汀),1次/天,5天/周,共治疗4周。于治疗前、治疗后4周测量汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数量表(PSQI)、血清BDNF及IL-6水平。结果:三组患者治疗后的HAMD评分、PSQI评分均低于本组治疗前,差异有统计学意义(P Objective: To observe the efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) in patients with post stroke depression (PSD), and to observe its influence on serum related indexes. Methods: 87 patients of PSD were enrolled prospectively in the department of rehabilitation from September 2020 to December 2023, and were divided into 3 groups according to the random number table: patients of the 3 groups received routine rehabilitation training, high frequency group (10 Hz rTMS, l-DLPFC + duloxetine), low frequency group (1 Hz rTMS, r-DLPFC + duloxetine) and control group (sham stimulation + duloxetine), 1 time/day, 5 times/week, for 4 consecutive weeks. The Hamilton Depression Scale-17 (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and serum BDNF and IL-6 levels were measured before treatment and 4 weeks after treatment. Results: The HAMD scores and PSQI scores in the three groups after treatment were lower than those before treatment, and the differences were statistically significant (P < 0.05). The levels of IL-6 in the three groups decreased and the levels of BDNF increased after treatment, and the differences were statistically significant (P < 0.05). Through group comparison, it was found that the high-frequency group had significantly better improvement in HAMD scores, serum BDNF levels, and IL-6 levels compared with the other two groups, and the differences were statistically significant (P < 0.05). The low-frequency group showed significantly better improvement in PSQI scores compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions: rTMS has a definite therapeutic effect on post-stroke depression, with a high patient acceptance. High-frequency rTMS on the l-DLPFC has a better therapeutic effect on depression than low-frequency rTMS on the r-DLPFC, and its mechanism may be related to increased levels of BDNF and decreased levels of IL-6 after treatment. Additionally, this study suggests that low-frequency rTMS on the r-DLPFC has a better improvement in sleep quality compared with high-frequency rTMS on the l-DLPFC.
