电针结合rTMS对焦虑抑郁障碍共病患者期待心理反应的影响

目的:探讨电针结合重复经颅磁刺激(rTMS)对焦虑抑郁共病(CAD)心理期待反应大脑高级功能电生理的影响。方法:将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的90例研究参与者随机分为3组,电针合并rTMS组(针磁组)30例予电针百会、印堂、神庭、神门、内关等穴,配合rTMS治疗,磁刺激组(rTMS组)30例采用单纯rTMS治疗,针磁组和rTMS组均按临床常规给予抗抑郁和抗焦虑药物治疗,30例基础治疗组单纯采用药物治疗。各组于治疗前和治疗10天后采用日本Nihon Kohden诱发电位仪检测Cz-A+导联关联性负变(CNV),并与30例正常对照组对照。结果:①各治疗组治疗前CNV期待波起始点(A点)潜伏期较对照组有延长趋势,但无显著差异(P>0.05),针磁组治疗后A点潜伏期较治疗前和基础治疗组显著缩短(P<0.05);各治疗组治疗前后、各组间期待波波幅与对照组无显著差异(P>0.05)。②各治疗组治疗前命令信号后负变化(PINV)回归基线百分率小于对照组(P<0.05),治疗后与对照组无显著差异(P>0.05)。结论:电针结合rTMS可显著提高CAD患者心理期待反应启动过程,改善精神动力不足;电针、rTMS和抗抑郁药物可降低患者大脑唤醒水平,缓解患者焦虑症状。

Effect of Electroacupuncture Combined with Repetitive Transcranial Magnetic Stimulation for Patients with Comorbid Anxiety and Depression on Psychological Reaction to Expectancy

Objective:To explore the effect on brain electrical physiology of advanced function in psychological reaction to expectancy by combination of electroacupuncture(EA) and repetitive transcranial magnetic stimulation(rTMS) to anxiety depression comorbidity(CAD).Methods:According with"China’s mental disorders classification and diagnosis standard(the third edition)"(CCMD-3)Ninety cases of the participants were randomly divided into 3 groups.Thirty cases of the group of electroacupuncture combined with rTMS(EA+rTMS) was treated with electroacupuncture at Baihui(GV 20),Yintang(EX-HN 3),Shenting(GV 24),Shenmen(HT 7) and Neiguan(PC 6) mainly,combined with rTMS.The rTMS group with 30 cases was treated with simple rTMS.Both the EA+rTMS group and rTMS group were given according to the clinical conventional antidepressants and resistance to anxiety drugs.Thirty cases of the foundation treatment group only with drugs.Separately,each group before the treatment and therapy after 10 days,were detected by the evoked potentials equipment of the Japanese Nihon Kohden recording(contingent negative variations,CNV) in Cz-A+channel,and comparing with 30 cases of normal control group.Results:①Comparing with the control group,the latecy of starting point of expectancy wave in CNV(A point) had prolonged the trend in each treatment group before treatment,but no significant difference among four groups(P > 0.05).The latecy of A point in EA+rTMS group is significantly reduced comparing with before treatment and the control group(P<0.05).Before and after treatment in each treatment group had no significant differences,as well as among the control group and all treatment groups(P > 0.05).②The percentages of post imperative negative variation(PINV) regression baseline in the treatment groups before treatment were less than that in the control group(P<0.05).and no significant difference with the control group(P > 0.05).Conclusion:EA combined with rTMS can significantly improve the patients with CAD to start process of psychological reaction to expectancy,and improve the spirit underpowered.EA,rTMS and antidepressant may reduce the patients brain arousal level,and ease patients anxiety symptoms.