重复经颅磁刺激联合音乐疗法治疗卒中后抑郁的疗效及机制研究

目的:探索重复经颅磁刺激(r TMS)联合音乐疗法对卒中后抑郁(PSD)的疗效及其可能机制。方法:PSD患者69例纳入研究,分为对照组(23例)、TMS组(21例)和联合组(25例),分别予以常规康复、常规+rTMS康复或常规+rTMS+音乐疗法康复4周。于入院后当天及治疗后第4周采用汉密尔顿抑郁量表(HAMD)评估患者抑郁情况,采用改良Barthel指数(m BI)评估患者日常生活能力,测定5-羟色胺(5-HT)水平。结果:治疗前,3组的HAMD评分、m BI评分和5-HT水平差异无统计学意义(P0.05)。与治疗前相比,治疗后第4周各组HAMD评分均有改善,其中联合组有效率高于其他2组(P0.05);各组的mBI评分和5-HT水平均高于同组治疗前(P0.05),且联合组高于其他2组(P0.05)。结论:rTMS联合音乐疗法治疗PSD可明显降低抑郁量表的评分,提高患者生活质量;其机制可能与5-HT水平升高有关。

Effect and Mechanism of Repetitive Transcranial Magnetic Stimulation Combined with Music Therapy on Post-Stroke Depression

To observe the effect of repetitive transcranial magnetic stimulation (rTMS) combined with music therapy on post-stroke depression (PSD), and to investigate its possible mechanism. Methods: A total of 69 patients with PSD were divided into the control group (23 cases), TMS group (21 cases), and combined treatment group (25 cases); the groups were treated with conventional therapy, conventional therapy + rTMS, or conventional therapy + rTMS + music therapy, respectively, for 4 weeks. The Hamilton Depression Scale (HAMD) was used to evaluate depression and the modified Barthel index (mBI) to assess activities of daily living in patients at hospital admission and again at 4 weeks after treatment. The serum level of 5-hydroxytryptamine (5-HT) in each group was measured at the same time points. Results: The HAMD score, mBI score, and 5-HT level were not significantly different between the 3 groups before treatment (P>0.05). Compared to before treatment, the HAMD score of each group 4 weeks after treatment showed improvement, and the combined treatment group showed greater effectiveness than the other 2 groups (P<0.05). The mBI score and 5-HT level in each group was higher after treatment compared to the same group before treatment, and the combined group showed a greater increase than those of the other 2 groups (P<0.05). Conclusion: Repetitive TMS combined with music therapy is effective in the treatment of PSD, significantly reducing depression scores and increasing quality of life; the mechanism may be related to the increase in serum 5-HT levels.