重复经颅磁刺激治疗对卒中后抑郁障碍患者失匹配负波和视觉P300的影响

目的:探讨重复经颅磁刺激(rTMS)治疗卒中后抑郁障碍(PSD)患者事件相关电位(ERPs)中失匹配负波(MMN)和视觉P300的影响。方法:68例PSD患者根据随机数表法分为rTMS组和单用药组各34例,另选择38名志愿者为健康对照组。单用药组服用文拉法辛治疗,150 mg/d缓释顿服;rTMS组合并高频rTMS治疗6周。治疗前后给予患者汉密尔顿抑郁量表(HAMD-17)评分及ERPs中MMN、视觉P300指标检测;ERP结果与健康对照组(38名)比较。结果:治疗后两患者组HAMD-17评分均明显降低,且rTMS组治疗第3、6周后HAMD-17评分明显低于单用药组(P均<0.01)。治疗前两患者组额区MMN及枕区P2、P3潜伏期明显长于健康对照组、波幅明显低于健康对照组(P均<0.05);与治疗前及单用药组比较,治疗后rTMS组额区MMN潜伏期明显缩短,波幅明显升高(P均<0.05);枕区P2、P3潜伏期明显缩短,P3波幅明显升高(P均<0.05);单用药组治疗前后MMN、视觉P300指标比较差异无统计学意义。结论:在常规药物治疗的基础上,联合高频rTMS可以提高PSD疗效,改善患者的神经认知功能。

Effects of repetitive transcranial magnetic stimulation on mismatch negativity and visual P300 in patients with post-stroke depression

Objective:To investigate the value of mismatch negativity(MMN)and visual P300 of event-related potential(ERPs)for evaluating the effect of repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke depression(PSD).Method:68 patients with PSD were randomly divided into rTMS group(n=34)and monotherapy group(n=34).Another 38 volunteers were selected as healthy control group.Monotherapy group was treated with venlafaxine treatment(150 mg/d)and sustained-release tablets orally.The rTMS group was given venlafaxine combined with rTMS treatment for 6 weeks.Scores of the Hamilton Depression Scale(HAMD-17)before and after treatment between the two patient groups were compared.Changes of MMN and P300 and their differences from healthy control groups were compared.Results:After treatment,the HAMD-17 scores of the two patient groups significantly decreased,and the scores of the rTMS group were significantly lower than those of the monotherapy group after 3 and 6 weeks of treatment(both P<0.01).Before treatment,MMN in the frontal area,P2 and P3 latency in the occipital area of the two patient groups were significantly longer than those of the healthy control group,and their amplitude were significantly lower than those of the healthy control group(P<0.05).Compared with the pre-treatment and monotherapy groups,the MMN latency of frontal area in the rTMS group significantly shortened and the amplitude significantly increased(P<0.05).P2 and P3 latency in the occipital area significantly shortened and the amplitude of P3 significantly increased(P<0.05).There were no statistically significant differences in the MMN and visual P300 in the monotherapy groups before and after treatment.Conclusion:High-frequency rTMS,on the basis of conventional drug therapy,can increase the efficacy of PSD and improve neurocognitive function of PSD patients.