重复经颅磁刺激对抑郁症患者的抑郁程度和HPA轴的影响

目的探讨重复经颅磁刺激对抑郁症患者的抑郁程度和下丘脑-垂体-肾上腺（HPA）轴活性的影响。方法采取双盲对照试验方案，将确诊的40例抑郁症患者随机分入工组（治疗组）和Ⅱ组（假刺激对照组），每组治疗10天。在治疗前及治疗结束后当天检测Hamilton抑郁量表（HAMD）积分、血清皮质醇（CORT）及血清促肾上腺皮质激素（ACTH）浓度。结果治疗前全组的HAMD积分与血清CORT（r=0．948）和ACTH（r=0．971）浓度和治疗后治疗组的HAMD积分与血清CORT（r=0．920）和ACTH（r=0．978）浓度间均呈显著正相关关系（均P〈0．05）。治疗前两组的HAMD积分（t〈0．001）、血清CORT（t=-0．328）和ACTH（t=-0．228）浓度无统计学差异（均P〉0．05）；治疗后两组的上述指标均有统计学差异（P〈0．05）。结论抑郁症患者的抑郁程度与其血清CORT和ACTH浓度呈正相关。rTMS有改善抑郁症状的作用，其抗抑郁作用的机制可能与其下调HPA轴的活性有关。

The Influences of Repetitive Transcranial Magnetic Stimulation on Depressive Degree and Hypothalamic-pituitary-adrenal Axis in the Patients with Depression

Objective To discuss the influences of repetitive transcranial magnetic stimulation（rTMS） on depressive degree and hypothalamic-pituitary-adrenal axis in the patients with depression. Methods According to double-blind contrast trial, 40 patients with definite depression were randomly allocated into two groups. Subjects were treated by rTMS （group Ⅰ ） or sham stimulation （group Ⅱ） for 10 days. At the beginning and termination of the therapy, the scores of Hamilton Rating Scale for Depression （HAMD）, the concentration in blood serum of adrenocorticotrophin （ACTH） and cortisol （CORT） were measured. Results Before therapy, the score of HAMD in two groups had a positive correlation with their ACTH （r=0. 971） and CORT （r=0. 948）concentration. Similarly, after therapy, the score of HAMD of patients in group Ⅰ had a positive correlation with their ACTH （r=0. 978） and CORT （r=0. 920） concentration. The HAMD（t〈0. 001） score, ACTH（t=-0. 228） and CORT（t=-0. 328） concentration in blood serum in two groups had no statistical significance （all P〉0. 05） before therapy, while the changes had obvious significance （all P〈0.05） after therapy. Conclusion The degree of depression has a positive correlation with ACTH and CORT concentration in blood serum, rTMS can improve the symptoms of depression, and decreasing the activity of HPA axis may be its mechanism.