重复经颅磁刺激治疗重型抑郁症的对照研究

背景:高频(15～25Hz)重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)技术能更多地兴奋大脑皮层水平走向连接神经元,导致皮层局部代谢浓度增高,与电休克疗法(electro convulsive therapy,ECT)相比较,其安全性高,副作用少。 目的:评价rTMS对重型抑郁症患者的治疗作用,探讨其治疗机制。 设计:以诊断为依据的病例对照研究。 地点和对象:36例来自于川北医学院附属医院的重型耐药性抑郁症患者,采用随机数字法将其分为rTMS治疗组和ECT组,每组18例患者。 方法:两组患者分别于治疗前及2周后采用汉密尔顿抑郁量表(Hamilton depression,HAMD)进行评定,同时测定rTMS治疗前后血浆5-羟色胺和去甲肾上腺素(norepinephrine,NE)含量变化。 主要观察指标:两组治疗前后HAMD评分;rTMS组治疗前后血浆5-羟色胺及NE含量;两组患者治疗后产生的副作用。 结果:rTMS治疗组和ECT组有效率分别为89％(16/18)、83％(15/18),差异无显著性意义(χ~2=0.812,P>0.05);两组患者治疗后HAMD评分分别为11.6±3.0、12.1±2.9,均较治疗前评分(27.8±3.2、26.7±2.8)明显下降,差异有显著性意义(t=2.891～3.279,P<0.05～0.005)。rTMS治疗组治疗后血浆5-羟色胺含量[(8.42±1.65)ng/L]较治疗前[(2.45±0.86)ng/L]显著增加(t=2.295

A controlled study ofthe treatment of repetitive transcranial magnetic stimulation in patients with majordepression

BACKGROUND:High-frequency repetitive transcranial magnetic stimulation(rTMS) has been reported to produce antidepressant effects for exciting more horizontally connected neurons in cerebral cortex and subsequently increased focal metabolite,which are preferable to electro convulsive therapy(ECT) when taking into account safety and side-effect. OBJECTIVE:To assess the therapeutic effect of rTMS in treating major depression,and to explore its therapeutic mechanism. DESIGN:A clinical case control study. SETTING,PARTICIPANTS and INTERVENTION:Thirty-six patients,with major depression from affiliated hospital of Chunbei Medical College were divided into rTMS group(n=18) and ECT group(n=18) according to Randomized Drawing lots.Patients of two groups were assessed with Hamilton depression(HAMD) rating scale before and two weeks after treatment,meanwhile levels of plasm 5-HT and norepinephrine(NE) were also determined. MAIN OUTCOME MEASURES:Scores for HAMD,levels of 5-HT and NE,and side effects resulted from treatment were observed. RESULTS:Efficacy was 89%( 16/18) in rTMS group,remarkably different from that in ECT group( 83% ,15/18) (χ 2=0.812,P >0.05).Scores of HAMD were 11.6± 3.0 and 12.1± 2.9 respectively in rTMS and ECT group after treatment,and both were statistically lowered than those before treatment(27.8± 3.2 and 26.7± 2.8,t=2.891- 3.279,P< 0.05- 0.005). Plasma 5-HT increased from(2.45± 0.86)ng/L to(8.42± 1.65) ng/L due to rTMS treatment,and differences were remarkable( t=2.295, P< 0.05) . Side effects were observed in patients receiving ECT treatment,including obvious dizziness,fatigue,impaired memory and so on,while obvious discomfort could not observed in rTMS group,except individually transient mild headache. CONCLUSION:rTMS and ECT are promising on treating major medicine-resistant depression,but the former proved to be preferable with respect to safety and side effect.The therapeutic mechanism was hypothetically correlated with 5-HT releasing.