重复经颅磁刺激联合强化认知锻炼对卒中后抑郁症伴认知功能障碍患者HPA轴的影响

目的探讨重复经颅磁刺激(r TMS)联合强化认知锻炼对卒中后抑郁症(PSD)伴认知功能障碍患者下丘脑-垂体-肾上腺素(HPA)轴的影响。方法选取2017年1月至2019年9月就诊治疗的PSD伴认知功能障碍患者84例,随机分为对照组和联合组,每组各42例。两组均予控制血脂、血糖和血压、营养脑细胞及改善脑部微循环等基础治疗。对照组在此基础上予强化认知锻炼,联合组在对照组基础上予r TMS治疗,两组治疗均为8周。观察两组治疗前后HPA轴功能变化,并评估神经、抑郁症状和认知功能情况。结果治疗8周后,两组血清CRH、ACTH和Cor较治疗前显著下调(P0.05或P0.01),且联合组下调值较对照组更明显(P0.05);同时两组CSS评分和HAMD评分较治疗前明显下调,而MoCA评分较治疗前明显上调(P0.05或P0.01),且联合组变化值较对照组更明显(P0.05)。结论 r TMS联合强化认知锻炼用于PSD伴认知功能障碍患者能加快神经功能的恢复,减轻抑郁症状和提高认知功能,其机制与抑制CRH、ACTH和Cor分泌,使紊乱HPA轴功能得到纠正密切相关。

Impacts of repetitive transcranial magnetic stimulation combined with intensive cognitive exercise on HPA axis in patients with post-stroke depression and cognitive dysfunction

Objective To investigate the impacts of repetitive transcranial magnetic stimulation (rTMS) combined with intensive cognitive exercise on hypothalamic-pituitary-adrenaline(HPA) axis in patients with post-stroke depression(PSD) and cognitive dysfunction.Methods A total of 84 PSD patients with cognitive dysfunction from January 2017 to September 2019 were selected and randomly divided into the combined groupand the control group,with 42 cases in each group.Both groups were given basic treatments such as controlling blood lipid,blood glucose and blood pressure,nourishing cerebral cells and improving cerebral microcirculation.On this basis,the control group was given intensive cognitive exercise,and the combined group was given rTMS treatment on the basis of the control group.Both groups were treated for 8 weeks.The changes of HPA axis function before and after treatment were observed,and the neurological,depressive symptoms and cognitive function were evaluated.Results After 8 weeks of treatment,serum CRH,ACTH and Co were significantly decreased in both groups (P<0.05 or P<0.01),and the change was more obvious in the combined group (P<0.05).At the same time,CSS scores and HAMD scores were significantly decreased,while MoCA score was significantly increased (P<0.05 or P<0.01),and the change value of the combined group was more obvious (P<0.05).Conclusion RTMS combined with intensive cognitive exercise can accelerate the recovery of neural function,relieve depression symptoms and improve cognitive function in PSD patients with cognitive dysfunction,and its mechanism is closely related to inhibiting CRH,ACTH and Cor secretion and correcting disordered HPA axis function.