摘要
背景左侧前额叶皮层的高频重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS) 对抑郁症治疗有效,但是作为难治性抑郁症除药物外的辅助治疗,rTMS 的疗程和对认知症状的作用尚不清楚。假设用抗抑郁药物治疗的难治性抑郁症患者接受 4 周的左侧前额叶皮层的高频 rTMS,其临床疗效和认知功能优于接受伪刺激的患者。方法用选择性 5-羟色胺再摄取抑制剂或 5-羟色胺与去甲肾上腺素再摄取抑制剂的 30 例难治性抑郁症[经过 2 种抗抑郁剂足量、足疗程治疗(足量是指最大剂量的 2/3 以上,足疗程指药物的治疗时间≥6 周) ,抑郁症状改善未达有效标准(17 项汉密尔顿抑郁量表减分率≤50%) ]患者,随机被分为真刺激组(n =15) 和伪刺激组(n =15) ,接受每周5 次连续 4 周的 rTMS 治疗。治疗开始及结束时采用盲法以 17 项汉密尔顿抑郁量表(17-item Hamilton DepressionRating Scale,HAMD ) 、蒙哥马利抑郁量表(Montgomery-Asberg Depression Rating Scale,MADRS) 、临床总体评定量表严重程度分量表(Severity of illness measure from the Clinical Global Impression,CGI-S) 评定抑郁症状; 以韦氏成人智力测验(Wechsler Adult Intelligence Scale,WAIS) 、韦氏成人记忆测验(Wechsler Memory Scale for adults,WMS) 、威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST) 评定认知功能。结果两组各完成 14 例。治疗 2 周两组 HAMD 总分的差异没有统计学意义,但治疗 4 周时平均 HAMD 总分减分率在真刺激组(49%,标准差 =19%) 大于伪刺激组(29%,标准差 =25%) ,平均差值为 20% [95% CI: 3%-37%; t26 =2.42; P = 0.023],两组 MADRS 总分减分率差异也有统计学意义[真刺激组: 47% (23% ) ,伪刺激组: 16% (40% ) ,Mann-Whitney Z = 2.62,P = 0.009],两组 CGI 严重程度评分减分率差异无统计学意义。治疗后两组智商、记忆力商数以及 WCST 结果均无明显改变。
Background：High-frequency repetitive transcranial magnetic stimulation（rTMS） to the left prefrontal cortex is a promising antidepressant treatment but the appropriate duration of treatment and its effect on cognitive symptoms in treatment resistant patients is uncertain.Hypothesis：Patients w ith treatment resistant depression on standard antidepressant medication w ho receive four w eeks of adjunctive treatment w ith high-frequency rTMS to the left prefrontal cortex w ill have better clinical outcomes and better cognitive functioning than those w ho receive sham rTMS treatments.Methods：Thirty patients w ith treatment resistant depression（defined as failure to respond to tw o or more antidepressants of different classes administered for at least 6 w eeks at or above tw o-thirds of the recommended maximum dose） receiving selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors w ere randomly assigned to receive adjunctive treatment w ith either real rTMS（n = 15） or sham rTMS（n = 15） 5 times a w eek for 4 consecutive w eeks.Blinded pre-post evaluations w ere conducted using the 17-item Hamilton Depression Rating Scale（HAMD）,the Montgomery-Asberg Depression Rating Scale（MADRS）,the severity of illness measure from the Clinical Global Impression rating scale（CGI-S）,the Wechsler Adult Intelligence Scale（WAIS）,the Wechsler Memory Scale（WMS）,and the Wisconsin Card Sorting Test（WCST）.Results：14 subjects from each group completed the study.There w as no significant difference in the HAMD total scores betw een the tw o groups after 2 w eeks of treatment but after 4 w eeks of treatment the mean percentage drop in the HAMD total score w as significantly greater in the real rTMS group（49%,SD = 19%） than in the sham rTMS group（29%,SD = 25%）,w ith a mean difference of 20% [95% CI = 3%-37% ;t26 = 2.42;P = 0.023].At 4 w eeks the mean（SD） reduction in the MADRS total score w as also greater in the real rTMS group [47%（23%） vs 16%（40%）,Mann-Whitney Z = 2.62,P = 0.009 ],but there w as no significant difference in the reduction of CGI-S scores betw een the tw o groups.Neither of the groups had significant pre-post changes in intelligence,memory or executive functioning.Conclusion：Repetitive transcranial magnetic stimulation is an effective adjunctive treatment for the affective symptoms of treatment resistant depression if administered for at least 4 w eeks,but it has no apparent effect on cognitive functioning.
出处
《上海精神医学》
2011年第1期17-24,共8页
Shanghai Archives of Psychiatry
基金
Young Professional Support Grant from the Shanghai Mental Health Center of the Shanghai Jiaotong University School of Medicine
关键词
难治性抑郁症
重复经颅磁刺激
疗效认知功能
Treatment resistant depression
Repetitive transcranial magnetic stimulation（rTMS）
Efficacy
Cognitive functions
