重复经颅磁刺激治疗食管癌相关性抑郁的临床应用研究及DTI影像学评估

发布时间：2018-03-01 20:36

本文关键词： 食管癌抑郁经颅磁刺激脑白质感兴趣区域弥散张量成像部分各向异性　出处：《川北医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的：研究重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)治疗食管癌相关性抑郁患者的临床效果,并采用弥散张量成像(Diffusion Tensor Imaging,DTI)评价其影像学表现。方法：收集2015年11月-2016年12月期间于南充市中心医院肿瘤科及心胸外科住院的食管癌患者。选取符合要求的食管癌相关性抑郁患者分成多次重复经颅磁刺激组(m-rTMS组)和单次重复经颅磁刺激组(s-rTMS组)。m-rTMS组食管癌抑郁症患者给予连续5天的rTMS治疗(刺激频率：10Hz,刺激强度：110%静息运动阈值,刺激部位：左侧背外侧前额叶皮层);s-rTMS组患者只治疗1次。两组患者在rTMS治疗前及治疗疗程结束后均行抑郁他评量表-汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-rating Depression Scale,SDS)临床评分,并进行DTI图像采集。对比分析单次、多次rTMS治疗前后HAMD、SDS、SAS临床评分间的差异;对比两组患者rTMS治疗前后抑郁相关脑区DTI各向异性参数(Fractional Anisotropy,FA)值的变化。结果：m-rTMS组共纳入10例(男性6例,女性4例),s-rTMS组12例(男性8例,女性4例)。治疗前两组患者基本资料及临床评分差异无统计学差异。1、两组受试者治疗后HAMD评分显著降低,差异有统计学意义(m-rTMS组：P=0.000;s-rTMS组：P=0.000);SAS评分降低,差异有统计学意义(m-rTMS组：P=0.000;s-rTMS组：P=0.001);SDS评分降低,差异有统计学意义(m-rTMS组：P=0.001;s-rTMS组：P=0.000)。并且,m-rTMS组及s-rTMS组治疗后组间HAMD、SAS、SDS三组评分差异有统计学意义(P=0.001/0.004/0.003)。2、两组患者经rTMS治疗后FA值升高的脑区包括双侧海马、丘脑及扣带回,左侧纹状体、右侧前额叶、左侧颞上回、左侧颞中回,差异有统计学意义(P0.05)。结论：高频rTMS治疗能改善患者的抑郁状态,且相关脑区FA值及临床评分改变明显;通过DTI监测到抑郁患者脑白质感兴趣区域内部分FA值降低,可能与抑郁发生有关,而部分脑区FA值增加,可能与治疗后神经纤维的潜在补偿性再生有关;DTI作为一种新的研究脑白质形态结构的方法,能够从组织微结构层面检测抑郁脑区变化。
[Abstract]:Objective: to study the clinical effect of repeated transcranial magnetic stimulation (TMS) on patients with esophageal cancer associated depression. The imaging findings were evaluated by diffusive Zhang Liang imaging with diffusion Tensor imaging. Methods: from November 2015 to December 2016, the patients with esophageal cancer were collected from the oncology department and cardiothoracic surgery department of Nanchong central hospital. Patients with cancer-related depression were divided into multiple repetitive transcranial magnetic stimulation group (m-rTMS group) and single repeated transcranial magnetic stimulation group (TMS group) and single repeated transcranial magnetic stimulation group (TMS group). Patients with esophageal cancer depression were treated with rTMS for 5 consecutive days (stimulation frequency: 10 Hz, stimulation intensity: 110% resting exercise threshold). Stimulation site: patients in left dorsolateral prefrontal cortex were treated only once. The patients in both groups were treated with Hamilton Depression scale before rTMS treatment and after the course of treatment. Scale scale, Self-rating Depression scale scale (SDSs), Self-rating Depression scale (SDSs), self rating Depression scale (SDSs), and self rating Depression scale (SDSs), DTI images were collected and the differences between the clinical scores of rTMS before and after rTMS treatment were compared and analyzed. Results 10 cases (6 males and 4 females) were included in 10 cases (male 6, female 4) in depression-related brain region (12 cases, male 8 cases) in the 10 cases of 10 cases (male 6 cases, female 4 cases) in the depression-related brain region before and after rTMS treatment, and the changes of the DTI anisotropy parameter in the depression-related brain region were compared between the two groups before and after the treatment. There was no significant difference in basic data and clinical scores between the two groups before and after treatment. The HAMD scores of the two groups decreased significantly after treatment, and the differences were statistically significant (P < 0.01). The difference was statistically significant (P < 0. 000). The SDS score of 1: P0. 001g / ml TMS group was significantly lower than that of the control group (P = 0. 000). The difference was statistically significant between the two groups. There were significant differences in the scores of Hamd, SASS-SDS between the two groups after treatment. The increased FA values of the two groups after rTMS treatment included bilateral hippocampus, thalamus and cingulate gyrus, left striatum, left striatum. The difference of right prefrontal lobe, left superior temporal gyrus and left middle temporal gyrus was statistically significant (P 0.05). Conclusion: high frequency rTMS treatment can improve the depression state of the patients, and the FA value and clinical score of the related brain area are obviously changed. The decrease of FA value in the area of white matter interest in depression patients was detected by DTI, which may be related to the occurrence of depression, while the FA value in some areas of brain increased. DTI may be related to the potential compensatory regeneration of nerve fibers after treatment. As a new method to study the morphology of white matter, DTI can be used to detect the changes of depressive brain area in tissue microstructure.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1;R749.4

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