重复经颅磁刺激治疗抑郁症患者的疗效及对负性认知偏向影响的研究

发布时间：2018-04-29 20:37

本文选题：负性认知偏向 + 重复经颅磁刺激　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景抑郁症是一种严重影响人类心身健康的精神疾病之一,它的发病机制尚不十分明确,可能与神经内分泌、生物化学、遗传、认知、心理社会因素等相关。认知因素作为其起病的原因之一,目前取得的共识是抑郁症患者存在负性认知偏向。重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作为一种物理疗法,那么它对抑郁症患者的疗效和负性认知偏向的影响,值得探讨。目的探讨rTMS治疗抑郁症患者的疗效及对抑郁症核心治疗靶点即负性认知偏向的影响。方法采用病例对照研究的方法,将71例首发抑郁症患者随机分为两组,研究组(36例)服用SNRIs类抗抑郁药物(盐酸文拉法辛缓释片)联合rTMS治疗。对照组(35例)服用SNRIs类抗抑郁药物(盐酸文拉法辛缓释片)联合rTMS伪刺激治疗。研究组选择左侧前额叶背外侧皮质为治疗部位,按照国际脑电图标准电极10/20放置法,选取F3点,治疗时线圈中心置于左前额叶背外侧皮质对应的脑区相切,刺激频率10HZ,刺激强度100%MT,每次治疗20分钟。对照组接受rTMS伪刺激,刺激线圈放置与头皮呈90度,其余参数与研究组相一致。在患者入院第2天行第1次治疗,每周治疗5天,治疗5次,中断2天,连续治疗4周,共计20次。采用汉密尔顿抑郁量表(HAMD)评估抑郁症患者临床症状,以HAMD8分为痊愈,HAMD减分率≥50%为显效。以负性认知加工偏向问卷、视觉搜索范式实验反应时作为抑郁症患者负性认知偏向评估指标,并与正常人群(30名)对比。以治疗时出现的症状量表(TESS)评估患者的不良反应。对比研究组与对照组的疗效、安全性、负性认知偏向的变化。以SPSS18.0统计软件,运用独立样本t检验、卡方检验、方差分析等对资料进行统计分析,以P0.05为有统计学意义。结果1.研究组、对照组、正常人群组在年龄、性别、文化程度的基本资料方面匹配,无统计学差异(P0.05)。研究组与对照组在病程和药物剂量方面无统计学差异(P0.05)。2.研究组与对照组在治疗前HAMD评分差异无统计学意义(t=0.424,P0.05)。在治疗2周末时,研究组与对照组HAMD评分相比有统计学差异(t=3.085,P0.05),在治疗4周末时,研究组与对照组HAMD评分相比有有统计学意义(t=4.919,P0.05)。治疗2周末时,研究组和对照组的HAMD评分与治疗前的评分差值相比具有统计学意义(t=3.451,P0.05)。3.治疗2周末,研究组显效率为66.67%(24/36),对照组显效率为40%(14/35),两组显效率相比有统计学差异(c2=5.073,P0.05)。研究组治愈率为38.88%(14/36),对照组治愈率为28.57%(10/35),两组治愈率相比无统计学差异(c2=0.844,P0.05);治疗4周末,研究组显效率91.66%(33/36),对照组为57.14%(20/35),两组在显效率上有明显统计学差异,(c2=5.844,P0.05)。研究组治愈率83.33%(30/36),对照组治愈率57.14%(20/35),两组在治愈率上有统计学意义(c2=5.844,P0.05)。4.参与本实验的患者未因严重不良反应脱离研究。研究组与对照组不良反应发生率,经卡方检验,结果无统计学差异(c2=0.097,P0.05)。两组联用苯二氮卓类等镇静催眠药物比例,经卡方检验,无统计学差异(c2=0.339,P0.05)。5.研究组与对照组在入院时及4周末时的负性认知加工偏向问卷评分,均高于正常组,差异有统计学意义(P0.05)。研究组组内负性认知加工偏向问卷评分差异具有统计学意义(P0.05),研究组治疗前与治疗4周末的评分差异有统计学意义(P0.05)。对照组组内问卷评分差异有统计学意义(P0.05),对照组在治疗前与治疗4周末的评分差异具有统计学意义(P0.05)。研究组在治疗2周末与入院时的负性认知加工偏向问卷评分差值,大于对照组的差值,差异有统计学意义(P0.05),表明研究组减分值大于对照组。治疗4周末时,研究组的负性认知加工偏向问卷评分低于对照组,差异具有统计学意义(P0.05)。6.在悲伤面孔环境视觉搜索靶刺激的任务中,研究组与对照组在入院时的反应时无明显统计学差异(P0.05),两组入院时的反应时高于正常组,差异具有统计学意义(P0.05)。在治疗4周末时研究组与对照组的反应时均低于入院时的反应时,差异有统计学差异(P0.05)。研究组在治疗4周末时的反应时低于对照组在4周末时的反应时,差异有统计学意义(P0.05),但与正常组反应时相比无显著统计学差异(P0.05),对照组与正常组反应时相比有统计学意义(P0.05)。结论1.rTMS联合抗抑郁药物治疗抑郁症,较单一采用抗抑郁药物治疗,具有起效时间早、疗效好、安全的特点。2.抑郁症患者存在明显的负性认知偏向;3.rTMS联合抗抑郁药物治疗,较单一采用抗抑郁药物治疗,能更早、更有效地改善抑郁症患者的负性认知偏向。
[Abstract]:Background depression is one of the mental diseases that seriously affect human body and body health. Its pathogenesis is not yet very clear. It may be related to neuroendocrine, biochemistry, genetics, cognition and psychosocial factors. As one of the causes of its onset, cognitive factors are negative cognitive bias in patients with depression. Repeat transcranial magnetic stimulation (repetitive transcranial magnetic stimulation, rTMS) as a physical therapy, then its effect on the effect of depression and negative cognitive bias is worth exploring. Objective to explore the effect of rTMS on the treatment of depressive patients and the effect on the negative cognitive bias in the core treatment targets of depression. 71 first-episode depression patients were randomly divided into two groups using a case-control study. The study group (36 cases) was treated with SNRIs antidepressant (Venlafaxine Hydrochloride Sustained-release Tablets) combined with rTMS. The control group (35 cases) took the SNRIs antidepressant (Venlafaxine Hydrochloride Sustained-release Tablets) combined with rTMS pseudo stimulus therapy. The study group chose the left frontal forehead The lateral cortex of the dorsolateral leaf was used as the treatment site. According to the standard electrode 10/20 placement of the international electroencephalogram, the F3 point was selected. The center of the coil was placed in the brain region corresponding to the left lateral prefrontal cortex at the time of treatment. The stimulation frequency was 10HZ and the stimulation intensity was 100%MT for 20 minutes each time. The control group received rTMS pseudo stimulus, the stimulation coil placed 90 degrees to scalp, and the rest. The parameters were in accordance with the study group. The patients were treated with first times for second days, 5 days a week for 5 days, 5 times, 2 days and 20 times for 4 weeks. The Hamilton Depression Scale (HAMD) was used to evaluate the clinical symptoms of depression, and the HAMD8 was recovered and the HAMD subtraction rate was more than 50%. The negative cognitive processing bias questionnaire and visual search were used. The cable paradigm test was used as a negative cognitive bias assessment index in patients with depression and compared with the normal population (30). The symptom scale (TESS) was used to evaluate the adverse reactions of the patients. The effects, safety and negative cognitive bias were compared between the study group and the control group. The independent sample t test was used by the SPSS18.0 statistics software. The data were statistically analyzed by chi square test and variance analysis. The results of P0.05 were statistically significant. Results there was no statistical difference between the 1. study group, the control group and the normal group in the basic data of age, sex and Education (P0.05). There was no statistical difference between the study group and the control group in the course of disease and drug dose (P0.05).2. study. There was no statistical difference between the group and the control group before the treatment (t=0.424, P0.05). At the end of the 2 week of treatment, there was a statistically significant difference between the study group and the control group (t=3.085, P0.05). At the end of the 4 week, the study group was statistically significant compared with the control group HAMD score (t=4.919, P0.05). At the end of the 2 week, the study group and the control group were compared with the control group. The HAMD score of the group was statistically significant compared with that before the treatment (t=3.451, P0.05). The effective rate of the study group was 66.67% (24/36) and 40% (14/35) in the control group at the end of the 2 week. The two groups showed significant difference (c2=5.073, P0.05). The cure rate of the study group was 38.88% (14/36), and the cure rate of the control group was 28.57% (10/35), two. The cure rate of the group was not statistically significant (c2=0.844, P0.05), the effective rate of the study group was 91.66% (33/36) and the control group was 57.14% (20/35) at the end of the 4 week. The two groups had significant statistical difference (c2=5.844, P0.05). The cure rate of the study group was 83.33% (30/36), the cure rate of the control group was 57.14% (20/35), and the two groups had statistical significance in the cure rate (c2=5.84). 4, P0.05).4. participated in the experiment without serious adverse reaction. The incidence of adverse reactions between the study group and the control group was not statistically significant (c2=0.097, P0.05). The proportion of sedative hypnotic drugs, such as benzene and two azinones, was found in the two groups, and there was no statistical difference (c2=0.339, P0.05).5. research group and the control group. The negative cognitive processing bias was higher than the normal group at the time of admission and 4 weeks. The difference was statistically significant (P0.05). The difference of negative cognitive processing bias in the study group was statistically significant (P0.05). The difference between the study group before treatment and the 4 weekend was statistically significant (P0.05). There was statistical significance (P0.05), the difference between the control group before the treatment and the 4 weekend of the treatment was statistically significant (P0.05). The difference value of the negative cognitive processing bias of the study group at the end of the 2 week and the admission was greater than that of the control group, the difference was statistically significant (P0.05), indicating that the subtraction score of the study group was greater than that of the control group. At the end of the 4 week, the negative cognitive processing bias of the study group was lower than that of the control group. The difference was statistically significant (P0.05).6. in the task of visual search target stimulation of the sad face environment, the response time of the study group and the control group was not significantly different (P0.05), and the two groups were higher than the normal group when they were admitted to the hospital. The difference was statistically significant (P0.05). The difference was statistically significant (P0.05) when the response of the study group was lower than the control group at the 4 weekend (P0.05). The response of the study group at the weekend of treatment was lower than that of the control group at the 4 weekend (P0.05), but there was no significant difference compared with the normal group. Statistically significant difference (P0.05), compared with the normal group (P0.05). Conclusion 1.rTMS combined with antidepressant drugs in the treatment of depression, compared with a single antidepressant, has early onset time, good efficacy and safety, and there is a significant negative cognitive bias in the patients with.2. depression; 3.rTMS combined with antidepressant drugs. Substance therapy, which is more effective than single antidepressant treatment, can improve the negative cognitive bias of patients with depression earlier and more effectively.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.4

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