高频重复经颅磁刺激治疗PTSD的疗效分析及相关机制研究
发布时间：2018-07-26 19:13
【摘要】：目的:比较伪刺激组(帕罗西汀)与真刺激组(帕罗西汀+高频重复经颅磁刺激)的疗效,分析治疗后创伤后应激障碍患者血浆中肾素、血管紧张素II和皮质醇含量以及创伤后应激障碍量表总分的变化,并进一步探究神经内分泌激素含量的变化与创伤后应激障碍症状改善的关系。方法:连续入组60例首发或3个月内未服用精神科药物的创伤后应激障碍患者作为试验组,入组后次日上午8点抽取试验组成员静脉血3ml检测血浆中肾素、血管紧张素II和皮质醇含量,同时运用创伤后应激障碍检查量表(PCL)评定其创伤后应激障碍程度。以年龄和性别为控制变量,入组60例身体健康者作为对照组,入组后次日上午8点抽取对照组成员静脉血3ml检测血浆中肾素、血管紧张素II和皮质醇含量。利用随机数字表将试验组成员随机分为真刺激组和伪刺激组各30例,伪刺激组只给予帕罗西汀治疗,真刺激组给予帕罗西汀治疗的同时联合高频重复经颅磁刺激治疗,治疗4周后次日上午8点抽取真刺激组和伪刺激组成员静脉血3ml重复检测血浆中肾素、血管紧张素II和皮质醇含量,同时运用创伤后应激障碍自评量表(PCL)再次评定其创伤后应激障碍程。结果:1试验组与对照组比较年龄、性别、城乡、婚姻、独生子女、文化程度无统计学差异;2试验组血浆中肾素、血管紧张素II和皮质醇含量与对照组比较无统计学差异,皮质醇含量显著低于对照组;3血浆中皮质醇含量对PTSD有一定的预测作用,当血浆中皮质醇=332.880nmol/L时,约登指数=0.267达最大值,此分界值预测PTSD的敏感度为96.7%,特异度为30.0%;4真刺激组与伪刺激组比较年龄、病程、盐酸帕罗西汀的剂量、性别、城乡、婚姻、独生子女、文化程度无统计学差异;5治疗4周后,真刺激组和伪刺激组PCL总分显著低于治疗前,血浆中皮质醇含量较治疗前有明显升高,肾素和血管紧张素II含量改变无统计学差异;6真刺激组与伪刺激组疗效比较,两组的疗效分布有统计学差异,真刺激组无效率显著低于伪刺激组,显著进步率明显高于伪刺激组,进步率和治愈率无统计学差异;7治疗前真刺激与伪刺激组比较PCL总分、血浆中肾素、血管紧张素II含量无统计学差异,治疗4周后真刺激组PCL总分显著低于伪刺激组、血浆中皮质醇含量显著高于伪刺激组,治疗前后真刺激组PCL的减分率和皮质醇差值明显高于伪刺激组,肾素差值和血管紧张素II差值与伪刺激组比较无统计学差异;8真刺激组皮质醇差值与PCL减分率呈显著正相关,皮质醇差值可以预测PCL减分率变异的29.2%,伪刺激组皮质醇差值与PCL减分率无明显相关;9经颅磁刺激治疗过程中,皮质醇差值对PTSD患者的疗效有很好的预测作用,当皮质醇差值=97.370nmol/L时,约登指数=0.540达最大值,此分界值预测PTSD患者疗效的敏感度为77.8%,特异度为76.2%。结论:1 HPA轴功能衰竭所致的血浆中皮质醇含量不足,可能是PTSD患者发病的病因之一;2盐酸帕罗西汀联合高频重复经颅磁刺激可以显著提高治疗PTSD的效果;3高频重复经颅磁刺激提高治疗PTSD效果的可能机制是其激活了HPA轴,使PTSD患者血浆中皮质醇含量不足得以恢复。
[Abstract]:Objective: To compare the effect of pseudo stimulus group (Pa Rossi Dean) and real stimulation group (Pa Rossi Dean + high frequency repetitive transcranial magnetic stimulation), and analyze the changes of the plasma renin, angiotensin II and cortisol content and the total score of posttraumatic stress disorder (PTSD) in patients with posttraumatic stress disorder after treatment, and to further explore the changes in the content of neuroendocrine hormones. Methods: the relationship between the improvement of posttraumatic stress disorder (PTSD) symptoms. Methods: 60 cases of posttraumatic stress disorder (PTSD) who did not take psychotropic drugs during the first or 3 months were taken as experimental group, and the plasma renin, angiotensin II and cortisol levels were detected by 3ml in the group of the test group at 8 a.m. after entering the group. Stress disorder checklist (PCL) was used to assess the degree of posttraumatic stress disorder. With age and sex as the control variable, 60 healthy persons were taken as control group, and the blood plasma renin, angiotensin II and cortisol content were detected by 3ml in the control group after the next day, and the random number table was used to make the test group members. 30 cases were randomly divided into 30 cases of real stimulation group and pseudo stimulus group. The pseudo stimulus group was only treated with Pa Rossi Dean. The real stimulation group was given Pa Rossi Dean treatment and combined high frequency and repetitive transcranial magnetic stimulation. After 4 weeks, the real stimulation group and the pseudo stimulus group were extracted and the members of the pseudo stimulus group were repeated 3ml to detect the plasma renin and angiotensin II. The content of cortisol and the posttraumatic stress disorder self rating scale (PCL) were used to reassess the post traumatic stress disorder. Results: there was no statistical difference in age, sex, urban and rural, marriage, and only child in the 1 group and the control group. In the 2 test group, the plasma renin, angiotensin II and cortisol content were no more than those in the control group. Statistical difference, cortisol content was significantly lower than the control group; 3 plasma cortisol content had a certain predictive effect on PTSD. When plasma cortisol =332.880nmol/L, the maximum value of the =0.267 index was 96.7%, the specificity was 30%; 4 true stimulus group was compared with the pseudo stimulus group, the course of disease, hydrochloric hydrochloric acid. There was no statistical difference between the dose, sex, urban and rural, marriage, and one child, and the total score of PCL in the real stimulation group and the pseudo stimulus group was significantly lower than that before the treatment. The plasma cortisol content was significantly higher than that before the treatment, and there was no significant difference in the content of renin and angiotensin II in the plasma of the real stimulation group and the pseudo stimulus group after 5 weeks of treatment; 6 real stimulation group and pseudo stimulus group. The effect distribution of the two groups was statistically different. The ineffectiveness of the real stimulation group was significantly lower than that of the pseudo stimulus group. The significant progress rate was significantly higher than that of the pseudo stimulus group, and there was no statistical difference between the progress rate and the cure rate. There was no statistical difference between the real stimulation and the pseudo stimulus group before 7 treatment, and there was no statistical difference between the plasma renin and angiotensin II after 4 weeks of treatment. The total score of PCL in the real stimulation group was significantly lower than that of the pseudo stimulus group. The plasma cortisol content in the plasma was significantly higher than that of the pseudo stimulus group. The reduction rate of PCL and the difference of cortisol in the real stimulation group were significantly higher than those of the pseudo stimulus group. The difference between the renin difference and the difference between the angiotensin II and the pseudo stimulus group had no statistical difference, and the difference between the cortisol and the PCL in the 8 real stimulation group was compared with that of the pseudo stimulus group. There was a significant positive correlation. The cortisol difference could predict 29.2% of the variation of the PCL reduction rate. There was no significant correlation between the cortisol difference and the PCL reduction rate in the pseudo stimulus group. 9 the difference value of cortisol had a good predictive effect on the curative effect of PTSD patients during the transcranial magnetic stimulation treatment. When the difference value of cortisol = 97.370nmol/L, the maximum value of the PCL index =0.540 reached the maximum value. The sensitivity of the estimated value of PTSD patients was 77.8%, and the specificity was 76.2%. conclusion: the deficiency of cortisol in plasma caused by 1 HPA axis failure may be one of the causes of PTSD patients; 2 Paroxetine Combined with high frequency repetitive transcranial magnetic stimulation can significantly improve the effect of PTSD treatment; 3 high frequency repetitive transcranial magnetic stimulation The possible mechanism for the treatment of PTSD is the activation of the HPA axis, resulting in the recovery of plasma cortisol levels in PTSD patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749.5
[Abstract]:Objective: To compare the effect of pseudo stimulus group (Pa Rossi Dean) and real stimulation group (Pa Rossi Dean + high frequency repetitive transcranial magnetic stimulation), and analyze the changes of the plasma renin, angiotensin II and cortisol content and the total score of posttraumatic stress disorder (PTSD) in patients with posttraumatic stress disorder after treatment, and to further explore the changes in the content of neuroendocrine hormones. Methods: the relationship between the improvement of posttraumatic stress disorder (PTSD) symptoms. Methods: 60 cases of posttraumatic stress disorder (PTSD) who did not take psychotropic drugs during the first or 3 months were taken as experimental group, and the plasma renin, angiotensin II and cortisol levels were detected by 3ml in the group of the test group at 8 a.m. after entering the group. Stress disorder checklist (PCL) was used to assess the degree of posttraumatic stress disorder. With age and sex as the control variable, 60 healthy persons were taken as control group, and the blood plasma renin, angiotensin II and cortisol content were detected by 3ml in the control group after the next day, and the random number table was used to make the test group members. 30 cases were randomly divided into 30 cases of real stimulation group and pseudo stimulus group. The pseudo stimulus group was only treated with Pa Rossi Dean. The real stimulation group was given Pa Rossi Dean treatment and combined high frequency and repetitive transcranial magnetic stimulation. After 4 weeks, the real stimulation group and the pseudo stimulus group were extracted and the members of the pseudo stimulus group were repeated 3ml to detect the plasma renin and angiotensin II. The content of cortisol and the posttraumatic stress disorder self rating scale (PCL) were used to reassess the post traumatic stress disorder. Results: there was no statistical difference in age, sex, urban and rural, marriage, and only child in the 1 group and the control group. In the 2 test group, the plasma renin, angiotensin II and cortisol content were no more than those in the control group. Statistical difference, cortisol content was significantly lower than the control group; 3 plasma cortisol content had a certain predictive effect on PTSD. When plasma cortisol =332.880nmol/L, the maximum value of the =0.267 index was 96.7%, the specificity was 30%; 4 true stimulus group was compared with the pseudo stimulus group, the course of disease, hydrochloric hydrochloric acid. There was no statistical difference between the dose, sex, urban and rural, marriage, and one child, and the total score of PCL in the real stimulation group and the pseudo stimulus group was significantly lower than that before the treatment. The plasma cortisol content was significantly higher than that before the treatment, and there was no significant difference in the content of renin and angiotensin II in the plasma of the real stimulation group and the pseudo stimulus group after 5 weeks of treatment; 6 real stimulation group and pseudo stimulus group. The effect distribution of the two groups was statistically different. The ineffectiveness of the real stimulation group was significantly lower than that of the pseudo stimulus group. The significant progress rate was significantly higher than that of the pseudo stimulus group, and there was no statistical difference between the progress rate and the cure rate. There was no statistical difference between the real stimulation and the pseudo stimulus group before 7 treatment, and there was no statistical difference between the plasma renin and angiotensin II after 4 weeks of treatment. The total score of PCL in the real stimulation group was significantly lower than that of the pseudo stimulus group. The plasma cortisol content in the plasma was significantly higher than that of the pseudo stimulus group. The reduction rate of PCL and the difference of cortisol in the real stimulation group were significantly higher than those of the pseudo stimulus group. The difference between the renin difference and the difference between the angiotensin II and the pseudo stimulus group had no statistical difference, and the difference between the cortisol and the PCL in the 8 real stimulation group was compared with that of the pseudo stimulus group. There was a significant positive correlation. The cortisol difference could predict 29.2% of the variation of the PCL reduction rate. There was no significant correlation between the cortisol difference and the PCL reduction rate in the pseudo stimulus group. 9 the difference value of cortisol had a good predictive effect on the curative effect of PTSD patients during the transcranial magnetic stimulation treatment. When the difference value of cortisol = 97.370nmol/L, the maximum value of the PCL index =0.540 reached the maximum value. The sensitivity of the estimated value of PTSD patients was 77.8%, and the specificity was 76.2%. conclusion: the deficiency of cortisol in plasma caused by 1 HPA axis failure may be one of the causes of PTSD patients; 2 Paroxetine Combined with high frequency repetitive transcranial magnetic stimulation can significantly improve the effect of PTSD treatment; 3 high frequency repetitive transcranial magnetic stimulation The possible mechanism for the treatment of PTSD is the activation of the HPA axis, resulting in the recovery of plasma cortisol levels in PTSD patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749.5
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