超低频经颅磁刺激联合帕罗西汀对首发抑郁症患者的早期效果分析
发布时间：2018-10-23 17:45
【摘要】：目的：分析超低频经颅磁刺激联合帕罗西汀治疗抑郁症首次发作患者的早期疗效及其对认知功能和神经递质功能的影响，为超低频经颅磁刺激的临床应用提供科学依据。 方法：从四川省精神卫生中心的门诊部及住院部选取首发抑郁症患者70例。采用完全数字随机分组的方法将受试者分为联合治疗组和药物治疗组各35例，对两组受试者进行为期4周的治疗观察。在治疗前2周，向联合治疗组施加1次/天的超低频经颅磁刺激（连续14天），每次30min，，刺激强度500GS，环形线圈置于头顶向全脑施加磁场，线圈直径25cm，距离头皮1.5-2.0cm，并服用帕罗西汀治疗（20-40mg/天）。药物治疗组接受假刺激和帕罗西汀（20-40mg/天）治疗。两周后，两组受试者只接受帕罗西汀治疗。两组药物剂量的调整依据临床症状及不良反应的严重程度。给予夜间失眠者阿普唑仑0.4-0.8mg。研究基线期、2周时、4周时指导所有受试者完成汉密尔顿抑郁量表（Hamilton rating for depression，HAMD）24项版本、威斯康星卡片分类测验（Wisconsin Card Sorting Test，WCST）、划消测验（cancellation test，CT）、脑涨落图检测。观察受试者在研究期间是否出现不良反应，如头晕、头痛、耳鸣等。采用SPSS19.0建立数据库和统计分析。 结果：①联合治疗组和药物治疗组完成全程研究的人数分别为32和34例。治疗2周时，联合治疗组有效率40.6%(13/32)高于药物治疗组17.6%(6/34)（χ~2=4.246，P=0.039）。治疗4周时，联合治疗组有效率71.9%(23/32)高于药物治疗组38.2%(13/34)（χ~2=7.542，P=0.006）。联合治疗组4周时有效率高于2周时（χ~2=6.349，P=0.012），药物治疗组4周时有效率与2周相比差异无统计学意义（χ~2=3.579，P=0.059）。②联合治疗组中，2周时WCST中完成分类数和正确应答数高于基线期（P0.05或P0.01），与第4周相比差异无统计学意义（P均0.05）；不同时间点划消粗分呈逐渐提高的趋势（P0.05或P0.01）。药物治疗组中，2周时WCST中完成分类数和正确应答数与基线期相比差异均无统计学意义（P均0.05），但均低于4周时（P0.01或P0.05）。2周时划消得分高于基线期（P0.05），与4周时相比差异无统计学意义（P0.05）；2周时联合治疗组中WCST的完成分类数、正确应答数及划消粗分和得分高于药物治疗组（P0.01或P0.05），将这一差异控制后，联合治疗组4周的完成分类数、正确应答数和划消得分高于药物治疗组（P均0.05）。③联合治疗组4周时的5-HT总功率及相对功率和NE总功率高于2周时（P0.01或P0.05）；2周时γ-GABA总功率高于基线期（P0.01），与4周时相比差异无统计学意义（P0.05）；各时间点Glu总功率呈逐渐增高的趋势（P均0.01）；4周时的Ach总功率较2周时有所下降（P0.01）；4周时的兴奋抑制指数高于基线期及2周时（P均0.01）；2周时的熵值低于基线期（P0.01），与4周时相比差异无统计学意义（P0.05）。药物治疗组中，4周时的NE相对功率高于基线期及2周时（P均0.01）；2周时γ-GABA相对功率高于基线期（P0.05），与4周时相差异比无统计学意义（P0.05）；4周时的兴奋抑制指数高于基线期及2周时（P均0.05）。联合治疗组与药物治疗组相比，基线期联合治疗组的γ-GABA总功率低于药物治疗组（P0.05）；4周时联合治疗组5-HT总功率及相对功率和NE总功率高于药物治疗组（P0.05或P0.01）；2周时及4周时联合治疗组γ-GABA总功率及相对功率、Glu总功率及相对功率高于药物治疗组（P均0.05），但熵值低于药物治疗组（P0.01）。④联合治疗组出现口干5（15.6%）人、恶心4（12.6%）人；药物治疗组出现口干3（9%）人、恶心6（18.2%）人。两组不良反应差异无统计学意义（P0.05）。 结论：①超低频经颅磁刺激联合帕罗西汀治疗首发抑郁症患者的早期疗效高于单独应用帕罗西汀。②超低频经颅磁刺激联合帕罗西汀可早期改善首发抑郁症患者的部分认知功能。③超低频经颅磁刺激联合帕罗西汀可提高5-HT相对功率、NE总功率、Glu与GABA的总功率和相对功率。
[Abstract]:Objective: To analyze the effect of super low frequency transcranial magnetic stimulation combined with pastatin in the treatment of patients with first episode of depression and its effect on cognitive function and neurotransmitter function, and to provide scientific basis for the clinical application of super low frequency transcranial magnetic stimulation. Methods: 7 patients with primary depression were selected from the outpatient department and inpatient department of mental health center in Sichuan Province. 0 cases. The subjects were divided into 35 patients with combined treatment group and drug treatment group using the method of complete digital random grouping, and two groups of subjects were treated for 4 weeks. Observations. For 2 weeks prior to treatment, 1/ day ultra low frequency transcranial magnetic stimulation was applied to the combined treatment group (continuous 14 days), the stimulation intensity was 500GS each time, the loop coil was placed on the top of the head to apply a magnetic field to the full brain, the coil diameter was 25cm, the distance from the scalp 1.5-2.0cm, and the treatment with paroxine (20-40mg/ Day). The drug treatment group received false stimulation and carnitine (20-40mg/ day) Treatment. After two weeks, two groups of subjects were treated only with Augustine. Treatment. The adjustment of two groups of drug dosages is based on clinical symptoms and serious adverse reactions. To a lesser extent. Apprenaline 0,4-0,8 for insomnia at night mg. Baseline period, 2 weeks, all subjects were instructed to complete Hamilton depression for depression (HAMD) 24 items, Wisconsin Card Sorting Test (WCST), cancelation test (CT), brain fluctuation map. To observe whether adverse reactions occurred during the study, such as dizziness, headache, ear, Construction of database and statistics using SPSS19. 0 Results: The total number of patients who completed the entire study was 3 in the combination therapy group and the drug treatment group. 2 and 34 cases. The effective rate of the combined treatment group was 42.6% (13/ 32) higher than that of the drug treatment group (17. 6% (6/ 34).. 039) In the treatment of 4 weeks, the effective rate of the combined treatment group was 71.9% (23/ 32) higher than that of the drug treatment group (38. 2% (13/ 34) (P = 7. 542, P = 0 (006) The effective rate of the combined treatment group at 4 weeks was higher than 2 weeks (P = 0. 012), and the effective rate was not statistically significant compared with 2 weeks at 4 weeks (P = 0. 05). The number of complete and correct responses in WCST at 2 weeks were higher than baseline (P0.05 or P0.01), and the difference was not statistically significant (P <0.05) compared with the 4th week (P <0.05). 0. 01) The number of complete and correct responses in WCST during 2 weeks were not statistically significant compared to baseline (P <0.05), but were lower than 4 weeks (P <0.05). The score was higher than baseline (P0.05), and the difference was not statistically significant compared with 4 weeks (P 0. 05) At 2 weeks, the number of complete classification, correct response number and score of WCST in the combined treatment group were higher than that of the drug treatment group (P0.01 or P0.05). After the difference was controlled, the number of complete classification, correct response number and score score of the combined treatment group were higher than that of the drug treatment group (P <0.05). 0. 05) The total power of 5-HT and the relative power and NE total power at 4 weeks in the combined treatment group were higher than those in the baseline period (P0.01 or P0.05). 0. 05) The total power of Glu in each time point was gradually increased (P <0.01); the total power of ACh at 4 weeks decreased (P <0.01); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P <0.01); the entropy value at 2 weeks was lower than baseline period (P 0. 01), no statistically significant difference compared with 4 weeks (P The relative power of NE during 4 weeks was higher than baseline and 2 weeks (P <0.01). Compared with baseline period (P0.05), the relative power of NE-GABA was higher than that of baseline (P 0. 05); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P The total power and relative power and NE total power of the combined treatment group at 4 weeks were higher than that of the drug treatment group (P0.05 or P The total power and relative power, Glu total power and relative power of the combined treatment group were higher than that of the drug treatment group (P <0.05) at 2 weeks and 4 weeks, but the entropy value was lower than that of the drug treatment group (P 0. 01). 5 (15. 6%) of patients in the combined treatment group, 4 (12.6%) nausea, 3 (9%) in the drug treatment group, 6 (18) nausea, 2%) There was no significant difference between the two groups (P Conclusion: The patients with first-episode depression treated with superlow frequency transcranial magnetic stimulation combined with pastatin were more effective than those in the early stage of depression. Early improvement of first-onset depression due to cranial magnetic stimulation combined with hyperlow-frequency transcranial magnetic stimulation Part of the cognitive function of the patients: the combination of super low frequency and cranial magnetic stimulation can improve the relative power of 5-HT, the total power of NE, Glu and GABA.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4
本文编号：2290008
[Abstract]:Objective: To analyze the effect of super low frequency transcranial magnetic stimulation combined with pastatin in the treatment of patients with first episode of depression and its effect on cognitive function and neurotransmitter function, and to provide scientific basis for the clinical application of super low frequency transcranial magnetic stimulation. Methods: 7 patients with primary depression were selected from the outpatient department and inpatient department of mental health center in Sichuan Province. 0 cases. The subjects were divided into 35 patients with combined treatment group and drug treatment group using the method of complete digital random grouping, and two groups of subjects were treated for 4 weeks. Observations. For 2 weeks prior to treatment, 1/ day ultra low frequency transcranial magnetic stimulation was applied to the combined treatment group (continuous 14 days), the stimulation intensity was 500GS each time, the loop coil was placed on the top of the head to apply a magnetic field to the full brain, the coil diameter was 25cm, the distance from the scalp 1.5-2.0cm, and the treatment with paroxine (20-40mg/ Day). The drug treatment group received false stimulation and carnitine (20-40mg/ day) Treatment. After two weeks, two groups of subjects were treated only with Augustine. Treatment. The adjustment of two groups of drug dosages is based on clinical symptoms and serious adverse reactions. To a lesser extent. Apprenaline 0,4-0,8 for insomnia at night mg. Baseline period, 2 weeks, all subjects were instructed to complete Hamilton depression for depression (HAMD) 24 items, Wisconsin Card Sorting Test (WCST), cancelation test (CT), brain fluctuation map. To observe whether adverse reactions occurred during the study, such as dizziness, headache, ear, Construction of database and statistics using SPSS19. 0 Results: The total number of patients who completed the entire study was 3 in the combination therapy group and the drug treatment group. 2 and 34 cases. The effective rate of the combined treatment group was 42.6% (13/ 32) higher than that of the drug treatment group (17. 6% (6/ 34).. 039) In the treatment of 4 weeks, the effective rate of the combined treatment group was 71.9% (23/ 32) higher than that of the drug treatment group (38. 2% (13/ 34) (P = 7. 542, P = 0 (006) The effective rate of the combined treatment group at 4 weeks was higher than 2 weeks (P = 0. 012), and the effective rate was not statistically significant compared with 2 weeks at 4 weeks (P = 0. 05). The number of complete and correct responses in WCST at 2 weeks were higher than baseline (P0.05 or P0.01), and the difference was not statistically significant (P <0.05) compared with the 4th week (P <0.05). 0. 01) The number of complete and correct responses in WCST during 2 weeks were not statistically significant compared to baseline (P <0.05), but were lower than 4 weeks (P <0.05). The score was higher than baseline (P0.05), and the difference was not statistically significant compared with 4 weeks (P 0. 05) At 2 weeks, the number of complete classification, correct response number and score of WCST in the combined treatment group were higher than that of the drug treatment group (P0.01 or P0.05). After the difference was controlled, the number of complete classification, correct response number and score score of the combined treatment group were higher than that of the drug treatment group (P <0.05). 0. 05) The total power of 5-HT and the relative power and NE total power at 4 weeks in the combined treatment group were higher than those in the baseline period (P0.01 or P0.05). 0. 05) The total power of Glu in each time point was gradually increased (P <0.01); the total power of ACh at 4 weeks decreased (P <0.01); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P <0.01); the entropy value at 2 weeks was lower than baseline period (P 0. 01), no statistically significant difference compared with 4 weeks (P The relative power of NE during 4 weeks was higher than baseline and 2 weeks (P <0.01). Compared with baseline period (P0.05), the relative power of NE-GABA was higher than that of baseline (P 0. 05); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P The total power and relative power and NE total power of the combined treatment group at 4 weeks were higher than that of the drug treatment group (P0.05 or P The total power and relative power, Glu total power and relative power of the combined treatment group were higher than that of the drug treatment group (P <0.05) at 2 weeks and 4 weeks, but the entropy value was lower than that of the drug treatment group (P 0. 01). 5 (15. 6%) of patients in the combined treatment group, 4 (12.6%) nausea, 3 (9%) in the drug treatment group, 6 (18) nausea, 2%) There was no significant difference between the two groups (P Conclusion: The patients with first-episode depression treated with superlow frequency transcranial magnetic stimulation combined with pastatin were more effective than those in the early stage of depression. Early improvement of first-onset depression due to cranial magnetic stimulation combined with hyperlow-frequency transcranial magnetic stimulation Part of the cognitive function of the patients: the combination of super low frequency and cranial magnetic stimulation can improve the relative power of 5-HT, the total power of NE, Glu and GABA.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4
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