重复经颅磁刺激治疗食管癌相关性抑郁临床疗效及功能磁共振成像评估

发布时间：2019-01-28 12:46

【摘要】：目的:观察重复经颅磁刺激(repetitive Transcranial Magnetic Stimulation,rTMS)对食管癌相关性抑郁患者的临床治疗效果,并采用功能磁共振成像(Functional Magnetic Resonance Imaging,fMRI)的方法观察rTMS治疗前后患者抑郁相关脑区的神经影像学变化,对比单次rTMS治疗与多次rTMS治疗对食管癌相关性抑郁患者的临床疗效,并探讨rTMS对患者的康复治疗机制。方法:收集2015年11月-2016年12月在南充市中心医院住院的食管癌患者,选取符合本研究入组要求的食管癌相关性抑郁患者22例,分为单次rTMS治疗组(s-rTMS组,12例)和多次rTMS治疗组(m-rTMS组,10例)两个实验组。s-rTMS组只接受1次rTMS治疗(刺激频率:10Hz,刺激部位:左侧背外侧前额叶皮层,刺激强度:110%静息运动阈值);m-r TMS组给予5次rTMS治疗(m-rTMS组的rTMS治疗参数与s-rTMS组的治疗参数完全相同),每天1次rTMS治疗,连续5天。s-rTMS组和m-rTMS组两组患者在接受rTMS治疗前后均行汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)、抑郁自评量表(Self-Rating Depression Scale,SDS)评分及进行静息态fMRI图像采集。对比s-rTMS组和m-rTMS组两组患者在rTMS治疗前后HAMD、SDS评分、低频振幅(Amplitude of Low Frequency Fluctuation,ALFF)的变化,对比两组患者在rTMS治疗后上述指标的差异;同时计算s-rTMS组和m-rTMS组两组实验组rTMS治疗前后HAMD、SDS评分改变量与ALFF改变量的相关性。结果:1、rTMS治疗前,s-rTMS组和m-rTMS组两组患者的基本临床资料、HAMD量表、SDS量表评分均无统计学差异(P0.05);s-rTMS组和m-rTMS组两组患者rTMS治疗前后HAMD量表、SDS量表评分均有显著改变(P0.05);s-rTMS组和m-r TMS组rTMS治疗后组间HAMD量表、SDS量表评分改变量有统计学差异(P0.05)。2、rTMS治疗前,srTMS组和m-rTMS组两组患者的ALFF无统计学差异(P0.05);两组患者rTMS治疗前后ALFF值均发生明显变化(P0.05):s-rTMS组患者双侧额叶、双侧前扣带回、右侧海马、右侧丘脑的ALFF显著增高,左侧丘脑的ALFF显著降低;m-r TMS组患者双侧额叶、双侧前扣带回、右侧海马、右侧苍白球的ALFF显著增高,双侧壳核、双侧丘脑的ALFF显著降低;此外,与s-rTMS组相比,m-rTMS组患者在rTMS治疗后双侧额中回、双侧前扣带回、右侧尾状核头的ALFF增加更显著。3、s-rTMS组患者rTMS治疗前后HAMD量表评分改变量与前扣带回ALFF改变量呈显著负相关(R=-0.7,P=0.011);m-rTMS组患者rTMS治疗前后HAMD量表评分改变量与前扣带回、海马ALFF改变量均呈显著负相关(R=-0.84,P=0.0023;R=-0.87,P=0.001)。结论:高频rTMS对食管癌相关性抑郁有良好的治疗效果,且多次rTMS治疗较单次rTMS治疗临床疗效更好,这可能与rTMS能影响大脑内相关区域的神经生理活动有关。ALFF是一种新的研究脑功能成像的方法,抑郁相关脑区的ALFF分析可以作为评价rTMS抗抑郁治疗效果的影像学指标之一。
[Abstract]:Objective: to observe the clinical effect of repeated transcranial magnetic stimulation (repetitive Transcranial Magnetic Stimulation,rTMS) in patients with esophageal cancer associated depression and to use functional magnetic resonance imaging (Functional Magnetic Resonance Imaging,). FMRI) method to observe the neuroimaging changes of depression-related brain area before and after rTMS treatment, to compare the clinical effect of single rTMS therapy and multiple rTMS therapy on patients with esophageal cancer associated depression, and to explore the mechanism of rTMS rehabilitation therapy. Methods: a total of 22 esophageal cancer patients who were hospitalized in Nanchong Central Hospital from November 2015 to December 2016 were selected and divided into single rTMS treatment group (s-rTMS group). S-rTMS group received rTMS only once (stimulation frequency: 10 Hz, stimulation site: left dorsolateral prefrontal cortex, stimulation intensity: 110% resting exercise threshold). The m-r TMS group was treated with rTMS for 5 times (the parameters of rTMS in m-rTMS group were exactly the same as those in s-rTMS group), and rTMS was given once a day. The patients in s-rTMS group and m-rTMS group were treated with Hamilton depression scale (Hamilton Depression Scale,HAMD), self-rating depression scale (Self-Rating Depression Scale,SDS) and resting fMRI images before and after rTMS treatment for 5 consecutive days. The changes of HAMD,SDS score and low frequency amplitude (Amplitude of Low Frequency Fluctuation,ALFF (Amplitude of Low Frequency Fluctuation,ALFF) before and after rTMS treatment in s-rTMS group and m-rTMS group were compared, and the differences of the above indexes after rTMS treatment were compared between the two groups. At the same time, the correlation between the changes of HAMD,SDS score and ALFF before and after rTMS treatment in s-rTMS and m-rTMS groups was calculated. Results: 1 before rTMS treatment, there was no significant difference in the basic clinical data, HAMD scale and SDS score between s-rTMS group and m-rTMS group (P0.05); There were significant changes in HAMD scale and SDS scale before and after rTMS treatment in s-rTMS group and m-rTMS group (P0.05). There was significant difference in HAMD scale and SDS scale between s-rTMS group and m-r TMS group after rTMS treatment (P0.05). Before treatment, there was no significant difference in ALFF between srTMS group and m-rTMS group (P0.05). Before and after rTMS treatment, the ALFF values of the two groups were significantly changed (P0.05): in the s-rTMS group, the bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus, right thalamus and right thalamus significantly increased ALFF, while the left thalamus ALFF significantly decreased. In m-r TMS group, ALFF in bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus and right globus pallidus increased significantly, and ALFF in bilateral putamen and thalamus decreased significantly. In addition, compared with s-rTMS group, the ALFF of bilateral middle frontal gyrus, bilateral anterior cingulate gyrus and right caudate nucleus head increased significantly in m-rTMS group after rTMS treatment. There was a significant negative correlation between the change of HAMD scale before and after rTMS treatment and the change of ALFF in anterior cingulate gyrus in s-rTMS group (RP0. 011). In m-rTMS group, the changes of HAMD scale before and after rTMS treatment were negatively correlated with the changes of ALFF in hippocampus and anterior cingulate gyrus. Conclusion: high frequency rTMS has a good therapeutic effect on esophageal cancer associated depression, and the clinical effect of multiple rTMS is better than that of single rTMS. ALFF is a new method to study brain function imaging. ALFF analysis in depressive brain area can be used as an imaging index to evaluate the antidepressant effect of rTMS.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1;R749.4

【参考文献】

相关期刊论文 前10条

1 陈万青;郑荣寿;张思维;曾红梅;邹小农;赫捷;;2013年中国恶性肿瘤发病和死亡分析[J];中国肿瘤;2017年01期

2 邱美慧;吴彦;彭代辉;;抑郁症海马的结构及功能磁共振成像的研究进展[J];上海交通大学学报(医学版);2015年06期

3 贾爱香;李伟;张爱霞;高强;曹晓华;张克让;;抑郁障碍患者脑功能磁共振研究[J];中国医学创新;2014年12期

4 母其文;;重复经颅磁刺激及其磁共振功能成像的研究进展[J];西部医学;2014年04期

5 冯晓荣;梁立华;吴明祥;吕建勋;;抑郁症患者治疗前后的静息态fMRI比较探究[J];中国医疗前沿;2013年10期

6 李凝;宋美;王学义;;重复经颅磁刺激治疗抑郁症作用机制的研究进展[J];中国健康心理学杂志;2012年07期

7 孙军;刘含秋;孙华平;张俊海;冯晓源;郭琴;施慎逊;;首发抑郁症患者治疗前后的静息态fMRI研究[J];中国医学计算机成像杂志;2011年03期

8 张咏梅;胡斌;王朝辉;孙玲;郭中孟;郭文;谭立文;;高频及低频重复经颅磁刺激治疗抑郁症的对照研究[J];临床荟萃;2011年05期

9 张龙江;杨桂芬;祁吉;;静息态脑功能成像的研究与进展[J];国外医学(临床放射学分册);2007年01期

10 李丽;董奇;;抑郁症的脑神经结构和功能改变研究[J];中国临床心理学杂志;2006年01期

，

本文编号：2417078