CAJ | 학술논문

背景:高频( 15～ 25 Hz)重复经颅磁刺激( repetitive transcranial magnetic stimulation,rTMS)技术能更多地兴奋大脑皮层水平走向连接神经元,导致皮层局部代谢浓度增高,与电休克疗法( electro convulsive therapy, ECT)相比较,其安全性高,副作用少. 目的:评价 rTMS对重型抑郁症患者的治疗作用,探讨其治疗机制. 设计:以诊断为依据的病例对照研究. 地点和对象:36例来自于川北医学院附属医院的重型耐药性抑郁症患者,采用随机数字法将其分为 rTMS治疗组和 ECT组,每组 18例患者. 方法:两组患者分别于治疗前及 2周后采用汉密尔顿抑郁量表( Hamilton depression,HAMD)进行评定,同时测定 rTMS治疗前后血浆 5-羟色胺和去甲肾上腺素( norepinephrine,NE)含量变化. 主要观察指标:两组治疗前后 HAMD评分; rTMS组治疗前后血浆 5-羟色胺及 NE含量;两组患者治疗后产生的副作用. 结果:rTMS治疗组和 ECT组有效率分别为 89%( 16/18)、 83%( 15/18),差异无显著性意义(χ 2=0.812,P >0.05);两组患者治疗后 HAMD评分分别为 11.6± 3.0、 12.1± 2.9,均较治疗前评分( 27.8± 3.2、 26.7± 2.8)明显下降,差异有显著性意义( t=2.891～ 3.279,P< 0.05～ 0.005). rTMS治疗组治疗后血浆 5-羟色胺含量 [(8.42± 1.65) ng/L]较治疗前 [(2.45± 0.86) ng/L]显著增加( t=2.295,P< 0.05). ECT组患者有明显的头昏、乏力、记忆力减退等副作用,而 rTMS治疗组除个别患者有短暂轻微头痛外,未见明显不适. 结论:rTMS与 ECT对治疗重型耐药性抑郁症均有较好的疗效,但 rTMS安全、副作用少; rTMS治疗抑郁症的机制可能与其促进 5-羟色胺释放有关.
배경:고빈( 15～ 25 Hz)중복경로자자격( repetitive transcranial magnetic stimulation,rTMS)기술능경다지흥강대뇌피층수평주향련접신경원,도치피층국부대사농도증고,여전휴극요법( electro convulsive therapy, ECT)상비교,기안전성고,부작용소. 목적:평개 rTMS대중형억욱증환자적치료작용,탐토기치료궤제. 설계:이진단위의거적병례대조연구. 지점화대상:36례래자우천북의학원부속의원적중형내약성억욱증환자,채용수궤수자법장기분위 rTMS치료조화 ECT조,매조 18례환자. 방법:량조환자분별우치료전급 2주후채용한밀이돈억욱량표( Hamilton depression,HAMD)진행평정,동시측정 rTMS치료전후혈장 5-간색알화거갑신상선소( norepinephrine,NE)함량변화. 주요관찰지표:량조치료전후 HAMD평분; rTMS조치료전후혈장 5-간색알급 NE함량;량조환자치료후산생적부작용. 결과:rTMS치료조화 ECT조유효솔분별위 89%( 16/18)、 83%( 15/18),차이무현저성의의(χ 2=0.812,P >0.05);량조환자치료후 HAMD평분분별위 11.6± 3.0、 12.1± 2.9,균교치료전평분( 27.8± 3.2、 26.7± 2.8)명현하강,차이유현저성의의( t=2.891～ 3.279,P< 0.05～ 0.005). rTMS치료조치료후혈장 5-간색알함량 [(8.42± 1.65) ng/L]교치료전 [(2.45± 0.86) ng/L]현저증가( t=2.295,P< 0.05). ECT조환자유명현적두혼、핍력、기억력감퇴등부작용,이 rTMS치료조제개별환자유단잠경미두통외,미견명현불괄. 결론:rTMS여 ECT대치료중형내약성억욱증균유교호적료효,단 rTMS안전、부작용소; rTMS치료억욱증적궤제가능여기촉진 5-간색알석방유관.
BACKGROUND:High-frequency repetitive transcranial magnetic stimulation(rTMS) has been reported to produce antidepressant effects for exciting more horizontally connected neurons in cerebral cortex and subsequently increased focal metabolite,which are preferable to electro convulsive therapy(ECT) when taking into account safety and side-effect. OBJECTIVE:To assess the therapeutic effect of rTMS in treating major depression,and to explore its therapeutic mechanism. DESIGN:A clinical case control study. SETTING,PARTICIPANTS and INTERVENTION:Thirty-six patients,with major depression from affiliated hospital of Chunbei Medical College were divided into rTMS group(n=18) and ECT group(n=18) according to Randomized Drawing lots.Patients of two groups were assessed with Hamilton depression(HAMD) rating scale before and two weeks after treatment,meanwhile levels of plasm 5-HT and norepinephrine(NE) were also determined. MAIN OUTCOME MEASURES:Scores for HAMD,levels of 5-HT and NE,and side effects resulted from treatment were observed. RESULTS:Efficacy was 89%( 16/18) in rTMS group,remarkably different from that in ECT group( 83% ,15/18) (χ 2=0.812,P >0.05).Scores of HAMD were 11.6± 3.0 and 12.1± 2.9 respectively in rTMS and ECT group after treatment,and both were statistically lowered than those before treatment(27.8± 3.2 and 26.7± 2.8,t=2.891- 3.279,P< 0.05- 0.005). Plasma 5-HT increased from(2.45± 0.86)ng/L to(8.42± 1.65) ng/L due to rTMS treatment,and differences were remarkable( t=2.295, P< 0.05) . Side effects were observed in patients receiving ECT treatment,including obvious dizziness,fatigue,impaired memory and so on,while obvious discomfort could not observed in rTMS group,except individually transient mild headache. CONCLUSION:rTMS and ECT are promising on treating major medicine-resistant depression,but the former proved to be preferable with respect to safety and side effect.The therapeutic mechanism was hypothetically correlated with 5-HT releasing.