上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2011年
1期
17-24
,共8页
张选红%王立伟%王继军%刘强%樊晔
張選紅%王立偉%王繼軍%劉彊%樊曄
장선홍%왕립위%왕계군%류강%번엽
难治性抑郁症%重复经颅磁刺激%疗效%认知功能
難治性抑鬱癥%重複經顱磁刺激%療效%認知功能
난치성억욱증%중복경로자자격%료효%인지공능
Treatment resistant depression%Repetitive transcranial magnetic stimulation(rTMS)%Efficacy%Cognitive
背景 左侧前额叶皮层的高频重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)对抑郁症治疗有效,但是作为难治性抑郁症除约物外的辅助治疗,rTMS的疗程和对认知症状的作用尚不清楚.假设 用抗抑郁药物治疗的难治性抑郁症患者接受4周的左侧前额叶皮层的高频,rTMS,其临床疗效和认知功能优于接受伪刺激的患者.方法 用选择性5-羟色胺再摄取抑制剂或5-羟色胺与去甲肾上腺素再摄取抑制剂的30例难治性抑郁症[经过2种抗抑郁剂足量、足疗程治疗(足昔是指最大剂量的2/3以上,足疗程指药物的治疗时间≥6周),抑郁症状改善未达有效标准(17项汉密尔顿抑郁量表减分率≤50%)]患者,随机被分为真刺激组(n=15)和伪刺激组(n=15),接受每周5次连续4周的rTMS治疗.治疗开始及结束时采用盲法以17项汉密尔顿抑郁量表(17-item Hamilton Depression Rating Scale,HAMD)、蒙哥马利抑郁量表(Montgomery-Asberg Depression Rating Scale,MADRS)、临床总体评定量表严重程度分量表(Severity of illness measure from the Clinical Global Impression,CGI-S)评定抑郁症状;以韦氏成人智力测验(Wechsler Adult Intelligence Scale,WAIS)、韦氏成人记忆测验(Wechsler Memory Scale for adults,WMS)、威斯康星卡片分类测验(Wisconsin card Sorting Test,WCST)评定认知功能.结果 两组各完成14例.治疗2周两组HAMD总分的差异没有统计学意义,但治疗4周时平均HAMD总分减分率在真刺激组(49%,标准差=19%)大于伪刺激组(29%,标准差=25%),平均差值为20%[95% CI:3%-37%;t26=2.42;P=0.023],两组MADRS总分减分率差异也有统计学意义[真刺激组:47%(23%),伪刺激组:16%(40%),Mann-Whitney Z=2.62,P=0.009],两组CGI严重程度评分减分率差异无统计学意义.治疗后两组智商、记忆力商数以及WCST结果均无明显改变.结论 4周重复经颅磁刺激治疗是难治性抑郁症的一种有效辅助治疗方法,但对认知功能改善作用不明显.
揹景 左側前額葉皮層的高頻重複經顱磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)對抑鬱癥治療有效,但是作為難治性抑鬱癥除約物外的輔助治療,rTMS的療程和對認知癥狀的作用尚不清楚.假設 用抗抑鬱藥物治療的難治性抑鬱癥患者接受4週的左側前額葉皮層的高頻,rTMS,其臨床療效和認知功能優于接受偽刺激的患者.方法 用選擇性5-羥色胺再攝取抑製劑或5-羥色胺與去甲腎上腺素再攝取抑製劑的30例難治性抑鬱癥[經過2種抗抑鬱劑足量、足療程治療(足昔是指最大劑量的2/3以上,足療程指藥物的治療時間≥6週),抑鬱癥狀改善未達有效標準(17項漢密爾頓抑鬱量錶減分率≤50%)]患者,隨機被分為真刺激組(n=15)和偽刺激組(n=15),接受每週5次連續4週的rTMS治療.治療開始及結束時採用盲法以17項漢密爾頓抑鬱量錶(17-item Hamilton Depression Rating Scale,HAMD)、矇哥馬利抑鬱量錶(Montgomery-Asberg Depression Rating Scale,MADRS)、臨床總體評定量錶嚴重程度分量錶(Severity of illness measure from the Clinical Global Impression,CGI-S)評定抑鬱癥狀;以韋氏成人智力測驗(Wechsler Adult Intelligence Scale,WAIS)、韋氏成人記憶測驗(Wechsler Memory Scale for adults,WMS)、威斯康星卡片分類測驗(Wisconsin card Sorting Test,WCST)評定認知功能.結果 兩組各完成14例.治療2週兩組HAMD總分的差異沒有統計學意義,但治療4週時平均HAMD總分減分率在真刺激組(49%,標準差=19%)大于偽刺激組(29%,標準差=25%),平均差值為20%[95% CI:3%-37%;t26=2.42;P=0.023],兩組MADRS總分減分率差異也有統計學意義[真刺激組:47%(23%),偽刺激組:16%(40%),Mann-Whitney Z=2.62,P=0.009],兩組CGI嚴重程度評分減分率差異無統計學意義.治療後兩組智商、記憶力商數以及WCST結果均無明顯改變.結論 4週重複經顱磁刺激治療是難治性抑鬱癥的一種有效輔助治療方法,但對認知功能改善作用不明顯.
배경 좌측전액협피층적고빈중복경로자자격(Repetitive Transcranial Magnetic Stimulation,rTMS)대억욱증치료유효,단시작위난치성억욱증제약물외적보조치료,rTMS적료정화대인지증상적작용상불청초.가설 용항억욱약물치료적난치성억욱증환자접수4주적좌측전액협피층적고빈,rTMS,기림상료효화인지공능우우접수위자격적환자.방법 용선택성5-간색알재섭취억제제혹5-간색알여거갑신상선소재섭취억제제적30례난치성억욱증[경과2충항억욱제족량、족료정치료(족석시지최대제량적2/3이상,족료정지약물적치료시간≥6주),억욱증상개선미체유효표준(17항한밀이돈억욱량표감분솔≤50%)]환자,수궤피분위진자격조(n=15)화위자격조(n=15),접수매주5차련속4주적rTMS치료.치료개시급결속시채용맹법이17항한밀이돈억욱량표(17-item Hamilton Depression Rating Scale,HAMD)、몽가마리억욱량표(Montgomery-Asberg Depression Rating Scale,MADRS)、림상총체평정량표엄중정도분량표(Severity of illness measure from the Clinical Global Impression,CGI-S)평정억욱증상;이위씨성인지력측험(Wechsler Adult Intelligence Scale,WAIS)、위씨성인기억측험(Wechsler Memory Scale for adults,WMS)、위사강성잡편분류측험(Wisconsin card Sorting Test,WCST)평정인지공능.결과 량조각완성14례.치료2주량조HAMD총분적차이몰유통계학의의,단치료4주시평균HAMD총분감분솔재진자격조(49%,표준차=19%)대우위자격조(29%,표준차=25%),평균차치위20%[95% CI:3%-37%;t26=2.42;P=0.023],량조MADRS총분감분솔차이야유통계학의의[진자격조:47%(23%),위자격조:16%(40%),Mann-Whitney Z=2.62,P=0.009],량조CGI엄중정도평분감분솔차이무통계학의의.치료후량조지상、기억력상수이급WCST결과균무명현개변.결론 4주중복경로자자격치료시난치성억욱증적일충유효보조치료방법,단대인지공능개선작용불명현.
Background:High-frequency repetitive transcranial magnetic stimulation(rTMS)to the left prefrontal cortex is a promising antidepressant treatment but the appropriate duration of treatment and its effect on cognitive symptoms in treatment resistant patients is uncertain.Hypothesis: Patients with treatment resistant depression on standard antidepressant medication who receive four weeks of adjunctive treatment with high-frequency rTMS to the left prefrontal cortex will have better clinical outcomes and better cognitive functioning than those who receive sham rTMS treatments. Methods: Thirty patients with treatment resistant depression(defined as failure to respond to two or more antidepressants of different classes administered for at least 6 weeks at or above two-thirds of the recommended maximum dose)receiving selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors were randomly assigned to receive adjunctive treatment with either real rTMS(n=15)or sham rTMS(n=15)5 times a week for 4 consecutive weeks.Blinded pre-post evaluations were conducted using the 17-item Hamilton Depression Rating Scale(HAMD),the Montgomery-Asberg Depression Rating Scale(MADRS),the severity of illness measure from the Clinical Global Impression rating scale(CGI-S),the Wechsler Adult Intelligence Scale(WAIS),the Wechsler Memory Scale(WMS),and the Wisconsin Card Sorting Test(WCST).Results:14 subjects from each group completed the study.There was no significant diffefence in the HAMD total scores between the two groups after 2 weeks of treatment but after 4 weeks of treatment the mean percentage drop in the HAMD total score was significantly greater in the real rTMS group(49%,SD=19%)than in the sham rTMS group(29%,SD=25%),with a mean difference of 20%[95%Cl=3%-37%;t(26)=2.42;P=0.023].At 4 weeks the mean(SD)reduction in the MADRS total score was also greater in the real rTMS group[47%(23%)vs 16% (40%),Mann-Whitney Z=2.62,P=0.009],but there was no significant difference in the reduction of CGI-S scores between the two groups.Neither of the groups had significant pre-post changes in intelligence, memory or executive functioning. Conclusion: Repetitive transcranial magnetic stimulation is an effective adjunctive treatment for the affective symptoms of treatment resistant depression if administered for at Ieast 4 weeks,but it has no apparent effect on cognitive functioning.
