CAJ | 학술논문

目的探讨低频重复经颅磁刺激(rTMS)对卒中后抑郁的远期效应及血浆5-羟色胺(5-HT)表达的影响.方法选取74例符合本研究标准的脑卒中后抑郁(PSD)患者,按随机数字表法分成对照组(35例)和治疗组(39例).最终资料完整纳入本研究患者65例,对照组31例,治疗组34例.对照组给予舍曲林及基础治疗,治疗组给予低频rTMS及基础治疗,疗程8周.分别于入组前(治疗前)和治疗8周后(治疗后),采用汉密尔顿抑郁量表(HAMD)、中国脑卒中量表(CSS)及改良Barthel指数(MBI)等指标来评定患者的临床抑郁状态、临床神经功能缺损程度及日常生活活动(ADL)能力;以高效液相色谱法检测2组患者治疗前后血浆5-HT浓度.并于12个月后追踪随访(随访时),复测上述指标,进行统计学分析比较.结果治疗后,2组患者HAMD评分和CSS评分均较治疗前明显下降(P＜0.05),MBI评分则较治疗前明显提高(P＜0.05);但2组间比较,差异无统计学意义(P＞0.05);对照组血浆5-HT浓度较治疗前明显升高(P＜0.05),但治疗组变化不明显(P＞0.05).12个月后随访时,2组患者HAMD评分和CSS评分均较治疗后进一步下降(P＜0.05),MBI评分亦进一步提高(P＜0.05);2组间比较,治疗组较对照组HAMD评分下降及MBI评分提高更为显著(P＜0.05);2组患者血浆5-HT浓度较治疗后稍高,但差异无统计学意义(P＞0.05).治疗后,对照组和治疗组脱离抑郁状态患者分别有10例(32.26％)和12例(35.29％),差异无统计学意义(x2 =0.067,P=0.796),但12个月后随访时,2组脱离抑郁状态患者分别有22例(70.97％)和31例(91.18％),组问差异有统计学意义(x2 =4.399,P=0.036).结论 rTMS治疗可以改善脑卒中后抑郁患者的远期效应,提高患者ADL能力,且其作用机制可能与血浆5-HT表达变化无关.
목적 탐토저빈중복경로자자격(rTMS)대졸중후억욱적원기효응급혈장5-간색알(5-HT)표체적영향.방법 선취74례부합본연구표준적뇌졸중후억욱(PSD)환자,안수궤수자표법분성대조조(35례)화치료조(39례).최종자료완정납입본연구환자65례,대조조31례,치료조34례.대조조급여사곡림급기출치료,치료조급여저빈rTMS급기출치료,료정8주.분별우입조전(치료전)화치료8주후(치료후),채용한밀이돈억욱량표(HAMD)、중국뇌졸중량표(CSS)급개량Barthel지수(MBI)등지표래평정환자적림상억욱상태、림상신경공능결손정도급일상생활활동(ADL)능력;이고효액상색보법검측2조환자치료전후혈장5-HT농도.병우12개월후추종수방(수방시),복측상술지표,진행통계학분석비교.결과 치료후,2조환자HAMD평분화CSS평분균교치료전명현하강(P＜0.05),MBI평분칙교치료전명현제고(P＜0.05);단2조간비교,차이무통계학의의(P＞0.05);대조조혈장5-HT농도교치료전명현승고(P＜0.05),단치료조변화불명현(P＞0.05).12개월후수방시,2조환자HAMD평분화CSS평분균교치료후진일보하강(P＜0.05),MBI평분역진일보제고(P＜0.05);2조간비교,치료조교대조조HAMD평분하강급MBI평분제고경위현저(P＜0.05);2조환자혈장5-HT농도교치료후초고,단차이무통계학의의(P＞0.05).치료후,대조조화치료조탈리억욱상태환자분별유10례(32.26％)화12례(35.29％),차이무통계학의의(x2 =0.067,P=0.796),단12개월후수방시,2조탈리억욱상태환자분별유22례(70.97％)화31례(91.18％),조문차이유통계학의의(x2 =4.399,P=0.036).결론 rTMS치료가이개선뇌졸중후억욱환자적원기효응,제고환자ADL능력,차기작용궤제가능여혈장5-HT표체변화무관.
Objective To explore any effect of low-frequency transcranial magnetic stimulation (rTMS) on post-stroke depression and the expression of plasma 5-hydroxytryptamine (5-HT).Methods Seventy-four patients suffering from post-stroke depression (PSD) were divided into a control group (31 cases) which received basic therapy and sertraline and a therapy group (34 cases) which received basic therapy and 8 weeks of low-frequency rTMS.Scores on the Hamihon depression (HAMD) scale and the Chinese stroke scale (CSS) and the modified Barthel index (MBI) were used to evaluate depression,neurological impairment,and ability in the activities of daily living (ADL) before and after the experiment.Levels of plasma 5-HT in the two groups were also detected with high performance liquid chromatography before and after the experiment.The patients were then followed up 1 year later,when these indexes were reassessed.Results After 8 weeks of treatment the HAMD and CSS scores in both groups had decreased significantly,and their MBI scores had increased significantly compared with prior to treatment,but there was no significant difference between the groups.The average plasma 5-HT concentration in the control group had increased significantly,but there was little change in the therapy group.One year later,the HAMD and CSS scores of both groups had declined significantly and their MBI scores had increased further.The average decrease in HAMD scores and rise in MBI scores in the therapy group was significantly greaterthan in the control group.There had been no significant change in plasma 5-HT concentration in either group.After 8 weeks of treatment,10 controls and 12 therapy group patients had escaped depression.A year later the numbers were 22 and 31 cases,a significant inter-group difference.Conclusion Low-frequency rTMS can help alleviate post-stroke depression,and enhance ADL ability.The mechanism might have nothing to do with any change in 5-HT expression.