CAJ | 학술논문

目的：探讨低频重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）联合度洛西汀治疗抑郁障碍的临床疗效和安全性。方法将69例抑郁障碍患者随机分为研究组（35例）和对照组（34例），研究组给予6周度洛西汀联合1 Hz rTMS治疗，rTMS作用于右侧前额叶背外侧皮质区域，对照组给予6周度洛西汀联合伪rTMS治疗。两组分别于治疗前和治疗2、4、6周采用汉密尔顿抑郁量表（Hamilton depression rating scale-24，HAMD-24）评估抑郁症状，并按量表减分情况划分疗效等级；治疗2、4、6周采用治疗时出现的症状量表（treatment emergent symptom scale，TESS）评定不良反应。结果两组各脱落2例患者。HAMD评分经重复测量方差分析，时间主效应（P<0.001）、分组主效应（P=0.029）及时间与分组交互效应（P<0.001）均有统计学意义。疗效评估表明，治疗2、4、6周时研究组的临床疗效均优于对照组（P<0.001）。对照组1例患者因不能耐受胃肠道不良反应而退组，两组其他不良反应均较轻微，未出现严重不良反应。结论1 Hz rTMS联合度洛西汀改善抑郁症状作用显著，疗效优于单一用药，且较为安全，值得临床推广应用。
목적：탐토저빈중복경로자자격（repetitive transcranial magnetic stimulation，rTMS）연합도락서정치료억욱장애적림상료효화안전성。방법장69례억욱장애환자수궤분위연구조（35례）화대조조（34례），연구조급여6주도락서정연합1 Hz rTMS치료，rTMS작용우우측전액협배외측피질구역，대조조급여6주도락서정연합위rTMS치료。량조분별우치료전화치료2、4、6주채용한밀이돈억욱량표（Hamilton depression rating scale-24，HAMD-24）평고억욱증상，병안량표감분정황화분료효등급；치료2、4、6주채용치료시출현적증상량표（treatment emergent symptom scale，TESS）평정불량반응。결과량조각탈락2례환자。HAMD평분경중복측량방차분석，시간주효응（P<0.001）、분조주효응（P=0.029）급시간여분조교호효응（P<0.001）균유통계학의의。료효평고표명，치료2、4、6주시연구조적림상료효균우우대조조（P<0.001）。대조조1례환자인불능내수위장도불량반응이퇴조，량조기타불량반응균교경미，미출현엄중불량반응。결론1 Hz rTMS연합도락서정개선억욱증상작용현저，료효우우단일용약，차교위안전，치득림상추엄응용。
Objective To investigate the clinical efficacy and safety of repetitive transcranial magnetic stimulation combined with duloxetine in treatment of depression. Methods Sixty-nine cases of depression were randomly divided in?to study group (n=35 patients) and control group (n=34 patients). The study group received duloxetine combined with 1Hz rTMS treatment on the right dorsolateral prefrontal cortex area for 6 weeks whereas the control group received duloxetine combined with pseudo-rTMS treatment for 6 weeks. The Hamilton Depression Rating Scale (HAMD-24) and Treatment Emergent Symptom Scale (TESS) were used to assess the clinical efficacy and the adverse reactions before, 2, 4 and 6 weeks after the treatment, respectively. Results Four patients (two from each group) dropped out of the study. The main effects of time (P<0.001) and groups (P=0.029) were significant and so was the interactive effect of time and group (P<0.001). The clinical curative effect of the study group were significantly better compared with the control group at the 2, 4, 6 weeks following treatment (P<0.001). The adverse reactions were mild in these two groups. Conclusions The combi?nation of 1 Hz rTMS with duloxetine is superior to either medication alone for the treatment depression.