本文選題：負(fù)性認(rèn)知偏向 + 重復(fù)經(jīng)顱磁刺激　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景抑郁癥是一種嚴(yán)重影響人類(lèi)心身健康的精神疾病之一,它的發(fā)病機(jī)制尚不十分明確,可能與神經(jīng)內(nèi)分泌、生物化學(xué)、遺傳、認(rèn)知、心理社會(huì)因素等相關(guān)。認(rèn)知因素作為其起病的原因之一,目前取得的共識(shí)是抑郁癥患者存在負(fù)性認(rèn)知偏向。重復(fù)經(jīng)顱磁刺激(repetitive transcranial magnetic stimulation,rTMS)作為一種物理療法,那么它對(duì)抑郁癥患者的療效和負(fù)性認(rèn)知偏向的影響,值得探討。目的探討rTMS治療抑郁癥患者的療效及對(duì)抑郁癥核心治療靶點(diǎn)即負(fù)性認(rèn)知偏向的影響。方法采用病例對(duì)照研究的方法,將71例首發(fā)抑郁癥患者隨機(jī)分為兩組,研究組(36例)服用SNRIs類(lèi)抗抑郁藥物(鹽酸文拉法辛緩釋片)聯(lián)合rTMS治療。對(duì)照組(35例)服用SNRIs類(lèi)抗抑郁藥物(鹽酸文拉法辛緩釋片)聯(lián)合rTMS偽刺激治療。研究組選擇左側(cè)前額葉背外側(cè)皮質(zhì)為治療部位,按照國(guó)際腦電圖標(biāo)準(zhǔn)電極10/20放置法,選取F3點(diǎn),治療時(shí)線(xiàn)圈中心置于左前額葉背外側(cè)皮質(zhì)對(duì)應(yīng)的腦區(qū)相切,刺激頻率10HZ,刺激強(qiáng)度100%MT,每次治療20分鐘。對(duì)照組接受rTMS偽刺激,刺激線(xiàn)圈放置與頭皮呈90度,其余參數(shù)與研究組相一致。在患者入院第2天行第1次治療,每周治療5天,治療5次,中斷2天,連續(xù)治療4周,共計(jì)20次。采用漢密爾頓抑郁量表(HAMD)評(píng)估抑郁癥患者臨床癥狀,以HAMD8分為痊愈,HAMD減分率≥50%為顯效。以負(fù)性認(rèn)知加工偏向問(wèn)卷、視覺(jué)搜索范式實(shí)驗(yàn)反應(yīng)時(shí)作為抑郁癥患者負(fù)性認(rèn)知偏向評(píng)估指標(biāo),并與正常人群(30名)對(duì)比。以治療時(shí)出現(xiàn)的癥狀量表(TESS)評(píng)估患者的不良反應(yīng)。對(duì)比研究組與對(duì)照組的療效、安全性、負(fù)性認(rèn)知偏向的變化。以SPSS18.0統(tǒng)計(jì)軟件,運(yùn)用獨(dú)立樣本t檢驗(yàn)、卡方檢驗(yàn)、方差分析等對(duì)資料進(jìn)行統(tǒng)計(jì)分析,以P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果1.研究組、對(duì)照組、正常人群組在年齡、性別、文化程度的基本資料方面匹配,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。研究組與對(duì)照組在病程和藥物劑量方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2.研究組與對(duì)照組在治療前HAMD評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.424,P0.05)。在治療2周末時(shí),研究組與對(duì)照組HAMD評(píng)分相比有統(tǒng)計(jì)學(xué)差異(t=3.085,P0.05),在治療4周末時(shí),研究組與對(duì)照組HAMD評(píng)分相比有有統(tǒng)計(jì)學(xué)意義(t=4.919,P0.05)。治療2周末時(shí),研究組和對(duì)照組的HAMD評(píng)分與治療前的評(píng)分差值相比具有統(tǒng)計(jì)學(xué)意義(t=3.451,P0.05)。3.治療2周末,研究組顯效率為66.67%(24/36),對(duì)照組顯效率為40%(14/35),兩組顯效率相比有統(tǒng)計(jì)學(xué)差異(c2=5.073,P0.05)。研究組治愈率為38.88%(14/36),對(duì)照組治愈率為28.57%(10/35),兩組治愈率相比無(wú)統(tǒng)計(jì)學(xué)差異(c2=0.844,P0.05);治療4周末,研究組顯效率91.66%(33/36),對(duì)照組為57.14%(20/35),兩組在顯效率上有明顯統(tǒng)計(jì)學(xué)差異,(c2=5.844,P0.05)。研究組治愈率83.33%(30/36),對(duì)照組治愈率57.14%(20/35),兩組在治愈率上有統(tǒng)計(jì)學(xué)意義(c2=5.844,P0.05)。4.參與本實(shí)驗(yàn)的患者未因嚴(yán)重不良反應(yīng)脫離研究。研究組與對(duì)照組不良反應(yīng)發(fā)生率,經(jīng)卡方檢驗(yàn),結(jié)果無(wú)統(tǒng)計(jì)學(xué)差異(c2=0.097,P0.05)。兩組聯(lián)用苯二氮卓類(lèi)等鎮(zhèn)靜催眠藥物比例,經(jīng)卡方檢驗(yàn),無(wú)統(tǒng)計(jì)學(xué)差異(c2=0.339,P0.05)。5.研究組與對(duì)照組在入院時(shí)及4周末時(shí)的負(fù)性認(rèn)知加工偏向問(wèn)卷評(píng)分,均高于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。研究組組內(nèi)負(fù)性認(rèn)知加工偏向問(wèn)卷評(píng)分差異具有統(tǒng)計(jì)學(xué)意義(P0.05),研究組治療前與治療4周末的評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組組內(nèi)問(wèn)卷評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組在治療前與治療4周末的評(píng)分差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。研究組在治療2周末與入院時(shí)的負(fù)性認(rèn)知加工偏向問(wèn)卷評(píng)分差值,大于對(duì)照組的差值,差異有統(tǒng)計(jì)學(xué)意義(P0.05),表明研究組減分值大于對(duì)照組。治療4周末時(shí),研究組的負(fù)性認(rèn)知加工偏向問(wèn)卷評(píng)分低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。6.在悲傷面孔環(huán)境視覺(jué)搜索靶刺激的任務(wù)中,研究組與對(duì)照組在入院時(shí)的反應(yīng)時(shí)無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),兩組入院時(shí)的反應(yīng)時(shí)高于正常組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。在治療4周末時(shí)研究組與對(duì)照組的反應(yīng)時(shí)均低于入院時(shí)的反應(yīng)時(shí),差異有統(tǒng)計(jì)學(xué)差異(P0.05)。研究組在治療4周末時(shí)的反應(yīng)時(shí)低于對(duì)照組在4周末時(shí)的反應(yīng)時(shí),差異有統(tǒng)計(jì)學(xué)意義(P0.05),但與正常組反應(yīng)時(shí)相比無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)照組與正常組反應(yīng)時(shí)相比有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.rTMS聯(lián)合抗抑郁藥物治療抑郁癥,較單一采用抗抑郁藥物治療,具有起效時(shí)間早、療效好、安全的特點(diǎn)。2.抑郁癥患者存在明顯的負(fù)性認(rèn)知偏向;3.rTMS聯(lián)合抗抑郁藥物治療,較單一采用抗抑郁藥物治療,能更早、更有效地改善抑郁癥患者的負(fù)性認(rèn)知偏向。
[Abstract]:Background depression is one of the mental diseases that seriously affect human body and body health. Its pathogenesis is not yet very clear. It may be related to neuroendocrine, biochemistry, genetics, cognition and psychosocial factors. As one of the causes of its onset, cognitive factors are negative cognitive bias in patients with depression. Repeat transcranial magnetic stimulation (repetitive transcranial magnetic stimulation, rTMS) as a physical therapy, then its effect on the effect of depression and negative cognitive bias is worth exploring. Objective to explore the effect of rTMS on the treatment of depressive patients and the effect on the negative cognitive bias in the core treatment targets of depression. 71 first-episode depression patients were randomly divided into two groups using a case-control study. The study group (36 cases) was treated with SNRIs antidepressant (Venlafaxine Hydrochloride Sustained-release Tablets) combined with rTMS. The control group (35 cases) took the SNRIs antidepressant (Venlafaxine Hydrochloride Sustained-release Tablets) combined with rTMS pseudo stimulus therapy. The study group chose the left frontal forehead The lateral cortex of the dorsolateral leaf was used as the treatment site. According to the standard electrode 10/20 placement of the international electroencephalogram, the F3 point was selected. The center of the coil was placed in the brain region corresponding to the left lateral prefrontal cortex at the time of treatment. The stimulation frequency was 10HZ and the stimulation intensity was 100%MT for 20 minutes each time. The control group received rTMS pseudo stimulus, the stimulation coil placed 90 degrees to scalp, and the rest. The parameters were in accordance with the study group. The patients were treated with first times for second days, 5 days a week for 5 days, 5 times, 2 days and 20 times for 4 weeks. The Hamilton Depression Scale (HAMD) was used to evaluate the clinical symptoms of depression, and the HAMD8 was recovered and the HAMD subtraction rate was more than 50%. The negative cognitive processing bias questionnaire and visual search were used. The cable paradigm test was used as a negative cognitive bias assessment index in patients with depression and compared with the normal population (30). The symptom scale (TESS) was used to evaluate the adverse reactions of the patients. The effects, safety and negative cognitive bias were compared between the study group and the control group. The independent sample t test was used by the SPSS18.0 statistics software. The data were statistically analyzed by chi square test and variance analysis. The results of P0.05 were statistically significant. Results there was no statistical difference between the 1. study group, the control group and the normal group in the basic data of age, sex and Education (P0.05). There was no statistical difference between the study group and the control group in the course of disease and drug dose (P0.05).2. study. There was no statistical difference between the group and the control group before the treatment (t=0.424, P0.05). At the end of the 2 week of treatment, there was a statistically significant difference between the study group and the control group (t=3.085, P0.05). At the end of the 4 week, the study group was statistically significant compared with the control group HAMD score (t=4.919, P0.05). At the end of the 2 week, the study group and the control group were compared with the control group. The HAMD score of the group was statistically significant compared with that before the treatment (t=3.451, P0.05). The effective rate of the study group was 66.67% (24/36) and 40% (14/35) in the control group at the end of the 2 week. The two groups showed significant difference (c2=5.073, P0.05). The cure rate of the study group was 38.88% (14/36), and the cure rate of the control group was 28.57% (10/35), two. The cure rate of the group was not statistically significant (c2=0.844, P0.05), the effective rate of the study group was 91.66% (33/36) and the control group was 57.14% (20/35) at the end of the 4 week. The two groups had significant statistical difference (c2=5.844, P0.05). The cure rate of the study group was 83.33% (30/36), the cure rate of the control group was 57.14% (20/35), and the two groups had statistical significance in the cure rate (c2=5.84). 4, P0.05).4. participated in the experiment without serious adverse reaction. The incidence of adverse reactions between the study group and the control group was not statistically significant (c2=0.097, P0.05). The proportion of sedative hypnotic drugs, such as benzene and two azinones, was found in the two groups, and there was no statistical difference (c2=0.339, P0.05).5. research group and the control group. The negative cognitive processing bias was higher than the normal group at the time of admission and 4 weeks. The difference was statistically significant (P0.05). The difference of negative cognitive processing bias in the study group was statistically significant (P0.05). The difference between the study group before treatment and the 4 weekend was statistically significant (P0.05). There was statistical significance (P0.05), the difference between the control group before the treatment and the 4 weekend of the treatment was statistically significant (P0.05). The difference value of the negative cognitive processing bias of the study group at the end of the 2 week and the admission was greater than that of the control group, the difference was statistically significant (P0.05), indicating that the subtraction score of the study group was greater than that of the control group. At the end of the 4 week, the negative cognitive processing bias of the study group was lower than that of the control group. The difference was statistically significant (P0.05).6. in the task of visual search target stimulation of the sad face environment, the response time of the study group and the control group was not significantly different (P0.05), and the two groups were higher than the normal group when they were admitted to the hospital. The difference was statistically significant (P0.05). The difference was statistically significant (P0.05) when the response of the study group was lower than the control group at the 4 weekend (P0.05). The response of the study group at the weekend of treatment was lower than that of the control group at the 4 weekend (P0.05), but there was no significant difference compared with the normal group. Statistically significant difference (P0.05), compared with the normal group (P0.05). Conclusion 1.rTMS combined with antidepressant drugs in the treatment of depression, compared with a single antidepressant, has early onset time, good efficacy and safety, and there is a significant negative cognitive bias in the patients with.2. depression; 3.rTMS combined with antidepressant drugs. Substance therapy, which is more effective than single antidepressant treatment, can improve the negative cognitive bias of patients with depression earlier and more effectively.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R749.4

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