高頻重復經(jīng)顱磁刺激治療PTSD的療效分析及相關(guān)機制研究
發(fā)布時間：2018-07-26 19:13
【摘要】：目的:比較偽刺激組(帕羅西汀)與真刺激組(帕羅西汀+高頻重復經(jīng)顱磁刺激)的療效,分析治療后創(chuàng)傷后應激障礙患者血漿中腎素、血管緊張素II和皮質(zhì)醇含量以及創(chuàng)傷后應激障礙量表總分的變化,并進一步探究神經(jīng)內(nèi)分泌激素含量的變化與創(chuàng)傷后應激障礙癥狀改善的關(guān)系。方法:連續(xù)入組60例首發(fā)或3個月內(nèi)未服用精神科藥物的創(chuàng)傷后應激障礙患者作為試驗組,入組后次日上午8點抽取試驗組成員靜脈血3ml檢測血漿中腎素、血管緊張素II和皮質(zhì)醇含量,同時運用創(chuàng)傷后應激障礙檢查量表(PCL)評定其創(chuàng)傷后應激障礙程度。以年齡和性別為控制變量,入組60例身體健康者作為對照組,入組后次日上午8點抽取對照組成員靜脈血3ml檢測血漿中腎素、血管緊張素II和皮質(zhì)醇含量。利用隨機數(shù)字表將試驗組成員隨機分為真刺激組和偽刺激組各30例,偽刺激組只給予帕羅西汀治療,真刺激組給予帕羅西汀治療的同時聯(lián)合高頻重復經(jīng)顱磁刺激治療,治療4周后次日上午8點抽取真刺激組和偽刺激組成員靜脈血3ml重復檢測血漿中腎素、血管緊張素II和皮質(zhì)醇含量,同時運用創(chuàng)傷后應激障礙自評量表(PCL)再次評定其創(chuàng)傷后應激障礙程。結(jié)果:1試驗組與對照組比較年齡、性別、城鄉(xiāng)、婚姻、獨生子女、文化程度無統(tǒng)計學差異;2試驗組血漿中腎素、血管緊張素II和皮質(zhì)醇含量與對照組比較無統(tǒng)計學差異,皮質(zhì)醇含量顯著低于對照組;3血漿中皮質(zhì)醇含量對PTSD有一定的預測作用,當血漿中皮質(zhì)醇=332.880nmol/L時,約登指數(shù)=0.267達最大值,此分界值預測PTSD的敏感度為96.7%,特異度為30.0%;4真刺激組與偽刺激組比較年齡、病程、鹽酸帕羅西汀的劑量、性別、城鄉(xiāng)、婚姻、獨生子女、文化程度無統(tǒng)計學差異;5治療4周后,真刺激組和偽刺激組PCL總分顯著低于治療前,血漿中皮質(zhì)醇含量較治療前有明顯升高,腎素和血管緊張素II含量改變無統(tǒng)計學差異;6真刺激組與偽刺激組療效比較,兩組的療效分布有統(tǒng)計學差異,真刺激組無效率顯著低于偽刺激組,顯著進步率明顯高于偽刺激組,進步率和治愈率無統(tǒng)計學差異;7治療前真刺激與偽刺激組比較PCL總分、血漿中腎素、血管緊張素II含量無統(tǒng)計學差異,治療4周后真刺激組PCL總分顯著低于偽刺激組、血漿中皮質(zhì)醇含量顯著高于偽刺激組,治療前后真刺激組PCL的減分率和皮質(zhì)醇差值明顯高于偽刺激組,腎素差值和血管緊張素II差值與偽刺激組比較無統(tǒng)計學差異;8真刺激組皮質(zhì)醇差值與PCL減分率呈顯著正相關(guān),皮質(zhì)醇差值可以預測PCL減分率變異的29.2%,偽刺激組皮質(zhì)醇差值與PCL減分率無明顯相關(guān);9經(jīng)顱磁刺激治療過程中,皮質(zhì)醇差值對PTSD患者的療效有很好的預測作用,當皮質(zhì)醇差值=97.370nmol/L時,約登指數(shù)=0.540達最大值,此分界值預測PTSD患者療效的敏感度為77.8%,特異度為76.2%。結(jié)論:1 HPA軸功能衰竭所致的血漿中皮質(zhì)醇含量不足,可能是PTSD患者發(fā)病的病因之一;2鹽酸帕羅西汀聯(lián)合高頻重復經(jīng)顱磁刺激可以顯著提高治療PTSD的效果;3高頻重復經(jīng)顱磁刺激提高治療PTSD效果的可能機制是其激活了HPA軸,使PTSD患者血漿中皮質(zhì)醇含量不足得以恢復。
[Abstract]:Objective: To compare the effect of pseudo stimulus group (Pa Rossi Dean) and real stimulation group (Pa Rossi Dean + high frequency repetitive transcranial magnetic stimulation), and analyze the changes of the plasma renin, angiotensin II and cortisol content and the total score of posttraumatic stress disorder (PTSD) in patients with posttraumatic stress disorder after treatment, and to further explore the changes in the content of neuroendocrine hormones. Methods: the relationship between the improvement of posttraumatic stress disorder (PTSD) symptoms. Methods: 60 cases of posttraumatic stress disorder (PTSD) who did not take psychotropic drugs during the first or 3 months were taken as experimental group, and the plasma renin, angiotensin II and cortisol levels were detected by 3ml in the group of the test group at 8 a.m. after entering the group. Stress disorder checklist (PCL) was used to assess the degree of posttraumatic stress disorder. With age and sex as the control variable, 60 healthy persons were taken as control group, and the blood plasma renin, angiotensin II and cortisol content were detected by 3ml in the control group after the next day, and the random number table was used to make the test group members. 30 cases were randomly divided into 30 cases of real stimulation group and pseudo stimulus group. The pseudo stimulus group was only treated with Pa Rossi Dean. The real stimulation group was given Pa Rossi Dean treatment and combined high frequency and repetitive transcranial magnetic stimulation. After 4 weeks, the real stimulation group and the pseudo stimulus group were extracted and the members of the pseudo stimulus group were repeated 3ml to detect the plasma renin and angiotensin II. The content of cortisol and the posttraumatic stress disorder self rating scale (PCL) were used to reassess the post traumatic stress disorder. Results: there was no statistical difference in age, sex, urban and rural, marriage, and only child in the 1 group and the control group. In the 2 test group, the plasma renin, angiotensin II and cortisol content were no more than those in the control group. Statistical difference, cortisol content was significantly lower than the control group; 3 plasma cortisol content had a certain predictive effect on PTSD. When plasma cortisol =332.880nmol/L, the maximum value of the =0.267 index was 96.7%, the specificity was 30%; 4 true stimulus group was compared with the pseudo stimulus group, the course of disease, hydrochloric hydrochloric acid. There was no statistical difference between the dose, sex, urban and rural, marriage, and one child, and the total score of PCL in the real stimulation group and the pseudo stimulus group was significantly lower than that before the treatment. The plasma cortisol content was significantly higher than that before the treatment, and there was no significant difference in the content of renin and angiotensin II in the plasma of the real stimulation group and the pseudo stimulus group after 5 weeks of treatment; 6 real stimulation group and pseudo stimulus group. The effect distribution of the two groups was statistically different. The ineffectiveness of the real stimulation group was significantly lower than that of the pseudo stimulus group. The significant progress rate was significantly higher than that of the pseudo stimulus group, and there was no statistical difference between the progress rate and the cure rate. There was no statistical difference between the real stimulation and the pseudo stimulus group before 7 treatment, and there was no statistical difference between the plasma renin and angiotensin II after 4 weeks of treatment. The total score of PCL in the real stimulation group was significantly lower than that of the pseudo stimulus group. The plasma cortisol content in the plasma was significantly higher than that of the pseudo stimulus group. The reduction rate of PCL and the difference of cortisol in the real stimulation group were significantly higher than those of the pseudo stimulus group. The difference between the renin difference and the difference between the angiotensin II and the pseudo stimulus group had no statistical difference, and the difference between the cortisol and the PCL in the 8 real stimulation group was compared with that of the pseudo stimulus group. There was a significant positive correlation. The cortisol difference could predict 29.2% of the variation of the PCL reduction rate. There was no significant correlation between the cortisol difference and the PCL reduction rate in the pseudo stimulus group. 9 the difference value of cortisol had a good predictive effect on the curative effect of PTSD patients during the transcranial magnetic stimulation treatment. When the difference value of cortisol = 97.370nmol/L, the maximum value of the PCL index =0.540 reached the maximum value. The sensitivity of the estimated value of PTSD patients was 77.8%, and the specificity was 76.2%. conclusion: the deficiency of cortisol in plasma caused by 1 HPA axis failure may be one of the causes of PTSD patients; 2 Paroxetine Combined with high frequency repetitive transcranial magnetic stimulation can significantly improve the effect of PTSD treatment; 3 high frequency repetitive transcranial magnetic stimulation The possible mechanism for the treatment of PTSD is the activation of the HPA axis, resulting in the recovery of plasma cortisol levels in PTSD patients.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R749.5
[Abstract]:Objective: To compare the effect of pseudo stimulus group (Pa Rossi Dean) and real stimulation group (Pa Rossi Dean + high frequency repetitive transcranial magnetic stimulation), and analyze the changes of the plasma renin, angiotensin II and cortisol content and the total score of posttraumatic stress disorder (PTSD) in patients with posttraumatic stress disorder after treatment, and to further explore the changes in the content of neuroendocrine hormones. Methods: the relationship between the improvement of posttraumatic stress disorder (PTSD) symptoms. Methods: 60 cases of posttraumatic stress disorder (PTSD) who did not take psychotropic drugs during the first or 3 months were taken as experimental group, and the plasma renin, angiotensin II and cortisol levels were detected by 3ml in the group of the test group at 8 a.m. after entering the group. Stress disorder checklist (PCL) was used to assess the degree of posttraumatic stress disorder. With age and sex as the control variable, 60 healthy persons were taken as control group, and the blood plasma renin, angiotensin II and cortisol content were detected by 3ml in the control group after the next day, and the random number table was used to make the test group members. 30 cases were randomly divided into 30 cases of real stimulation group and pseudo stimulus group. The pseudo stimulus group was only treated with Pa Rossi Dean. The real stimulation group was given Pa Rossi Dean treatment and combined high frequency and repetitive transcranial magnetic stimulation. After 4 weeks, the real stimulation group and the pseudo stimulus group were extracted and the members of the pseudo stimulus group were repeated 3ml to detect the plasma renin and angiotensin II. The content of cortisol and the posttraumatic stress disorder self rating scale (PCL) were used to reassess the post traumatic stress disorder. Results: there was no statistical difference in age, sex, urban and rural, marriage, and only child in the 1 group and the control group. In the 2 test group, the plasma renin, angiotensin II and cortisol content were no more than those in the control group. Statistical difference, cortisol content was significantly lower than the control group; 3 plasma cortisol content had a certain predictive effect on PTSD. When plasma cortisol =332.880nmol/L, the maximum value of the =0.267 index was 96.7%, the specificity was 30%; 4 true stimulus group was compared with the pseudo stimulus group, the course of disease, hydrochloric hydrochloric acid. There was no statistical difference between the dose, sex, urban and rural, marriage, and one child, and the total score of PCL in the real stimulation group and the pseudo stimulus group was significantly lower than that before the treatment. The plasma cortisol content was significantly higher than that before the treatment, and there was no significant difference in the content of renin and angiotensin II in the plasma of the real stimulation group and the pseudo stimulus group after 5 weeks of treatment; 6 real stimulation group and pseudo stimulus group. The effect distribution of the two groups was statistically different. The ineffectiveness of the real stimulation group was significantly lower than that of the pseudo stimulus group. The significant progress rate was significantly higher than that of the pseudo stimulus group, and there was no statistical difference between the progress rate and the cure rate. There was no statistical difference between the real stimulation and the pseudo stimulus group before 7 treatment, and there was no statistical difference between the plasma renin and angiotensin II after 4 weeks of treatment. The total score of PCL in the real stimulation group was significantly lower than that of the pseudo stimulus group. The plasma cortisol content in the plasma was significantly higher than that of the pseudo stimulus group. The reduction rate of PCL and the difference of cortisol in the real stimulation group were significantly higher than those of the pseudo stimulus group. The difference between the renin difference and the difference between the angiotensin II and the pseudo stimulus group had no statistical difference, and the difference between the cortisol and the PCL in the 8 real stimulation group was compared with that of the pseudo stimulus group. There was a significant positive correlation. The cortisol difference could predict 29.2% of the variation of the PCL reduction rate. There was no significant correlation between the cortisol difference and the PCL reduction rate in the pseudo stimulus group. 9 the difference value of cortisol had a good predictive effect on the curative effect of PTSD patients during the transcranial magnetic stimulation treatment. When the difference value of cortisol = 97.370nmol/L, the maximum value of the PCL index =0.540 reached the maximum value. The sensitivity of the estimated value of PTSD patients was 77.8%, and the specificity was 76.2%. conclusion: the deficiency of cortisol in plasma caused by 1 HPA axis failure may be one of the causes of PTSD patients; 2 Paroxetine Combined with high frequency repetitive transcranial magnetic stimulation can significantly improve the effect of PTSD treatment; 3 high frequency repetitive transcranial magnetic stimulation The possible mechanism for the treatment of PTSD is the activation of the HPA axis, resulting in the recovery of plasma cortisol levels in PTSD patients.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R749.5
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