【摘要】：目的：分析超低頻經(jīng)顱磁刺激聯(lián)合帕羅西汀治療抑郁癥首次發(fā)作患者的早期療效及其對認知功能和神經(jīng)遞質(zhì)功能的影響，為超低頻經(jīng)顱磁刺激的臨床應用提供科學依據(jù)。 方法：從四川省精神衛(wèi)生中心的門診部及住院部選取首發(fā)抑郁癥患者70例。采用完全數(shù)字隨機分組的方法將受試者分為聯(lián)合治療組和藥物治療組各35例，對兩組受試者進行為期4周的治療觀察。在治療前2周，向聯(lián)合治療組施加1次/天的超低頻經(jīng)顱磁刺激（連續(xù)14天），每次30min，，刺激強度500GS，環(huán)形線圈置于頭頂向全腦施加磁場，線圈直徑25cm，距離頭皮1.5-2.0cm，并服用帕羅西汀治療（20-40mg/天）。藥物治療組接受假刺激和帕羅西�。�20-40mg/天）治療。兩周后，兩組受試者只接受帕羅西汀治療。兩組藥物劑量的調(diào)整依據(jù)臨床癥狀及不良反應的嚴重程度。給予夜間失眠者阿普唑侖0.4-0.8mg。研究基線期、2周時、4周時指導所有受試者完成漢密爾頓抑郁量表（Hamilton rating for depression，HAMD）24項版本、威斯康星卡片分類測驗（Wisconsin Card Sorting Test，WCST）、劃消測驗（cancellation test，CT）、腦漲落圖檢測。觀察受試者在研究期間是否出現(xiàn)不良反應，如頭暈、頭痛、耳鳴等。采用SPSS19.0建立數(shù)據(jù)庫和統(tǒng)計分析。 結(jié)果：①聯(lián)合治療組和藥物治療組完成全程研究的人數(shù)分別為32和34例。治療2周時，聯(lián)合治療組有效率40.6%(13/32)高于藥物治療組17.6%(6/34)（χ~2=4.246，P=0.039）。治療4周時，聯(lián)合治療組有效率71.9%(23/32)高于藥物治療組38.2%(13/34)（χ~2=7.542，P=0.006）。聯(lián)合治療組4周時有效率高于2周時（χ~2=6.349，P=0.012），藥物治療組4周時有效率與2周相比差異無統(tǒng)計學意義（χ~2=3.579，P=0.059）。②聯(lián)合治療組中，2周時WCST中完成分類數(shù)和正確應答數(shù)高于基線期（P0.05或P0.01），與第4周相比差異無統(tǒng)計學意義（P均0.05）；不同時間點劃消粗分呈逐漸提高的趨勢（P0.05或P0.01）。藥物治療組中，2周時WCST中完成分類數(shù)和正確應答數(shù)與基線期相比差異均無統(tǒng)計學意義（P均0.05），但均低于4周時（P0.01或P0.05）。2周時劃消得分高于基線期（P0.05），與4周時相比差異無統(tǒng)計學意義（P0.05）；2周時聯(lián)合治療組中WCST的完成分類數(shù)、正確應答數(shù)及劃消粗分和得分高于藥物治療組（P0.01或P0.05），將這一差異控制后，聯(lián)合治療組4周的完成分類數(shù)、正確應答數(shù)和劃消得分高于藥物治療組（P均0.05）。③聯(lián)合治療組4周時的5-HT總功率及相對功率和NE總功率高于2周時（P0.01或P0.05）；2周時γ-GABA總功率高于基線期（P0.01），與4周時相比差異無統(tǒng)計學意義（P0.05）；各時間點Glu總功率呈逐漸增高的趨勢（P均0.01）；4周時的Ach總功率較2周時有所下降（P0.01）；4周時的興奮抑制指數(shù)高于基線期及2周時（P均0.01）；2周時的熵值低于基線期（P0.01），與4周時相比差異無統(tǒng)計學意義（P0.05）。藥物治療組中，4周時的NE相對功率高于基線期及2周時（P均0.01）；2周時γ-GABA相對功率高于基線期（P0.05），與4周時相差異比無統(tǒng)計學意義（P0.05）；4周時的興奮抑制指數(shù)高于基線期及2周時（P均0.05）。聯(lián)合治療組與藥物治療組相比，基線期聯(lián)合治療組的γ-GABA總功率低于藥物治療組（P0.05）；4周時聯(lián)合治療組5-HT總功率及相對功率和NE總功率高于藥物治療組（P0.05或P0.01）；2周時及4周時聯(lián)合治療組γ-GABA總功率及相對功率、Glu總功率及相對功率高于藥物治療組（P均0.05），但熵值低于藥物治療組（P0.01）。④聯(lián)合治療組出現(xiàn)口干5（15.6%）人、惡心4（12.6%）人；藥物治療組出現(xiàn)口干3（9%）人、惡心6（18.2%）人。兩組不良反應差異無統(tǒng)計學意義（P0.05）。 結(jié)論：①超低頻經(jīng)顱磁刺激聯(lián)合帕羅西汀治療首發(fā)抑郁癥患者的早期療效高于單獨應用帕羅西汀。②超低頻經(jīng)顱磁刺激聯(lián)合帕羅西汀可早期改善首發(fā)抑郁癥患者的部分認知功能。③超低頻經(jīng)顱磁刺激聯(lián)合帕羅西汀可提高5-HT相對功率、NE總功率、Glu與GABA的總功率和相對功率。
[Abstract]:Objective: To analyze the effect of super low frequency transcranial magnetic stimulation combined with pastatin in the treatment of patients with first episode of depression and its effect on cognitive function and neurotransmitter function, and to provide scientific basis for the clinical application of super low frequency transcranial magnetic stimulation. Methods: 7 patients with primary depression were selected from the outpatient department and inpatient department of mental health center in Sichuan Province. 0 cases. The subjects were divided into 35 patients with combined treatment group and drug treatment group using the method of complete digital random grouping, and two groups of subjects were treated for 4 weeks. Observations. For 2 weeks prior to treatment, 1/ day ultra low frequency transcranial magnetic stimulation was applied to the combined treatment group (continuous 14 days), the stimulation intensity was 500GS each time, the loop coil was placed on the top of the head to apply a magnetic field to the full brain, the coil diameter was 25cm, the distance from the scalp 1.5-2.0cm, and the treatment with paroxine (20-40mg/ Day). The drug treatment group received false stimulation and carnitine (20-40mg/ day) Treatment. After two weeks, two groups of subjects were treated only with Augustine. Treatment. The adjustment of two groups of drug dosages is based on clinical symptoms and serious adverse reactions. To a lesser extent. Apprenaline 0,4-0,8 for insomnia at night mg. Baseline period, 2 weeks, all subjects were instructed to complete Hamilton depression for depression (HAMD) 24 items, Wisconsin Card Sorting Test (WCST), cancelation test (CT), brain fluctuation map. To observe whether adverse reactions occurred during the study, such as dizziness, headache, ear, Construction of database and statistics using SPSS19. 0 Results: The total number of patients who completed the entire study was 3 in the combination therapy group and the drug treatment group. 2 and 34 cases. The effective rate of the combined treatment group was 42.6% (13/ 32) higher than that of the drug treatment group (17. 6% (6/ 34).. 039) In the treatment of 4 weeks, the effective rate of the combined treatment group was 71.9% (23/ 32) higher than that of the drug treatment group (38. 2% (13/ 34) (P = 7. 542, P = 0 (006) The effective rate of the combined treatment group at 4 weeks was higher than 2 weeks (P = 0. 012), and the effective rate was not statistically significant compared with 2 weeks at 4 weeks (P = 0. 05). The number of complete and correct responses in WCST at 2 weeks were higher than baseline (P0.05 or P0.01), and the difference was not statistically significant (P <0.05) compared with the 4th week (P <0.05). 0. 01) The number of complete and correct responses in WCST during 2 weeks were not statistically significant compared to baseline (P <0.05), but were lower than 4 weeks (P <0.05). The score was higher than baseline (P0.05), and the difference was not statistically significant compared with 4 weeks (P 0. 05) At 2 weeks, the number of complete classification, correct response number and score of WCST in the combined treatment group were higher than that of the drug treatment group (P0.01 or P0.05). After the difference was controlled, the number of complete classification, correct response number and score score of the combined treatment group were higher than that of the drug treatment group (P <0.05). 0. 05) The total power of 5-HT and the relative power and NE total power at 4 weeks in the combined treatment group were higher than those in the baseline period (P0.01 or P0.05). 0. 05) The total power of Glu in each time point was gradually increased (P <0.01); the total power of ACh at 4 weeks decreased (P <0.01); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P <0.01); the entropy value at 2 weeks was lower than baseline period (P 0. 01), no statistically significant difference compared with 4 weeks (P The relative power of NE during 4 weeks was higher than baseline and 2 weeks (P <0.01). Compared with baseline period (P0.05), the relative power of NE-GABA was higher than that of baseline (P 0. 05); the excitation inhibition index at 4 weeks was higher than baseline and 2 weeks (P The total power and relative power and NE total power of the combined treatment group at 4 weeks were higher than that of the drug treatment group (P0.05 or P The total power and relative power, Glu total power and relative power of the combined treatment group were higher than that of the drug treatment group (P <0.05) at 2 weeks and 4 weeks, but the entropy value was lower than that of the drug treatment group (P 0. 01). 5 (15. 6%) of patients in the combined treatment group, 4 (12.6%) nausea, 3 (9%) in the drug treatment group, 6 (18) nausea, 2%) There was no significant difference between the two groups (P Conclusion: The patients with first-episode depression treated with superlow frequency transcranial magnetic stimulation combined with pastatin were more effective than those in the early stage of depression. Early improvement of first-onset depression due to cranial magnetic stimulation combined with hyperlow-frequency transcranial magnetic stimulation Part of the cognitive function of the patients: the combination of super low frequency and cranial magnetic stimulation can improve the relative power of 5-HT, the total power of NE, Glu and GABA.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R749.4

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