重復(fù)經(jīng)顱磁刺激治療食管癌相關(guān)性抑郁臨床療效及功能磁共振成像評(píng)估
發(fā)布時(shí)間：2019-01-28 12:46
【摘要】：目的:觀察重復(fù)經(jīng)顱磁刺激(repetitive Transcranial Magnetic Stimulation,rTMS)對(duì)食管癌相關(guān)性抑郁患者的臨床治療效果,并采用功能磁共振成像(Functional Magnetic Resonance Imaging,fMRI)的方法觀察rTMS治療前后患者抑郁相關(guān)腦區(qū)的神經(jīng)影像學(xué)變化,對(duì)比單次rTMS治療與多次rTMS治療對(duì)食管癌相關(guān)性抑郁患者的臨床療效,并探討rTMS對(duì)患者的康復(fù)治療機(jī)制。方法:收集2015年11月-2016年12月在南充市中心醫(yī)院住院的食管癌患者,選取符合本研究入組要求的食管癌相關(guān)性抑郁患者22例,分為單次rTMS治療組(s-rTMS組,12例)和多次rTMS治療組(m-rTMS組,10例)兩個(gè)實(shí)驗(yàn)組。s-rTMS組只接受1次rTMS治療(刺激頻率:10Hz,刺激部位:左側(cè)背外側(cè)前額葉皮層,刺激強(qiáng)度:110%靜息運(yùn)動(dòng)閾值);m-r TMS組給予5次rTMS治療(m-rTMS組的rTMS治療參數(shù)與s-rTMS組的治療參數(shù)完全相同),每天1次rTMS治療,連續(xù)5天。s-rTMS組和m-rTMS組兩組患者在接受rTMS治療前后均行漢密爾頓抑郁量表(Hamilton Depression Scale,HAMD)、抑郁自評(píng)量表(Self-Rating Depression Scale,SDS)評(píng)分及進(jìn)行靜息態(tài)fMRI圖像采集。對(duì)比s-rTMS組和m-rTMS組兩組患者在rTMS治療前后HAMD、SDS評(píng)分、低頻振幅(Amplitude of Low Frequency Fluctuation,ALFF)的變化,對(duì)比兩組患者在rTMS治療后上述指標(biāo)的差異;同時(shí)計(jì)算s-rTMS組和m-rTMS組兩組實(shí)驗(yàn)組rTMS治療前后HAMD、SDS評(píng)分改變量與ALFF改變量的相關(guān)性。結(jié)果:1、rTMS治療前,s-rTMS組和m-rTMS組兩組患者的基本臨床資料、HAMD量表、SDS量表評(píng)分均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);s-rTMS組和m-rTMS組兩組患者rTMS治療前后HAMD量表、SDS量表評(píng)分均有顯著改變(P0.05);s-rTMS組和m-r TMS組rTMS治療后組間HAMD量表、SDS量表評(píng)分改變量有統(tǒng)計(jì)學(xué)差異(P0.05)。2、rTMS治療前,srTMS組和m-rTMS組兩組患者的ALFF無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);兩組患者rTMS治療前后ALFF值均發(fā)生明顯變化(P0.05):s-rTMS組患者雙側(cè)額葉、雙側(cè)前扣帶回、右側(cè)海馬、右側(cè)丘腦的ALFF顯著增高,左側(cè)丘腦的ALFF顯著降低;m-r TMS組患者雙側(cè)額葉、雙側(cè)前扣帶回、右側(cè)海馬、右側(cè)蒼白球的ALFF顯著增高,雙側(cè)殼核、雙側(cè)丘腦的ALFF顯著降低;此外,與s-rTMS組相比,m-rTMS組患者在rTMS治療后雙側(cè)額中回、雙側(cè)前扣帶回、右側(cè)尾狀核頭的ALFF增加更顯著。3、s-rTMS組患者rTMS治療前后HAMD量表評(píng)分改變量與前扣帶回ALFF改變量呈顯著負(fù)相關(guān)(R=-0.7,P=0.011);m-rTMS組患者rTMS治療前后HAMD量表評(píng)分改變量與前扣帶回、海馬ALFF改變量均呈顯著負(fù)相關(guān)(R=-0.84,P=0.0023;R=-0.87,P=0.001)。結(jié)論:高頻rTMS對(duì)食管癌相關(guān)性抑郁有良好的治療效果,且多次rTMS治療較單次rTMS治療臨床療效更好,這可能與rTMS能影響大腦內(nèi)相關(guān)區(qū)域的神經(jīng)生理活動(dòng)有關(guān)。ALFF是一種新的研究腦功能成像的方法,抑郁相關(guān)腦區(qū)的ALFF分析可以作為評(píng)價(jià)rTMS抗抑郁治療效果的影像學(xué)指標(biāo)之一。
[Abstract]:Objective: to observe the clinical effect of repeated transcranial magnetic stimulation (repetitive Transcranial Magnetic Stimulation,rTMS) in patients with esophageal cancer associated depression and to use functional magnetic resonance imaging (Functional Magnetic Resonance Imaging,). FMRI) method to observe the neuroimaging changes of depression-related brain area before and after rTMS treatment, to compare the clinical effect of single rTMS therapy and multiple rTMS therapy on patients with esophageal cancer associated depression, and to explore the mechanism of rTMS rehabilitation therapy. Methods: a total of 22 esophageal cancer patients who were hospitalized in Nanchong Central Hospital from November 2015 to December 2016 were selected and divided into single rTMS treatment group (s-rTMS group). S-rTMS group received rTMS only once (stimulation frequency: 10 Hz, stimulation site: left dorsolateral prefrontal cortex, stimulation intensity: 110% resting exercise threshold). The m-r TMS group was treated with rTMS for 5 times (the parameters of rTMS in m-rTMS group were exactly the same as those in s-rTMS group), and rTMS was given once a day. The patients in s-rTMS group and m-rTMS group were treated with Hamilton depression scale (Hamilton Depression Scale,HAMD), self-rating depression scale (Self-Rating Depression Scale,SDS) and resting fMRI images before and after rTMS treatment for 5 consecutive days. The changes of HAMD,SDS score and low frequency amplitude (Amplitude of Low Frequency Fluctuation,ALFF (Amplitude of Low Frequency Fluctuation,ALFF) before and after rTMS treatment in s-rTMS group and m-rTMS group were compared, and the differences of the above indexes after rTMS treatment were compared between the two groups. At the same time, the correlation between the changes of HAMD,SDS score and ALFF before and after rTMS treatment in s-rTMS and m-rTMS groups was calculated. Results: 1 before rTMS treatment, there was no significant difference in the basic clinical data, HAMD scale and SDS score between s-rTMS group and m-rTMS group (P0.05); There were significant changes in HAMD scale and SDS scale before and after rTMS treatment in s-rTMS group and m-rTMS group (P0.05). There was significant difference in HAMD scale and SDS scale between s-rTMS group and m-r TMS group after rTMS treatment (P0.05). Before treatment, there was no significant difference in ALFF between srTMS group and m-rTMS group (P0.05). Before and after rTMS treatment, the ALFF values of the two groups were significantly changed (P0.05): in the s-rTMS group, the bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus, right thalamus and right thalamus significantly increased ALFF, while the left thalamus ALFF significantly decreased. In m-r TMS group, ALFF in bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus and right globus pallidus increased significantly, and ALFF in bilateral putamen and thalamus decreased significantly. In addition, compared with s-rTMS group, the ALFF of bilateral middle frontal gyrus, bilateral anterior cingulate gyrus and right caudate nucleus head increased significantly in m-rTMS group after rTMS treatment. There was a significant negative correlation between the change of HAMD scale before and after rTMS treatment and the change of ALFF in anterior cingulate gyrus in s-rTMS group (RP0. 011). In m-rTMS group, the changes of HAMD scale before and after rTMS treatment were negatively correlated with the changes of ALFF in hippocampus and anterior cingulate gyrus. Conclusion: high frequency rTMS has a good therapeutic effect on esophageal cancer associated depression, and the clinical effect of multiple rTMS is better than that of single rTMS. ALFF is a new method to study brain function imaging. ALFF analysis in depressive brain area can be used as an imaging index to evaluate the antidepressant effect of rTMS.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1;R749.4
本文編號(hào)：2417078
[Abstract]:Objective: to observe the clinical effect of repeated transcranial magnetic stimulation (repetitive Transcranial Magnetic Stimulation,rTMS) in patients with esophageal cancer associated depression and to use functional magnetic resonance imaging (Functional Magnetic Resonance Imaging,). FMRI) method to observe the neuroimaging changes of depression-related brain area before and after rTMS treatment, to compare the clinical effect of single rTMS therapy and multiple rTMS therapy on patients with esophageal cancer associated depression, and to explore the mechanism of rTMS rehabilitation therapy. Methods: a total of 22 esophageal cancer patients who were hospitalized in Nanchong Central Hospital from November 2015 to December 2016 were selected and divided into single rTMS treatment group (s-rTMS group). S-rTMS group received rTMS only once (stimulation frequency: 10 Hz, stimulation site: left dorsolateral prefrontal cortex, stimulation intensity: 110% resting exercise threshold). The m-r TMS group was treated with rTMS for 5 times (the parameters of rTMS in m-rTMS group were exactly the same as those in s-rTMS group), and rTMS was given once a day. The patients in s-rTMS group and m-rTMS group were treated with Hamilton depression scale (Hamilton Depression Scale,HAMD), self-rating depression scale (Self-Rating Depression Scale,SDS) and resting fMRI images before and after rTMS treatment for 5 consecutive days. The changes of HAMD,SDS score and low frequency amplitude (Amplitude of Low Frequency Fluctuation,ALFF (Amplitude of Low Frequency Fluctuation,ALFF) before and after rTMS treatment in s-rTMS group and m-rTMS group were compared, and the differences of the above indexes after rTMS treatment were compared between the two groups. At the same time, the correlation between the changes of HAMD,SDS score and ALFF before and after rTMS treatment in s-rTMS and m-rTMS groups was calculated. Results: 1 before rTMS treatment, there was no significant difference in the basic clinical data, HAMD scale and SDS score between s-rTMS group and m-rTMS group (P0.05); There were significant changes in HAMD scale and SDS scale before and after rTMS treatment in s-rTMS group and m-rTMS group (P0.05). There was significant difference in HAMD scale and SDS scale between s-rTMS group and m-r TMS group after rTMS treatment (P0.05). Before treatment, there was no significant difference in ALFF between srTMS group and m-rTMS group (P0.05). Before and after rTMS treatment, the ALFF values of the two groups were significantly changed (P0.05): in the s-rTMS group, the bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus, right thalamus and right thalamus significantly increased ALFF, while the left thalamus ALFF significantly decreased. In m-r TMS group, ALFF in bilateral frontal lobe, bilateral anterior cingulate gyrus, right hippocampus and right globus pallidus increased significantly, and ALFF in bilateral putamen and thalamus decreased significantly. In addition, compared with s-rTMS group, the ALFF of bilateral middle frontal gyrus, bilateral anterior cingulate gyrus and right caudate nucleus head increased significantly in m-rTMS group after rTMS treatment. There was a significant negative correlation between the change of HAMD scale before and after rTMS treatment and the change of ALFF in anterior cingulate gyrus in s-rTMS group (RP0. 011). In m-rTMS group, the changes of HAMD scale before and after rTMS treatment were negatively correlated with the changes of ALFF in hippocampus and anterior cingulate gyrus. Conclusion: high frequency rTMS has a good therapeutic effect on esophageal cancer associated depression, and the clinical effect of multiple rTMS is better than that of single rTMS. ALFF is a new method to study brain function imaging. ALFF analysis in depressive brain area can be used as an imaging index to evaluate the antidepressant effect of rTMS.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1;R749.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 陳萬(wàn)青;鄭榮壽;張思維;曾紅梅;鄒小農(nóng);赫捷;;2013年中國(guó)惡性腫瘤發(fā)病和死亡分析[J];中國(guó)腫瘤;2017年01期
2 邱美慧;吳彥;彭代輝;;抑郁癥海馬的結(jié)構(gòu)及功能磁共振成像的研究進(jìn)展[J];上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年06期
3 賈愛香;李偉;張愛霞;高強(qiáng);曹曉華;張克讓;;抑郁障礙患者腦功能磁共振研究[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2014年12期
4 母其文;;重復(fù)經(jīng)顱磁刺激及其磁共振功能成像的研究進(jìn)展[J];西部醫(yī)學(xué);2014年04期
5 馮曉榮;梁立華;吳明祥;呂建勛;;抑郁癥患者治療前后的靜息態(tài)fMRI比較探究[J];中國(guó)醫(yī)療前沿;2013年10期
6 李凝;宋美;王學(xué)義;;重復(fù)經(jīng)顱磁刺激治療抑郁癥作用機(jī)制的研究進(jìn)展[J];中國(guó)健康心理學(xué)雜志;2012年07期
7 孫軍;劉含秋;孫華平;張俊海;馮曉源;郭琴;施慎遜;;首發(fā)抑郁癥患者治療前后的靜息態(tài)fMRI研究[J];中國(guó)醫(yī)學(xué)計(jì)算機(jī)成像雜志;2011年03期
8 張?jiān)伱?胡斌;王朝輝;孫玲;郭中孟;郭文;譚立文;;高頻及低頻重復(fù)經(jīng)顱磁刺激治療抑郁癥的對(duì)照研究[J];臨床薈萃;2011年05期
9 張龍江;楊桂芬;祁吉;;靜息態(tài)腦功能成像的研究與進(jìn)展[J];國(guó)外醫(yī)學(xué)(臨床放射學(xué)分冊(cè));2007年01期
10 李麗;董奇;;抑郁癥的腦神經(jīng)結(jié)構(gòu)和功能改變研究[J];中國(guó)臨床心理學(xué)雜志;2006年01期
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