重复经颅磁刺激对产后轻中度抑郁患者脑血流动力学及初级运动区激活的影响

Effects of rTMS on cerebral hemodynamics and primary motor area activation in postpartum patients with mild to moderate depression

摘要:

目的 探讨重复经颅磁刺激（rTMS）治疗产后轻中度抑郁患者的效果及对脑血流动力学及初级运动区激活的影响。方法 选取2020年2月—2023年2月深圳市中医院收治的84例产后轻中度抑郁患者，以随机数表法分为对照组和研究组，每组42例。对照组给予抗抑郁药物，研究组在对照组基础上给予rTMS，治疗后8周评价疗效。对比两组抑郁病情、临床疗效、脑血流动力学指标、脑功能初级运动区激活情况、脑神经因子及不良反应。结果 两组治疗前及治疗后4、8周的汉密顿抑郁量表（HAMD）评分比较，结果 ①不同时间点HAMD评分比较，差异有统计学意义（F =8.013，P =0.000）；②两组HAMD评分比较，差异有统计学意义（F =7.429，P =0.000）；③两组HAMD评分变化趋势比较，差异有统计学意义（F =7.005，P =0.000）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后的大脑中动脉、大脑前动脉、大脑后动脉血流速度差值均高于对照组（P <0.05）。研究组治疗前后的左、右手握拳对侧初级运动区激活体积差值均高于对照组（P <0.05）。研究组治疗前后的脑源性神经营养因子、胶质纤维酸性蛋白、5-羟色胺差值均高于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 rTMS治疗产后轻中度抑郁效果显著，可改善患者脑部血流动力学，激活大脑皮层，改善脑神经因子分泌，安全可靠。

Abstract:

Objective To investigate the efficacy of repeated transcranial magnetic stimulation (rTMS) in the treatment of postpartum patients with mild to moderate depression and its influences on cerebral hemodynamics and activation of the primary motor area.Methods Eighty-four patients with postpartum mild to moderate depression admitted to Shenzhen Traditional Chinese Medicine Hospital from February 2020 to February 2023 were selected, and they were divided into the control group and the study group by the random number table method, with 42 cases in each group. The control group was treated with antidepressant drugs, and the study group was treated with rTMS on the basis of the antidepressant drugs. The therapeutic efficacy was evaluated after 8 weeks of treatment. The disease condition, clinical efficacy, cerebral hemodynamic indexes, activation of the primary motor area, brain-derived proteins and adverse reactions were compared between the two groups.Results The Hamilton Depression Scale (HAMD) scores in the two groups before treatment, and 4 weeks and 8 weeks after treatment were compared, which showed that there were statistically significant differences in HAMD scores at different time points (F = 8.013, P = 0.000) and between the two groups (F = 7.429, P = 0.000), and that there were statistically significant differences in the change trends of HAMD scores between the two groups (P < 0.05). The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of blood flow velocity of the middle cerebral artery, anterior cerebral artery and posterior cerebral artery before and after treatment in the study group were higher than those in the control group (P < 0.05). The differences of the volume of the activated contralateral primary motor area induced by right and left fist clenching before and after treatment were higher in the study group than in the control group (P < 0.05). The differences of levels of brain-derived neurotrophic factor, glial fibrillary acidic protein and 5-hydroxytryptamine before and after treatment in the study group were higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions rTMS is effective in the treatment of postpartum patients with mild to moderate depression, which can improve cerebral hemodynamics, activate cerebral cortex and promote the secretion of brain-derived proteins with being safe and reliable.