经颅电刺激联合草酸艾司西酞普兰对脑出血后抑郁症患者神经递质水平及应激指标的影响

Effects of transcranial electrical stimulation and escitalopram oxalate on neurotransmitter levels and stress indicators in individuals with post-hemorrhagic depression

摘要:

目的 探讨经颅电刺激联合草酸艾司西酞普兰在改善脑出血后抑郁症（PHD）患者神经递质水平和应激指标的临床效果。方法 选取2021年4月—2023年4月在南京医科大学附属淮安第一医院院收治的81例PHD患者为研究对象。采用随机数字表法将患者分为草酸艾司西酞普兰组（ESC组）、经颅电刺激组（tES组）及联合组（小剂量草酸艾司西酞普兰+tES治疗），各27例。评估患者治疗前后的抑郁程度［汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）］、神经递质水平［谷氨酸（Glu）、γ-氨基丁酸（GABA）、5-羟色胺（5-HT）、去甲肾上腺素（NE）］、氧化应激指标［皮质醇（CORT）、脑源性神经营养因子（BDNF）、一氧化氮（NO）、丙二醛（MDA）］、免疫炎症指标［中性粒细胞（Neu）、淋巴细胞计数（Lym）、中性粒细胞/淋巴细胞比值（NLR）、系统性炎症反应指数（SII）］、生活质量评分［脑卒中专用生活质量量表（SS-QOL）、匹兹堡睡眠质量指数（PSQI）］，并评估治疗的安全性。结果 联合组治疗前后HAMA、HAMD的差值均高于ESC组、tES组（P <0.05）。联合组治疗前后Glu、GABA、5-HT、NE的差值均高于ESC组、tES组（P <0.05）。联合组治疗前后CORT、BDNF、NO、MDA的差值均高于ESC组、tES组（P <0.05）。联合组治疗前后Neu、Lym、SII的差值均高于ESC组、tES组（P <0.05）。联合组治疗前后SS-QOL、PSQI的差值均高于ESC组、tES组（P <0.05）。结论 经颅电刺激联合草酸艾司西酞普兰治疗PHD能有效改善患者的抑郁症状，提高神经递质水平，降低应激反应，改善免疫炎症状态，提升生活质量。且经颅电刺激能减少草酸艾司西酞普兰的用量，值得临床推广应用。

Abstract:

Objective To investigate the clinical efficacy of transcranial electrical stimulation (tES) combined with escitalopram oxalate in improving neurotransmitter levels and stress indicators in patients with post-hemorrhagic depression (PHD).Methods From April 2021 to April 2023, the 81 PHD patients admitted to our hospital were selected for the study. They were randomly assigned into the ESC group (normal dose of escitalopram oxalate), the tES group (tES treatment), and the combination group (low dose of escitalopram oxalate plus tES treatment) by the random number table method, with 27 patients in each group. The depression severity [Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) ], neurotransmitter levels [glutamate (Glu), γ-aminobutyric acid (GABA), 5-hydroxytryptamine (5-HT), norepinephrine (NE) ], oxidative stress indicators [cortisol (CORT), brain-derived neurotrophic factor (BDNF), nitric oxide (NO), malondialdehyde (MDA) ], immune-inflammatory indicators [neutrophil count (Neu), lymphocyte count (Lym), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) ], and quality of life scores [Stroke-Specific Quality of Life Scale (SS-QOL), Pittsburgh Sleep Quality Index (PSQI) ] were assessed before and after treatment. The safety of the treatments was also evaluated.Results The pre- to post-treatment differences in HAMA and HAMD scores were significantly greater in the combination group compared with the ESC and tES groups. Similarly, the combination group showed greater changes in Glu, GABA, 5-HT, and NE levels; CORT, BDNF, NO, and MDA levels; Neu, Lym, and SII values; as well as SS-QOL and PSQI scores, compared with the other two groups.Conclusion The tES combined with escitalopram oxalate effectively alleviates depressive symptoms in patients with PHD, increases neurotransmitter levels, attenuates stress responses, improves immune-inflammatory status, and enhances quality of life. Moreover, tES allows for a reduction in the required dose of escitalopram, making this combination therapy worthy of clinical promotion and application.