低频重复经颅磁刺激对难治性抑郁症的疗效及认知功能的影响

摘要

目的:探讨低频重复经颅磁刺激(rTMS)对难治性抑郁症的疗效及认知功能的影响.方法:59例难治性抑郁症患者随机分为研究组和对照组,患者均予艾司西酞普兰片治疗,在此基础上,研究组给予4周rTMS真刺激治疗,对照组给予4周rTMS伪刺激治疗,分别于治疗前及治疗第2、第4周末采用汉密尔顿抑郁量表(HAMD-17项)评定疗效,并采用威斯康星卡片分类测验(WCST)及持续操作测验(CPT)评估认知功能.结果:①治疗后两组HAMD评分比较差异有显著性(P＜0.05),研究组有效率高于对照组(P＜0.05).②WCST评分结果显示,治疗后研究组完成分类数及正确反应数与治疗前相比差异有显著性意义(P均＜0.05),并且与对照组比较差异有显著性(P＜0.05).CPT评分结果显示,治疗前后两组组内及组间比较差异均无显著性(P＞0.05).③治疗后两组均未出现严重不良反应.结论:低频rTMS对难治性抑郁症的治疗有明显的增效作用,安全性高,而且能够改善难治性抑郁症的认知功能.%Objective:To study the efficacy of low frequency repetitive transcranial magnetic stimulation (rTMS) on treatment-resistant depression and cognitive function.Method:Fifty-nine patients with treatment-resistant depression were randomly divided into study group and control group.All patients were given treatment of escitalopram.Then study group were given real rTMS for four weeks,and control group were given unreal rTMS for four weeks.Curative effect was evaluated by Hamilton depression rating scale(HAMD) and cognitive function by Wisconsin card sorting test(WCST) and continuous performance test(CPT) at baseline,2 weeks and 4 weeks after rTMS.Result:①There was significant difference between two groups in HAMD after treatment(P＜0.05),the effective rate of study group was 77％,the control group was 48％,there was significant difference(P＜0.05);②The resuits of categories completed and response correct of WCST were significant different between two groups(P＜0.05),but there was no significant difference of the result of CPT between two groups.③There was no obvioust adverse reaction in two groups.Conclusion:Low frequency rTMS has synergistic action on treatment-resistant depression with high safety and can improve the cognitive function of patients with refractory depression.