深部经颅磁刺激联合草酸艾司西酞普兰治疗抑郁症的疗效：一项随机对照试验

doi:10.12114/j.issn.1007-9572.2023.0555

中国全科医学 ›› 2024, Vol. 27 ›› Issue (17): 2098-2103.DOI: 10.12114/j.issn.1007-9572.2023.0555

深部经颅磁刺激联合草酸艾司西酞普兰治疗抑郁症的疗效：一项随机对照试验

庞兰¹, 李佩璠¹, 朱晓岗², 杨再红¹, 郑蕾¹^,^*()

1．550004　贵州省贵阳市，贵州医科大学附属医院精神科
2．550004　贵州省贵阳市，贵州医科大学附属医院神经电生理中心

收稿日期:2023-09-01 修回日期:2023-11-06 出版日期:2024-06-15 发布日期:2024-03-22
通讯作者: 郑蕾
作者贡献：庞兰负责研究的构思与设计、数据收集、数据整理、统计学处理、结果分析与解释、绘制图表、论文撰写；李佩璠负责研究的实施与可行性进行分析，并对论文进行审校；朱晓岗及杨再红负责数据收集、数据整理；郑蕾负责研究的构思与设计、研究的实施与可行性分析、文章的质量控制及审校，对文章整体负责并进行监督管理及论文修订工作。
基金资助:
国家自然科学基金资助项目(82060651); 贵州医科大学附属医院博士研究基金(GYFYBSKY-2021-67)

Deep Transcranial Magnetic Stimulation Combined with Escitalopram Oxalate in the Treatment of Depression: a Randomized Controlled Trial

PANG Lan¹, LI Peifan¹, ZHU Xiaogang², YANG Zaihong¹, ZHENG Lei¹^,^*()

1. Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
2. Center for Neuroelectrophysiology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China

Received:2023-09-01 Revised:2023-11-06 Published:2024-06-15 Online:2024-03-22
Contact: ZHENG Lei

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摘要/Abstract

摘要： 背景抑郁症是一种常见精神疾病，目前治疗手段有限，深部经颅磁刺激（dTMS）作为一种新型非侵入性神经调控技术，已经被运用于重度抑郁症（MDD）的治疗，但临床研究证据较少。目的探究dTMS联合草酸艾司西酞普兰（Esc）治疗抑郁症的临床疗效，为dTMS治疗抑郁症患者进一步提供可靠的数据参考。方法选取2021年12月—2023年1月就诊于贵州医科大学附属医院精神科的73例抑郁症患者为研究对象，按随机数字表法分为药物对照组35例、联合治疗组38例。药物对照组患者给予Esc（第1周10 mg/d，第2周起20 mg/d，连续2周），联合治疗组患者在药物对照组治疗基础上给予dTMS治疗[左侧背外侧前额叶（DLPFC）为刺激靶点，18 Hz，120%MT，1 980次/d，一共2周，总计10次]。分别于治疗开始前及治疗2周后应用汉密尔顿抑郁量表（HAMD）、贝克自杀意念量表（BSS）、蒙特利尔认知评估量表（MoCA）及基于言语流畅性任务（VFT）期间的功能性近红外光谱成像仪（fNIRS）测量的前额叶平均氧合血红蛋白（oxy-Hb）浓度变化对两组患者的抑郁症状及认知功能改善情况进行评定。结果实际完成试验的药物对照组30例、联合治疗组31例。联合治疗组患者治疗后HAMD、BSS评分低于药物对照组，MoCA评分高于药物对照组（P<0.05）。两组患者治疗后HAMD、BSS评分低于组内治疗前，MoCA评分高于组内治疗前（P<0.05）。两组患者治疗后前额叶皮质未见明显激活。联合治疗组患者治疗后抑郁症状及认知功能改善情况优于药物对照组。结论 dTMS联合Esc治疗较单独Esc治疗能更好地改善抑郁症患者抑郁症状及认知功能。

关键词: 抑郁症, 深部经颅磁刺激, 近红外光谱成像, 认知功能, 治疗结果

Abstract:

Background

Depression is a common psychiatric disorder with limited treatment options. Deep transcranial magnetic stimulation (dTMS), as a new non-invasive neuromodulation technique, has been utilized in the treatment of major depressive disorder (MDD), but there is less evidence from clinical studies.

Objective

To explore the clinical efficacy of dTMS combined with escitalopram oxalate (Esc) in the treatment of depression, and provide further reliable data reference for dTMS in the treatment of depression patients.

Methods

A total of 73 patients with depression who attended Department of Psychiatry, Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group (n=35) and combined treatment group (n=38) according to the random number table. Patients in the control group were given Esc ( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks). The combined treatment group received the treatment of dTMS (left DLPFC as the stimulation target, 18 Hz, 120%MT, 1 980 times per day for 2 weeks, 10 times in total) based on the same treatment for the control group. The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale (HAMD), Beck Scale for Suicide Ideation (BSS), Montreal Cognitive Assessment Scale (MoCA) and the mean oxygenated hemoglobin (oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy (fNIRS) based on the verbal fluency text (VFT) task.

Results

The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group. After treatment, the HAMD and BSS scores of the combined treatment group were lower than those of the control group, and the MoCA score was higher than that of the control group (P<0.05). After treatment, the HAMD and BSS scores of patients in the two groups were lower than those before treatment, and the MoCA score was higher than that before treatment (P<0.05). There was no significant activation of the prefrontal cortex after treatment in both groups. The improvement of depression symptoms and cognitive function in the combined treatment group was better than that in the control group.

Conclusion

The combination of dTMS and Esc can improve the depressive symptoms and cognitive function better than Esc treatment alone in depression patients.

Key words: Depressive disorder, Deep transcranial magnetic stimulation, Near-infrared spectroscopy imaging, Cognitive function, Treatment outcome

庞兰,李佩璠,朱晓岗,等. 深部经颅磁刺激联合草酸艾司西酞普兰治疗抑郁症的疗效：一项随机对照试验[J]. 中国全科医学, 2024, 27(17): 2098-2103. DOI: 10.12114/j.issn.1007-9572.2023.0555.
PANG Lan,LI Peifan,ZHU Xiaogang, et al. Deep Transcranial Magnetic Stimulation Combined with Escitalopram Oxalate in the Treatment of Depression: a Randomized Controlled Trial[J]. Chinese General Practice, 2024, 27(17): 2098-2103. DOI: 10.12114/j.issn.1007-9572.2023.0555.

图/表 6

图1 26通道的探头位置和通道的设置注：根据Brodmann脑区显示前额叶皮质内26个感觉区（从通道1到通道26）；VLPFC=腹外侧前额叶，DLPFC=背外侧前额叶，FPPFC=额极前额叶。

Figure 1 Locations of the probes and channel settings in 26-channel near-infrared spectroscopy

图2 VFT任务图注：分为30 s的任务前期，60 s的任务期（等分为每个子任务15 s），60 s的任务后期。

Figure 2 Verbal fluency task map

表1 治疗前两组患者一般资料、抑郁症状及认知功能的比较

Table 1 Comparison of general information，depressive symptoms and cognitive function between the two groups before treatment

组别	例数	性别（男/女）	年龄[M（P₂₅，P₇₅），岁]	受教育年限[M（P₂₅，P₇₅），年]	病程[M（P₂₅，P₇₅），月]	发病年龄[M（P₂₅，P₇₅），岁]
药物对照组	30	9/21	20.5（18.0，24.5）	12.5（12.0，16.0）	19.0（2.8，33.0）	18.5（16.0，24.5）
联合治疗组	31	11/20	21.0（19.0，24.0）	14.0（12.0，16.0）	24.0（8.0，37.0）	19.0（17.0，22.0）
Z（χ²）值		0.208^a	-0.944	-0.588	-0.224	-0.615
P值		0.648	0.345	0.557	0.823	0.538

表2 两组患者治疗前后HAMD、BSS、MoCA评分比较（±s，分）

Table 2 Comparison of HAMD，BSS，and MoCA scores before and after treatment between the two groups of patients

组别	例数	HAMD评分				BSS评分				MoCA评分
组别	例数	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值
药物对照组	30	27.5±3.7	19.5±4.8	15.360	<0.001	19.8±7.7	13.0±8.7	6.959	<0.001	23.8±1.6	26.6±1.8	-8.445	<0.001
联合治疗组	31	27.7±4.1	16.9±4.0	19.505	<0.001	18.7±7.7	7.4±7.4	8.430	<0.001	23.7±1.3	27.9±1.0	-18.432	<0.001
t值		0.177	-2.259			-0.553	-2.733			-0.417	3.698
P值		0.860	0.028			0.583	0.008			0.678	0.001

表3 两组患者治疗前后HAMD、BSS、MoCA评分变化值比较（±s，分）

Table 3 Comparison of the change values of HAMD，BSS，and MoCA scores before and after treatment in the two groups of patients

组别	例数	HAMD评分变化值	BSS评分变化值	MoCA评分变化值
药物对照组	30	8.0±2.9	6.8±5.4	2.8±1.8
联合治疗组	31	10.7±3.1	11.4±7.5	4.3±1.3
t值		3.576	2.737	3.811
P值		0.001	0.008	<0.001

图3 两组患者治疗前后前额叶皮质激活情况注：A为联合治疗组治疗前，B为药物对照组治疗前，C为联合治疗组治疗后，D为药物对照组治疗后[根据两组患者前额叶26通道平均氧合血红蛋白（oxy-Hb）浓度所绘制患者治疗前后言语流畅性任务（VFT）中前额叶皮质的激活情况，颜色比例描绘了26个通道平均oxy-Hb值变化范围为-2.5~1.0 μmol×mm]。

Figure 3 Activation of prefrontal cortex before and after treatment in the two groups

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深部经颅磁刺激联合草酸艾司西酞普兰治疗抑郁症的疗效：一项随机对照试验

Deep Transcranial Magnetic Stimulation Combined with Escitalopram Oxalate in the Treatment of Depression: a Randomized Controlled Trial

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