中国临床心理学杂志

反复经颅磁刺激治疗对难治性抑郁症白质微结构整合水平的影响

作者：彭红军¹ 李凌江² 郑会蓉³

单位：1 广州市脑科医院广州 510370
2 中南大学湘雅二医院精神卫生研究所长沙 410011
3 广东省人民医院精神卫生研究所广州 510180

分类号：R395.1

出版年,卷(期):页码：2013,21(4):528-531

摘要：

目的:探讨反复经颅磁刺激治疗(rTMS)对难治性抑郁症白质微结构整合的影响及其与临床疗效的关系。方法:30例难治性抑郁症病人(男19,女11),25例性别、年龄、教育程度等匹配的正常人作为对照组。采用rTMS(15Hz)治疗4周,30例病人采取随机双盲的方法 17例病人进行真刺激治疗,13例进行假刺激治疗。治疗前后分别进行汉密尔顿抑郁量表(HAMD,17项)、贝克抑郁量表(BDI)评估,并进行全脑弥散张量成像扫描。使用基于像素的分析方法比较各向异性分数(FA)。结果:难治性抑郁症左侧额中回(x=-18 y=46 z=-14)白质FA值显著降低(经像素水平FWE校正,P<0.05,像素值>50)。经真刺激治疗后,该脑区降低的FA值显著增高,并且增高的FA值与抑郁症病人降低的BDI及HAMD分值呈正相关;而假刺激组未发现该脑区在治疗后FA值的增高。结论:反复经颅磁刺激可能通过提高左侧额中回白质微结构整合水平达到治疗难治性抑郁症的目的。

Objective: To explore the impact of repetitive transcranial magnetic stimulation (rTMS) on white matter integrity of patients with treatment-resistant depression and the relationship with curative effect. Methods: A double-blind, randomized study was done, in which 30 treatment-resistant unipolar depression patients were compared with 25 age- and gender-matched healthy controls. In these 30 patients, 17 were treated with real stimulation, and 13 were treated with sham stimulation. HAMD and BDI were used to evaluate the severity of depression. Voxel-based analysis (VBA) method was used to evaluate white-matter fractional anisotropy (FA). Results: We found significant decreased white matter FA in the left middle frontal gyrus in TRD patients. And the abnormal FA could be restored by active rTMS treatment, but not by sham one. FA increases were correlated with decreased BDI and HAMD scores. Conclusion: rTMS treatment increases white matter FA in the left middle frontal gyrus in patients with treatment-resistant depression, which may be related to curative effect.

基金项目：

国家自然科学基金(30830046);广州市卫生科技计划项目(2008-YB-219);广东省科技计划项目(2012B031800015);广东省医学科学技术研究基金(A2012523)等资助

作者简介：

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