摘要
目的探讨磁共振成像(magnetic resonance imaging,MRI)引导下个体化精准定位重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗青少年抑郁症患者抑郁和焦虑症状的有效性、可接受性和安全性。方法选取2023年2—12月于杭州市第七人民医院就诊的80例抑郁症患者作为研究对象。根据随机数字表法分为精准定位组和常规组。精准定位组基于MRI精准定位左侧背外侧前额叶皮质(dorsolateral prefrontal cortex,DLPFC)作为刺激靶点,常规组使用传统“5cm”定位左侧DLPFC。所有患者均每周5次,连续2周,共治疗10次(静息运动阈值90%的刺激强度,刺激频率为10Hz,每次40个脉冲,串间隔10s,60串/d,共2400个脉冲)。评估汉密尔顿抑郁评定量表17(Hamilton depression rating scale 17,HAMD-17)、汉密尔顿焦虑评定量表(Hamilton anxiety rating scale,HAMA)的变化,以HAMD-17、HAMA减分率≥50%为治疗有效。在每日访谈中收集并记录患者的不良反应。结果精准定位组和常规组在基线时HAMD-17、HAMA评分差异无统计学意义(P>0.05);治疗2周后HAMD-17评分、HAMA评分差异有统计学意义(t=3.940,P=0.027;Z=–2.060,P=0.039)。精准定位组抑郁、焦虑症状的有效率分别为81.48%、51.85%,常规组分别为43.33%、23.33%,两组差异均有统计学意义(χ^(2)=8.730,P=0.003;χ^(2)=4.970,P=0.026)。两组均无严重不良事件发生。结论对于青少年抑郁症患者,MRI引导下个体化精准定位的rTMS是一种有效、安全的治疗选择,可快速减轻患者的抑郁、焦虑症状。
Objective To evaluate the safety,tolerability and clinical effects of magnetic resonance imaging(MRI)-guided personalized repetitive transcranial magnetic stimulation(rTMS)in adolescents with depression.Methods Select 80 patients with depression who visited Hangzhou Seventh People’s Hospital from February to December 2023 as the research subjects.According to the random number table method,it is divided into precision localization group and routine group.The precision localization group targeted the left dorsolateral prefrontal cortex(DLPFC)as the stimulus target based on MRI,while the conventional group used the traditional“5cm”to locate the left DLPFC.Treatment of all particioants was administered five times,continues two weeks,per week for a total of 10 sessions(resting motor threshold with 90%,stimulation frequency with 10Hz,40 pulses per session,inter-train interval 10 seconds,60 trains per day,totaling 2400 pulses).Changes of Hamilton depression rating scale 17(HAMD-17)and Hamilton anxiety rating scale(HAMA)were evaluated,with treatment response defined as≥50%reduction in HAMD-17 or HAMA scores.Adverse events were collected and recorded during daily interviews.Results There were no significant differences in baseline HAMD-17 and HAMA scores between precision localization group and routine group(P>0.05).However,after 2 weeks of treatment,there were significant differences in HAMD-17 and HAMA scores(t=3.940,P=0.027;Z=-2.060,P=0.039).The effective rates for depression and anxiety symptoms in precision localization group was 81.48%and 51.85%respectively,and 43.33%and 23.33%respectively in routine group,with statistically significant differences between two groups(χ^(2)=8.730,P=0.003;χ^(2)=4.970,P=0.026).No serious adverse events occurred in two groups.Conclusion For adolescents with depression,rTMS guided by MRI for individualized precise localization is an effective and safe treatment option,rapidly alleviats depressive and anxiety symptoms.
作者
钟怡
刘汉英
辛仲伟
刘晓妍
ZHONG Yi;LIU Hanying;XIN Zhongwei;LIU Xiaoyan(Affiliated Mental Health Center,Zhejiang University School of Medicine,Department of Psychiatry,Hangzhou Seventh People’s Hospital,Hangzhou 310013,Zhejiang,China;Department of Psychiatry,Quzhou Third Hospital,Quzhou 324000,Zhejiang,China)
出处
《中国现代医生》
2024年第24期16-20,共5页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2023KY980)。
关键词
磁共振成像
重复经颅磁刺激
抑郁症
青少年
Magnetic resonance imaging
Repetitive transcranial magnetic stimulation
Depression
Adolescents
