观察不同模式重复经颅磁刺激对卒后抑郁患者的疗效以及血清相关指标的影响

To Observe the Effect of Repeated Transcranial Magnetic Stimulation with Different Modes on the Patients with Post-Stroke Depression and the Influence of Serum Related Indexes

摘要: 目的：探讨不同模式重复经颅磁刺激(repetitive Transcranial Magnetic Stimulation, rTMS)对脑卒中后抑郁(Post-stroke depression, PSD)患者的治疗效果，并观察其对血清相关指标的影响。方法：纳入2022年9月到2023年12月确诊的87例患者。所有患者均接受脑卒中常规治疗、口服度洛西汀抗抑郁药物治疗。按照双盲随机对照试验方案分为三组，高频rTMS组(刺激频率10 HZ，左侧DLPFC + 度洛西汀)、低频rTMS组(刺激频率1 HZ，右侧DLPFC + 度洛西汀)、对照组(假线圈刺激治疗 + 度洛西汀)，1次/天，5天/周，共治疗4周。于治疗前、治疗后4周测量汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数量表(PSQI)、血清BDNF及IL-6水平。结果：三组患者治疗后的HAMD评分、PSQI评分均低于本组治疗前，差异有统计学意义(P < 0.05)；三组患者的IL-6水平较治疗前均降低，BDNF水平较治疗前均升高，差异有统计学意义(P < 0.05)；通过组间比较发现，高频组在改善HAMD评分、血清BDNF及IL-6水平上与其他两组对比更优，且差异具有统计学意义(P < 0.05)；而低频组在改善PSQI评分方面较其他两组更有优势，差异有统计学意义(P < 0.05)。结论：rTMS治疗PSD有确切疗效，患者接受性较高，且高频rTMS刺激左侧DLPFC改善抑郁状态效果优于低频rTMS刺激右侧DLPFC，其作用机制可能与治疗后BDNF水平升高，IL-6水平降低相关。且本研究还发现低频rTMS刺激右侧DLPFC改善睡眠质量方面优于高频rTMS刺激左侧DLPFC。

Abstract: Objective: To observe the efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) in patients with post stroke depression (PSD), and to observe its influence on serum related indexes. Methods: 87 patients of PSD were enrolled prospectively in the department of rehabilitation from September 2020 to December 2023, and were divided into 3 groups according to the random number table: patients of the 3 groups received routine rehabilitation training, high frequency group (10 Hz rTMS, l-DLPFC + duloxetine), low frequency group (1 Hz rTMS, r-DLPFC + duloxetine) and control group (sham stimulation + duloxetine), 1 time/day, 5 times/week, for 4 consecutive weeks. The Hamilton Depression Scale-17 (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and serum BDNF and IL-6 levels were measured before treatment and 4 weeks after treatment. Results: The HAMD scores and PSQI scores in the three groups after treatment were lower than those before treatment, and the differences were statistically significant (P < 0.05). The levels of IL-6 in the three groups decreased and the levels of BDNF increased after treatment, and the differences were statistically significant (P < 0.05). Through group comparison, it was found that the high-frequency group had significantly better improvement in HAMD scores, serum BDNF levels, and IL-6 levels compared with the other two groups, and the differences were statistically significant (P < 0.05). The low-frequency group showed significantly better improvement in PSQI scores compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions: rTMS has a definite therapeutic effect on post-stroke depression, with a high patient acceptance. High-frequency rTMS on the l-DLPFC has a better therapeutic effect on depression than low-frequency rTMS on the r-DLPFC, and its mechanism may be related to increased levels of BDNF and decreased levels of IL-6 after treatment. Additionally, this study suggests that low-frequency rTMS on the r-DLPFC has a better improvement in sleep quality compared with high-frequency rTMS on the l-DLPFC.