摘要目的 探讨重复经颅磁刺激θ短阵快速脉冲刺激(TBS)模式联合文拉法辛治疗对抑郁症首次发病患者疗效、认知功能及安全性的影响.方法 符合美国精神障碍诊断与统计手册第4版诊断标准的抑郁症首次发病患者43例,采用随机数字表法随机分为TBS组(21例)和伪刺激组(22例),2组患者均接受盐酸文拉法辛缓释片(150～ 300) mg/d治疗.TBS组接受左侧背外侧前额叶皮质经颅磁刺激,伪刺激组线圈放置与头皮呈90度,其他参数的设置与研究组一致,治疗4周.治疗前及治疗第2、4周末应用汉密尔顿抑郁量表(HAMD-24)评估患者的临床症状,治疗前和治疗第4周末应用威斯康星卡片分类测验(WCST)和持续性操作测验(CPT)评估患者的执行功能和注意功能.结果 治疗前,TBS组与伪刺激组的HAMD评分差异无统计学意义[(38.2±7.1)vs.(37.5±6.8),t=0.314,P=0.754];治疗第2、4周末,TBS组HAMD评分减分值均高于对照组[(20.5±4.8)vs.(16.1±5.9),(30.3±5.2)vs.(26.0±6.3)],差异有统计学意义(t=2.547,P=0.015;t=2.318,P=0.026).治疗第2周末,TBS组显效率(57.9％)高于伪刺激组(25％),差异有统计学意义(x2=4.358,P=0.037);治疗第4周末,TBS组显效率为和治愈率(94.7％和78.9％)均高于伪刺激组(65％和45％),差异有统计学意义(x2=5.284,P=0.021;x2=4.744,P=0.029).治疗第4周末,TBS组WCST的完成分类数、正确应答数、错误应答数、持续性错误、非持续性错误的改善优于伪刺激组,CPT1、CPT2、CPT3的改善也优于伪刺激组,差异有统计学意义(P＜0.05).结论 相对于单一应用抗抑郁药物治疗,联合应用θ短阵快速脉冲经颅磁刺激治疗抑郁症首次发病患者起效快,疗效好,对执行功能和注意功能改善更显著.

abstractsObjective To evaluate the antidepressant efficacy,cognitive effect and safety of theta-burst transcranial magnetic stimulation (TBS) in treatment of first-episode depression.Methods 43 hospitalized patients with first-episode depression meeting with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ) were randomly divided into theta-burst stimulation group (TBS group,n=21) and sham-stimulation group(sham group,n=22).All patients were treated at left dorsolateral prefrontal cortex (DLPFC) for 4 weeks,and were concomitantly taking venlafaxine (150-300)mg/d.Hamilton Depression Scale-24 was used to assess the severity of depression before treatment,at week 2 and week 4 in both groups.Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) were used to estimate cognitive function of depression before and after treatment.Results There was no difference on HAMD score before treatment between two groups((38.2±7.1) vs.(37.5±6.8),t=0.314,P=0.754).The reduction of HAMD score in TBS group showed significantly faster than that in sham group at week 2 ((20.5±4.8)vs.(16.1±5.9),t=2.547,P=0.015) and week 4((30.3±5.2) vs.(26.0± 6.3),t=2.318,P=0.026).After 2-week stimulation,the response rate was higher in TBS group than that in sham group (57.9％vs.25％,x2 =4.358,P=0.037).The response and remission rates were significantly higher in TBS group than those in sham group after 4-week stimulation period (94.7％vs.65％,x2=5.284,P=0.021 ;78.9％vs.45％,x2=4.744,P=0.029).The improvements on WCST and CPT after treatment in TBS group,such as categories completed,correct responses,error responses,perseveiative responses errors,nonperseverative responses errors,CPT1,CPT2 and CPT3,were significant than those in sham group (P＜0.05).Conclusions Theta-burst stimulation of the left dorsolateral prefrontal cortex is safe and well-tolerated,while offering the potential to enhance early effects and modulate cognition in first-episode depressive patients.