摘要目的:与传统非精准定位左侧背外侧前额叶（dorsolateral prefrontal cortex，DLPFC）相比，探索精准定位是否可以提高重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗抑郁症的疗效，以及右侧眶额叶（right orbital frontal cortex，rOFC）靶点的疗效。方法:将2018年1月至2021年3月在上海市精神卫生中心招募的符合DSM-Ⅳ抑郁症诊断标准的患者分为3组：非精准DLPFC组（19例）作为对照组，精准DLPFC组（19例）和rOFC组（14例）作为试验组。3组在基线和10次rTMS治疗后接受HAMD 17和HAMA评估，以HAMD 17有效率为主要评估指标，以HAMD 17和HAMA减分、减分率等为次要评估指标，采用卡方检验或方差分析比较3组rTMS治疗的疗效差异。 结果:基线时3组HAMD 17和HAMA评分差异均无统计学意义。rTMS治疗后，3组HAMD 17有效率差异有统计学意义（χ2=6.86， P=0.032），精准DLPFC组有效率（74%）显著高于非精准DLPFC组（32%，χ2=6.76， P=0.011），而与rOFC组（57%）比较差异无统计学意义（χ2=2.16， P=0.133），非精准DLPFC组和rOFC组差异无统计学意义（χ2=0.99， P=0.266）。精准DLPFC组HAMD 17减分最高，非精准DLPFC组与rOFC组相当，3组患者HAMD 17减分差异接近有统计学意义（ F=2.95， P=0.062）。3组HAMA减分、HAMA减分率和HAMD 17减分率差异均无统计学意义。 结论:精准定位DLPFC可能是提高rTMS治疗抑郁症疗效的有效手段，rOFC靶点可能是rTMS治疗抑郁症的候选靶点。

abstractsObjective:Compared to imprecisely repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC), this study aimed to explore whether localizing the DLPFC precisely or targeting on the right orbital frontal cortex (rOFC) can improve the rTMS efficacy for the treatment of depressive disorder.Methods:From January 2018 to March 2021, this study recruited patients who met the DSM-Ⅳ diagnostic criteria for depressive disorder in Shanghai Mental Health Center. Nineteen patients were located in the imprecise DLPFC group, 19 patients in the precise DLPFC group, and 14 patients in the rOFC group. All patients were assessed by the 17-item Hamilton Depression Scale (HAMD 17) and Hamilton Anxiety Scale (HAMA) at baseline and after 10-session rTMS treatments. The primary outcome of this study was the HAMD 17 response rate, and the second outcome included the reduction score and reduction ratio of the HAMD 17/HAMA. Results:At baseline, there was no significant group difference in HAMD 17 or HAMA scores among the three groups. After the rTMS treatment, the HAMD 17 response rate was significantly different among the three groups (χ2=6.86, P=0.032). The HAMD 17 response rate in the precise DLPFC group (74%) was significantly higher than that in the imprecise DLPFC group (32%, χ2=6.76, P=0.011), but was comparable with that in the rOFC group (57%, χ2=2.16, P=0.133). HAMD 17 response rate did not significantly differ between the precise DLPFC group and the rOFC group (χ2=0.99, P=0.266). The HAMD 17 reduction score tended to be significantly different among the three groups ( F=2.95, P=0.062), with the precise DLPFC group presented the highest HAMD 17 reduction score. There were no significantly differences in the reduction score of HAMD and the reduction ratio of HAMA and HAMD 17 among the three groups. Conclusions:Precisely localizing the DLPFC target may be helpful to improve the rTMS efficacy for the treatment of depressive disorder, while rOFC may be a candidate target for rTMS treatment of the depressive disorder.