重复经颅磁刺激联合舍曲林对产后抑郁症患者抑郁症状及外周血相关miR表达的影响

刘文娟; 宋明芬; 王伟; 刘学军

doi:10.16766/j.cnki.issn.1674-4152.001831

重复经颅磁刺激联合舍曲林对产后抑郁症患者抑郁症状及外周血相关miR表达的影响

doi: 10.16766/j.cnki.issn.1674-4152.001831

杭州市第七人民医院临床心理科，浙江杭州 310013

基金项目:

国家自然科学基金 81601183

详细信息

通讯作者:
刘文娟，E-mail：jiejiagui621057@163.com

中图分类号: R395.6 R454.1
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- 文章访问数: 183
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-24
- 网络出版日期: 2022-02-19

Effects of repetitive transcranial magnetic stimulation combined with sertraline on depressive symptoms and related miR-expression in peripheral blood of patients with postpartum depression

Department of Clinical Psychology, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的探究重复经颅磁刺激联合舍曲林对产后抑郁症(PPD)患者抑郁症状及外周血miR-195、miR-124表达的影响。方法选取2017年6月—2019年10月杭州市第七人民医院PPD患者96例, 按简单随机化法分为联合组、对照A组、对照B组, 各32例。对照A组予以舍曲林(第1周50 mg/d, 1周后增至100 mg/d), 对照B组予以重复经颅磁刺激(1次/d, 5次/周), 联合组予以重复经颅磁刺激联合舍曲林, 均治疗8周。比较3组疗效与治疗前后抑郁(EPDS)评分、生活质量(GQOLI-74)评分、血浆miR-195和miR-124表达、血清神经递质水平。结果联合组总有效率为93.75%, 高于对照A组、对照B组(均P＜0.05);治疗8周后联合组血浆miR-195表达水平(0.15±0.07)及血清NE、5-HT、E₂水平[(23.05±4.11)、(239.57±12.24)、(176.98±14.13)ng/L]高于对照A组[0.11±0.05、(17.18±3.09)ng/L、(214.06±15.37)ng/L、(149.13±11.50)ng/L]、对照B组[0.09±0.06、(16.34±3.28)ng/L、(207.81±13.62)ng/L、(145.09±12.72)ng/L], 血浆miR-124表达水平(0.11±0.05)及血清P水平[(21.87±3.16)ng/L]低于对照A组[0.17±0.06、(30.65±4.24)ng/L]、对照B组[0.20±0.09、(31.98±4.09)ng/L, 均P＜0.05];治疗8周后联合组GQOLI-74评分高于对照A组、B组, EPDS评分低于对照A组、B组(均P＜0.05)。结论重复经颅磁刺激联合舍曲林治疗PPD患者, 可调节血清神经递质、性激素水平及血浆miR-195、miR-124表达, 降低EPDS评分, 改善生活质量, 疗效显著。
- 重复经颅磁刺激 /
- 舍曲林 /
- 产后抑郁症 /
- 爱丁堡产后抑郁量表 /
- miR-195 /
- miR-124
Abstract: Objective To investigate the effects of repeated transcranial magnetic stimulation combined with sertraline on the depressive symptoms and expression of peripheral blood miR-195 and miR-124 in patients with postpartum depression (PPD). Methods A total of 96 patients with PPD were selected from June 2017 to October 2019 in Hangzhou Seventh People's Hospital. They were divided into a combined group, control group A and control group B via a simple randomization method, 32 cases in each group. Control group A was given sertraline (50 mg/d at 1 week, which was increased to 100 mg/d after 1 week), whereas control group B was given transcranial magnetic stimulation (1 time/d, 5 times/week).The combined group was treated with repeated transcranial magnetic stimulation and sertraline. All patients were treated for 8 weeks. The efficacy and depression score (EPDS), quality of life (GQOLI-74) score, plasma miR-195 and miR-124 expressions and levels of serum neurotransmitters before and after treatment among the three groups were compared. Results The total effective rate of the combined group (93.75%) was significantly higher than that of control group A (71.88%) and control group B (68.75%, all P < 0.05). After 8 weeks of treatment, the plasma miR-195 expression[(0.15±0.07) ng/L] and serum NE[(23.05±4.11) ng/L], 5-HT[(239.57±12.24) ng/L], and E2[(176.98±14.13) ng/L] levels of the combined group were higher than those of control group A[0.11±0.05, (17.18±3.09)ng/L, (214.06±15.37)ng/L and (149.13±11.50) ng/L, respectively] and control group B[0.09±0.06, (16.34±3.28)ng/L, (207.81±13.62)ng/L and (145.09±12.72) ng/L, respectively]. Moreover, plasma miR-124 expressions[(0.11±0.05) ng/L] and serum P levels[(21.87±3.16) ng/L] of the combined group were lower than those of control group A[0.17±0.06 and (30.65±4.24) ng/L, respectively] and control group B[0.20±0.09 and (31.98±4.09) ng/L, all P < 0.05]. After 8 weeks of treatment, the GQOLI-74 score of the combined group was higher than that of control groups A and B, and the EPDS score was lower than that of control groups A and B (all P < 0.05). Conclusion Repeated transcranial magnetic stimulation combined with sertraline for the treatment of patients with PPD can regulate the levels of serum neurotransmitters, sex hormones and the expression levels of miR-195 and miR-124 in plasma, reduce the EPDS score and improve the quality of life of patients.
- Repetitive transcranial magnetic stimulation /
- Sertraline /
- Postpartum depression /
- Edinburgh postpartum depression scale /
- miR-195 /
- miR-124

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表 1 3组PPD患者一般资料比较[例(%)]

组别	例数	年龄(x±s, 岁)	体重指数(x±s)	病程(x±s, 月)	产妇类型			分娩类型
组别	例数	年龄(x±s, 岁)	体重指数(x±s)	病程(x±s, 月)	初产妇	经产妇		顺产	手术产
对照A组	32	27.85±2.36	21.90±1.75	3.28±0.47	20(62.50)	12(37.50)		19(59.38)	13(40.63)
对照B组	32	28.03±2.71	22.04±1.90	3.35±0.54	21(65.63)	11(34.38)		20(62.50)	12(37.50)
联合组	32	28.26±2.90	22.17±1.84	3.41±0.60	19(59.38)	13(40.63)		18(56.25)	14(43.75)
统计量		0.190^a	0.174^a	0.466^a	0.267^b			0.259^b
P值		0.827	0.841	0.629	0.875			0.879

组别	例数	病情程度					文化程度
组别	例数	轻度	中度	重度			大专及以上	高中	初中
对照A组	32	12(37.50)	14(43.75)	6(18.75)			10(31.25)	14(43.75)	8(25.00)
对照B组	32	13(40.63)	12(37.50)	7(21.88)			11(34.38)	12(37.50)	9(28.13)
联合组	32	11(34.38)	13(40.63)	8(25.00)			9(28.13)	13(40.63)	10(31.25)
统计量		0.606^b					0.576^b
P值		0.962					0.966
注：^a为F值，^b为χ²值。

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表 2 3组PPD患者总有效率比较[例(%)]

组别	例数	无效	好转	显著好转	痊愈	总有效
联合组	32	2(6.25)	5(15.63)	7(21.88)	18(56.25)	30(93.75)
对照A组	32	9(28.13)	4(12.50)	5(15.63)	14(43.75)	23(71.88)^a
对照B组	32	10(31.25)	6(18.75)	4(12.50)	12(37.50)	22(68.75)^a
注：经校正后检验水准α=0.025，与联合组比较，^aP < 0.025。

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表 3 3组PPD患者EPDS、GQOLI-74评分比较(x ±s，分)

组别	例数	EPDS评分		GQOLI-74评分
组别	例数	治疗前	治疗8周后	治疗前	治疗8周后
联合组	32	18.69±3.37	6.35±1.40^a	170.84±10.27	206.30±14.16^a
对照A组	32	19.52±2.94	9.24±1.85^ab	172.63±9.75	189.68±12.53^ab
对照B组	32	19.03±3.16	10.12±2.07^ab	171.45±10.60	185.46±13.42^ab
F值		0.689	38.628	0.254	21.677
P值		0.505	＜0.001	0.776	＜0.001
注：与本组治疗前比较，^aP＜0.05；与联合组比较，^bP＜0.05。

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表 4 3组PPD患者miR-195、miR-124表达水平比较(x ±s)

组别	例数	miR-195		miR-124
组别	例数	治疗前	治疗8周后	治疗前	治疗8周后
联合组	32	0.04±0.02	0.15±0.07^a	0.27±0.11	0.11±0.05^a
对照A组	32	0.05±0.03	0.11±0.05^ab	0.31±0.08	0.17±0.06^ab
对照B组	32	0.04±0.03	0.09±0.06^ab	0.29±0.10	0.20±0.09^ab
F值		1.455	8.146	1.347	14.197
P值		0.239	＜0.001	0.265	＜0.001
注：与本组治疗前比较，^aP＜0.05；与联合组比较，^bP＜0.05。

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表 5 3组PPD患者血清神经递质指标水平比较(x ±s，ng/L)

组别	例数	NE		5-HT
组别	例数	治疗前	治疗8周后	治疗前	治疗8周后
联合组	32	11.28±1.75	23.05±4.11^a	122.85±16.47	239.57±12.24^a
对照A组	32	10.35±2.14	17.18±3.09^ab	119.97±18.56	214.06±15.37^ab
对照B组	32	10.92±1.96	16.34±3.28^ab	121.41±17.51	207.81±13.62^ab
F值		1.838	34.490	0.216	47.548
P值		0.165	＜0.001	0.806	＜0.001
注：与本组治疗前比较，^aP＜0.05；与联合组比较，^bP＜0.05。

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表 6 3组PPD患者血清性激素指标比较(x ±s，ng/L)

组别	例数	P		E₂
组别	例数	治疗前	治疗8周后	治疗前	治疗8周后
联合组	32	50.16±4.24	21.87±3.16^a	80.74±9.81	176.98±14.13^a
对照A组	32	51.24±5.18	30.65±4.24^ab	82.12±9.16	149.13±11.50^ab
对照B组	32	50.70±4.62	31.98±4.09^ab	81.27±10.35	145.09±12.72^ab
F值		0.423	64.825	0.162	60.231
P值		0.656	＜0.001	0.851	＜0.001
注：与本组治疗前比较，^aP＜0.05；与联合组比较，^bP＜0.05。

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