重复经颅磁刺激联合舍曲林对首发青少年抑郁早期疗效及冷执行功能的影响

陈海思; 高静芳; 王晓乐; 胡希文

doi:10.16766/j.cnki.issn.1674-4152.002631

重复经颅磁刺激联合舍曲林对首发青少年抑郁早期疗效及冷执行功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002631

陈海思¹,
高静芳^{2, 3, ,},
王晓乐³,
胡希文¹

1.
浙江大学医学院附属精神卫生中心，杭州市第七人民医院，浙江杭州 310013
2.
浙江中医药大学第一临床医学院，浙江杭州 310053
3.
浙江中医药大学附属第一医院精神卫生科，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2020KY747

详细信息

通讯作者:
高静芳, E-mail: gjingfang@hotmail.com

中图分类号: R749.41 R749.94
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-07
- 网络出版日期: 2022-11-29

Early effects and impacts on cold executive function of repetitive transcranial magnetic stimulation combined with sertraline in first-episode adolescent depression

1.
Psychosomatic Department, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的探讨重复经颅磁刺激联合舍曲林对首发青少年抑郁症早期抗抑郁作用及冷执行功能的影响。方法选取2021年3—6月杭州市第七人民医院收治的首发青少年抑郁症患者77例，按随机数字法分为研究组(38例)和对照组(39例)。2组均予舍曲林(第1周25 mg/d，2周内增至100 mg/d)，研究组加用2周重复经颅磁刺激治疗(1次/d, 5次/周)。治疗前后采用汉密尔顿抑郁量表(HAMD-17)、儿童抑郁评定量表(CDRS-R)、视听整合持续操作测验(IVA-CPT)及THINC-it评估抑郁症状及冷执行功能。结果研究组早期改善率为92.11%(35/38)，高于对照组的71.79%(28/39，P＜0.05)；治疗第2、4周后，2组HAMD-17及CDRS-R评分较治疗前下降，治疗后研究组评分低于对照组(均P＜0.05)；治疗4周后，研究组注意力商数[听、视、综合分别为(98.24±20.72)分、(90.00±21.97)分、(94.24±21.43)分]高于对照组[(82.62±27.71)分、(78.10±27.85)分、(80.21±24.47)分]，差异有统计学意义(均P＜0.05)；研究组THINC-it中PDQ5及2组Spotter、Symbol Check、Codebreaker、Trails指标明显高于治疗前(均P＜0.05)。结论舍曲林联合重复经颅磁刺激可早期改善首发青少年抑郁症患者的临床症状及冷执行功能。
- 青少年 /
- 抑郁症 /
- 重复经颅磁刺激 /
- 冷执行功能
Abstract: Objective To explore the early effects and impacts on cold executive function of repetitive transcranial magnetic stimulation (rTMS) combined with sertraline in adolescents with first-episode major depressive disorder. Methods A total of 77 adolescent patients with first-episode depression from Hangzhou 7th Hospital were divided into study group (38 cases) and control group (39 cases) by random number method. The control group was treated with sertraline (25 mg/d in first week, up to 100 mg/ d in 2 weeks). The study group was given sertraline combined with rTMS (1 time/d, 5 times/ week). Depressive symptoms and cold executive function before and after treatment were evaluated using Hamilton Depression Scale (HAMD-17), children's Depression Rating Scale (CDRS-R), audiovisual integration continuous operation test (IVA-CPT) and THINC-it. Results The early improvement rate in the study group was 92.11% (35/38), higher than 71.79% (28/39) in the control group (P < 0.05). After 2 and 4 weeks of treatment, the HAMD-17 and CDRs-R scores of the two groups decreased compared with those before treatment, and the scores of the study group were lower than those of the control group after treatment (all P < 0.05). After 4 weeks of treatment, the attention quotient (listening, visual and full-scale) in the study group [(98.24±20.72) points, (90.00±21.97) points, (94.24±21.43) points] was higher than that in the control group [(82.62±27.71) points, (78.10±27.85) points, (80.21±24.47) points], and the difference was statistically significant (all P < 0.05). Both two groups improved statistically significant in Spotter, Symbol Check, Codebreake, and Trails (all P < 0.05). The study group showed significantly higher score in PDQ5 in THINC-it after treatment (P < 0.05). Conclusion Sertraline combined with rTMS can early improve the clinical symptoms and cold executive function of first-episode adolescent depression patients.
- Adolescents /
- Depression /
- Repetitive transcranial magnetic stimulation /
- Cold executive function

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表 1 2组首发青少年抑郁症患者一般资料比较

Table 1. Comparison of general data of two groups of first-episode adolescent depression patients

组别	例数	性别(例)		年龄(x±s，岁)	受教育年限(x±s，年)	病程[M(P₂₅, P₇₅), 月]	首发年龄(x±s，岁)
组别	例数	男性	女性	年龄(x±s，岁)	受教育年限(x±s，年)	病程[M(P₂₅, P₇₅), 月]	首发年龄(x±s，岁)
研究组	38	7	31	14.45±2.19	7.45±2.19	12(6, 36)	12.97±2.59
对照组	39	8	31	14.82±1.60	7.79±1.59	12(6, 18)	13.85±1.73
统计量		0.054^a		0.851^b	0.795^b	-1.528^c	-1.733^b
P值		0.817		0.398	0.430	0.126	0.088
注：^a为χ²值，^b为t值, ^c为Z值。

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表 2 2组首发青少年抑郁症患者早期疗效比较[例(%)]

Table 2. Comparison of early efficacy between the two groups of adolescent patients with first-episode depression [cases (%)]

组别	例数	2周后早期改善	2周后治疗有效	4周后治疗有效
研究组	38	35(92.11)	22(57.89)	23(60.50)
对照组	39	28(71.79)	8(20.51)	9(23.10)
χ²值		5.337	11.309	11.114
P值		0.021	0.001	0.001

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表 3 2组首发青少年抑郁症患者治疗前后HAMD-17及CDRS-R评分比较(x ±s，分)

Table 3. Comparison of HAMD-17 and CRS-R scores before and after treatment in two groups of adolescent patients with first episode depression (x ±s, points)

组别	例数	HAMD-17			CDRS-R
组别	例数	治疗前	治疗2周	治疗4周	治疗前	治疗2周	治疗4周
研究组	38	19.03±3.70	9.87±4.29^a	8.71±4.59^ab	77.00±19.49	55.00±19.66^a	50.45±20.30^ab
对照组	39	18.97±3.45	13.56±4.47^a	13.21±4.91^ab	75.62±13.59	69.18±20.99^a	71.26±21.35^ab
t值		-0.064	3.698	4.149	-0.361	3.057	4.381
P值		0.949	< 0.001	< 0.001	0.719	0.003	< 0.001
注：与同组治疗前比较，^aP＜0.05;与同组治疗2周比较，^bP＜0.05。

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表 4 2组首发青少年抑郁症患者治疗前后IVA-CPT及THINC-it评分比较

Table 4. Comparison of IVA-CPT and THINC-it scores before and after treatment in two groups of first-episode adolescent depression patients

组别	例数	注意力商数(听，x±s，分)		注意力商数(视，x±s，分)		综合注意力商数(x±s，分)		PDQ5[M(P₂₅, P₇₅)，分]
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组	38	70.55±31.24	98.24±20.72^b	70.18±30.73	90.00±21.97^b	98.24±20.72	94.24±21.43^b	-11.50(-16.00, -9.00)	-9.00(-13.00, -6.00)^b
对照组	39	69.03±32.60	82.62±27.71^b	65.00±32.95	78.10±27.85^b	70.87±29.06	80.21±24.47^b	-12.00(-14.00, -9.00)	-11.00(-13.00, -7.00)
统计量		-0.210^a	-2.807^a	-0.714^a	-2.078^a	-0.338^a	-2.674^a	-0.665^c	-1.583^c
P值		0.834	0.006	0.478	0.041	0.736	0.009	0.506	0.113

组别	例数	Spotter[M(P₂₅, P₇₅)，分]		Symbol Check[M(P₂₅, P₇₅)，分]		Codebreaker[M(P₂₅, P₇₅)，分]		Trails[M(P₂₅, P₇₅)，分]
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组	38	0.18(0.03, 0.29)	0.32(0.21, 0.39)^b	0.99(0.81, 1.21)	1.08(0.92, 1.29)^b	45.50(39.00, 53.00)	53.00(46.00, 62.00)^b	-1.40(-1.50, -1.37)	-1.28(-1.37, -1.21)^b
对照组	39	0.20(0.00, 0.30)	0.30(0.10, 0.39)^b	0.99(0.81, 1.17)	1.14(0.96, 1.25)^b	46.00(38.50, 53.50)	49.00(43.00, 57.50)^b	-1.49(-1.62, -1.39)	-1.31(-1.39, -1.19)^b
统计量		-0.082^c	-1.019^c	-0.184^c	-0.526^c	-0.219^c	-0.913^c	-1.895^c	-0.173^c
P值		0.935	0.308	0.854	0.599	0.826	0.361	0.058	0.862
注：^a为t值；与同组治疗前比较，^bP＜0.05；^c为Z值。

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