目的 通过采集行为学和脑电数据,考察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对首发抑郁症患者的疗效及对执行功能的影响,初步探讨rTMS治疗抑郁症患者潜在的认知神经影响的机制.方法 采用随机数字表法将首发抑郁症患者分为试验组(n=26)和对照组(n=25),试验组患者进行8周的rTMS联合药物治疗,对照组患者仅进行单纯药物治疗.于干预前和干预后采用汉密尔顿抑郁量表24(24-item Hamilton depres-sion rating scale,HAMD-24)、汉密尔顿焦虑量表 14(14-item Hamilton anxiety rating scale,HAMA-14)以及行为学工具和事件相关电位(event-related potential,ERP)评估患者的抑郁焦虑状态和执行功能的变化.结果 两组抑郁症患者治疗后的HAMD-24评分和HAMA-14评分较干预前均显著下降(P均＜0.001),且试验组患者HAMD-24评分显著低于对照组(P＜0.05).Go/Nogo任务中,两组抑郁症患者Nogo条件正确应答数较干预前均明显提升(P均＜0.05);Stroop任务中,试验组抑郁症患者不一致条件的正确应答数较干预前明显提升,不一致条件反应时较干预前明显变短,且试验组抑郁症患者不一致条件的正确应答数较对照组明显提升、不一致条件反应时明显变短(P均＜0.05).脑电指标中,试验组抑郁症患者干预后较干预前诱发了更大的Nogo N2波幅和P3波幅(P均＜0.05);试验组抑郁症患者的N2差异波波幅和P3差异波波幅显著大于对照组(P均＜0.05).结论 rTMS可以加强抑郁症患者的认知神经活动水平,提升执行功能,对抑郁症患者抑郁症状的治疗效果更好.
Effects of Repetitive Transcranial Magnetic Stimulation on Executive Functioning in Patients with First-episode Depression
Objective To investigate the effectiveness and executive function of repetitive transcranial magnetic stimulation(rTMS)on patients with first-episode depression by means of collecting behavioristics and electroencephalo-gram data,and to preliminary explore the potential cognitive neural mechanism of rTMS treatment in patients with de-pression.Methods Patients with first-episode depression were divided into experimental group(n=26)and control group(n=25)by randomized numerical table,the experimental group was treated with rTMS combined with drug therapy for 8 weeks,and the control group was treated with drug therapy alone.Changes of depression,anxiety and executive function were evaluated by 24-item Hamilton depression rating scale(HAMD-24),14-item Hamilton anxiety rating scale(HAMA-14),behavioral tools and event-related potential(ERP)before and after intervention.Results The scores of HAMD-24 and HAMA-14 of depression patients after treatment were significantly lower in both groups than before inter-vention(all P＜0.001),the score of H AMD-24 in the experimental group was significantly lower than that in the control group(P＜0.05).In the Go/Nogo task,the number of correct responses to Nogo conditions of depression patients in the two groups was significantly higher than that before intervention(all P＜0.05);in the Stroop task,the number of correct responses in inconsistent conditions of depression patients in the experimental group was significantly higher than that be-fore the intervention,and the reaction time in inconsistent conditions of depression patients was significantly shorter than that before the intervention,the number of correct responses to inconsistent conditions of depression patients in the experimental group was significantly higher than that in the control group,and the reaction time to incon-sistent conditions of depression patients was significantly shorter(all P＜0.05).Among the electroencephalogram indica-tors,the experimental group elicited larger Nogo N2 amplitude and P3 amplitude of depression patients after intervention than before intervention(all P＜0.05);the N2 differential wave amplitude and P3 differential wave amplitude of depres-sion patients in the experimental group were significantly higher than those of the control group(all P＜0.05).Conclusion rTMS can enhance the level of cognitive nerve activity and improve executive function of depression patients,which works better for depression patients.
DepressionRepetitive transcranial magnetic stimulationDrug therapyExecutive function
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