艾司西酞普兰联合重复经颅磁刺激在卒中后抑郁患者中的疗效分析

doi:10.3760/cma.j.cn441417-20241127-10011

摘要/Abstract

摘要：

目的　观察艾司西酞普兰和重复经颅磁刺激在卒中后抑郁患者中的治疗效果及其对神经递质的影响。方法　采用前瞻性研究方法，选取2023年2月至2024年3月于西北大学附属神木医院神经内科收治的90例卒中后抑郁患者作为研究对象，根据随机数字表法分为研究组和对照组。研究组中49例，男21例、女18例，年龄（58.31±4.26）岁，采用草酸艾司西酞普兰（1次/d，10 mg/次）联合重复经颅磁刺激（1次/d）治疗1个月。对照组中49例，男22例、女17例，年龄（58.82±4.17）岁，采用草酸艾司西酞普兰（1次/d，10 mg/次）治疗1个月。比较两组患者的治疗有效率及汉密尔顿抑郁量表-17（HAMD-17）评分、改良Barthel指数、神经递质水平。采用独立样本t检验、χ2检验进行统计比较。结果　治疗1个月后，研究组患者总有效率为93.88%（46/49），对照组为79.59%（39/49）；研究组患者的HAMD-17评分、改良Barthel指数分别为（8.64±3.28）分、（63.81±3.27）分，对照组分别为（11.13±3.37）分、（55.76±5.64）分；研究组5-羟色胺、去甲肾上腺素水平分别为（110.53±10.24）μg/L、（10.27±1.05）μg/L，对照组分别为（90.79±10.33）μg/L、（8.14±1.13）μg/L；以上指标两组比较，差异均有统计学意义（均P<0.05）。结论　艾司西酞普兰联合重复经颅磁刺激可以提高卒中后抑郁患者的治疗有效率，降低抑郁程度，提高生活能力和神经递质水平。

关键词: 卒中后抑郁, , , 艾司西酞普兰, , , 重复经颅磁刺激, , , 神经递质

Abstract:

Objective　To observe the therapeutic effect of escitalopram and repetitive transcranial magnetic stimulation for patients with post-stroke depression and the effect on their neurotransmitters. Methods　This was a prospective study. Ninety patients with post-stroke depression who were admitted to Department of Neurology, Shenmu Hospital, Northwest University from February 2023 to March 2024 were selected as the study objects, and were divided into a study group and a control group by the random number table method, with 49 cases in each group. There were 21 males and 18 females in the study group; they were (58.31±4.26) years old. There were 22 males and 17 females in the control group; they were (58.82±4.17) years old. The control group took escitalopram once per day, 10 mg per time; the study group took escitalopram and repetitive transcranial magnetic stimulation. Both groups were treated for 1 month. The treatment effective rates, scores of Hamilton Depression Rating Scale-17 (HAMD-17) and modified Barthel index, and levels of neurotransmitter and were compared between the two groups. The independent-sample t and χ² tests were used for the statistical analysis. Results　After one month's treatment, the total effective rate in the study group was higher than that in the control group [93.88% (46/49) vs. 79.59% (39/49)]; the scores of HAMD-17 and modified Barthel index in the study group were better than those in the control group (8.64±3.28 vs. 11.13±3.37 and 63.81±3.27 vs. 55.76±5.64); the levels of serotonin and norepinephrine in the study group were higher than those in the control group [(110.53±10.24) μg/L vs. (90.79±10.33) μg/L and (10.27±1.05) μg/L vs. (8.14±1.13) μg/L]; there were statistical differences in the above indicators between the two groups (all P<0.05). Conclusion　Escitalopram combined with repetitive transcranial magnetic stimulation for patients with post-stroke depression can improve the treatment effective rate and their depression, daily life ability, and levels of neurotransmitters.

Key words: Post-stroke depression, , Escitalopram, , Repetitive transcranial magnetic stimulation, , Neurotransmitters

耿琳罗奋阳马现仓. 艾司西酞普兰联合重复经颅磁刺激在卒中后抑郁患者中的疗效分析 [J]. 国际医药卫生导报, 2025, 31(10): 1637-1640.

Geng Lin, Luo Fenyang, Ma Xiangcang.

Efficacy of escitalopram combined with repetitive transcranial magnetic stimulation for patients with post-stroke depression [J]. International Medicine and Health Guidance News, 2025, 31(10): 1637-1640.

参考文献

[1]刘仕武,卢展宏,陈翠云.注射用重组人TNK组织型纤溶酶原激活剂对急性缺血性脑卒中的有效性及安全性研究[J].中国实用医药,2021,16(5):96-98. DOI:10.14163/j.cnki.11-5547/r.2021.05.036.

[2]张杰,何福培,林蓓蕾,等.脑卒中高危人群抑郁症状潜在类别分析及影响因素研究[J].现代预防医学,2024,51(19):3643-3648. DOI:10.20043/j.cnki.MPM.202405386.

[3]李清金,韩玉惠,洪春永,等.基于抑郁程度、心理痛苦、自理能力分析的脑卒中后抑郁患者自杀倾向的影响因素探讨[J].临床误诊误治,2024,37(5):23-28. DOI:10.3969/j.issn.1002-3429.2024.05.006.

[4]王子东,范习康,耿侯跃,等.卒中后抑郁流行现状及预防[J].江苏预防医学,2024,35(04):501-505.DOI:10.13668/j.issn.1006-9070.2024.04.025.

[5]刘淇丰,王丽娜,郝新梅.草酸艾司西酞普兰联合盐酸度洛西汀治疗抑郁症的临床价值[J].心理月刊,2024,19(18):125-127.DOI:10.19738/j.cnki.psy.2024.18.036.

[6]欧阳泽华,王瑞见,李海军,等.重复经颅磁刺激合并抗抑郁药对难治性抑郁障碍的疗效分析[J].国际精神病学杂志,2024,51(4):1128-1132.DOI:10.13479/j.cnki.jip. 2024. 04.084.

[7]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志,2001,34(3):184-188. DOI:10.3760/j:issn:1006-7884.2001.03.028.

[8]崔元孝.脑血管病的分类与诊断标准[J].山东医药,2004,44(30):62-63.DOI:10.3969/j.issn.1002- 266X.2004.30.055.

[9]高政,刘启贵,姜潮.脑卒中急性期汉密尔顿抑郁评分的多因素分析[J].中国临床康复,2002,6(17):2526-2527. DOI:10.3321/j.issn:1673-8225.2002.17.010.

[10]李翔,俞君,吴晓亚,等.应用改良Barthel指数(MBI)评估上肢离断再植术后日常生活活动能力(ADL)的信度与效度研究[J].实用手外科杂志,2021,35(3):379-381. DOI:10.3969/j.issn.1671-2722.2021.03.033.

[11]汪玲玲,尹正录,张熙斌,等.重复经颅磁刺激联合艾司西酞普兰对脑卒中后抑郁患者睡眠质量及认知功能的影响[J].重庆医学,2021,50(20):3478-3481,3486. DOI:10.3969/j.issn.1671-8348.2021.20.013.

[12]郑力强.艾司西酞普兰联合高频重复经颅磁刺激对缺血性脑卒中后抑郁及神经功能恢复的影响[J].中国健康心理学杂志,2019,27(6):880-883.DOI:10.13342/j.cnki.cjhp. 2019.06.022.

[13]许俊杰,王平,杜静.重复经颅磁刺激联合草酸艾司西酞普兰治疗男性精神分裂症后抑郁的效果[J].中国当代医药,2021,28(7):85-88. DOI:10.3969/j.issn.1674-4721. 2021.07.025.

[14]邢静静,王化宁,周平.重复经颅磁刺激治疗对抑郁症患者额上回和辅助运动皮层度中心性的影响[J].山西医科大学学报,2023,54(8):1147-1153. DOI:10.13753/j.issn. 1007-6611.2023.08.018.

[15]黄佩佩,董雪冰,付琳,等.重复经颅磁刺激治疗卒中后抑郁的研究进展[J].心理月刊,2024,19(20):234-236.DOI:10.19738/j.cnki.psy.2024.20.076.

[16]侯瑞丰,周晶,孙忠国.艾司西酞普兰联合高频重复经颅磁刺激对复发性抑郁障碍患者疗效、认知功能及生活质量的影响[J].潍坊医学院学报,2024,46(1):48-51.DOI:10.16846/j.issn.1004-3101.2024.01.013.

[17]Schwartzmann B, Chatterjee R, Vaghei Y, et al. Modulation of neural oscillations in escitalopram treatment: a Canadian biomarker integration network in depression study[J]. Transl Psychiatry, 2024,14(1):432. DOI: 10.1038/s41398-024-03110-8.

[18]彭源,张熙斌,梅伟文,等.不同治疗时程的重复经颅磁刺激对脑卒中患者上肢运动功能及脑功能连接的影响[J].中国康复医学杂志,2024,39(10):1436-1442. DOI:10.3969/j.issn.1001-1242.2024.10.005.

[19]张言午,王海,高松年,等.重复经颅磁刺激对急性卒中后中枢性疼痛病人疼痛及生活质量的疗效评价[J].实用老年医学,2024,38(12):1250-1254. DOI:10.3969/j.issn.1003- 9198. 2024.12.014.

[20]訾叶,万丹,甘萍,等.曲唑酮片联合帕罗西汀片治疗脑卒中后抑郁患者对神经递质和神经因子的影响[J].中国实用神经疾病杂志,2024,27(10):1201-1205. DOI:10.12083/SYSJ.231485.

[21]谭庆晶,龙丽灯,陈卓,等.解郁宁神汤联合草酸艾司西酞普兰对抑郁性神经症肝气郁结证患者血清DA、5-HT、NE及TNF-α的影响[J].中医药导报,2023,29(1):81-85. DOI:10.13862/j.cn43-1446/r.2023.01.015.

[22]马长寿,陈光强,琼琼.重复经颅磁刺激联合阿戈美拉汀对产后抑郁患者神经肽Y和5-羟色胺水平的影响[J].中国妇幼保健,2024,39(8):1407-1410. DOI:10.19829/j.zgfybj.issn.1001-4411.2024.08.013.

[23]Liu Z, Yu S, Hu Y, et al. Efficacy and safety of repeated transcranial magnetic stimulation combined with escitalopram in the treatment of major depressive disorder: a meta-analysis[J]. Front Psychiatry, 2024,14:1275839. DOI: 10.3389/fpsyt.2023.1275839.