低频rTMS联合治疗对帕金森病伴抑郁病人MMN和CNV的影响

田志刚; 位玲; 刘时华; 汪国胜

低频rTMS联合治疗对帕金森病伴抑郁病人MMN和CNV的影响

The influence of low-frequency rTMS combined therapy on MMN and CNV in patients with Parkinson's disease complicated with depression

摘要

摘要:
目的： 分析低频重复经颅磁刺激（rTMS）联合治疗对帕金森病伴抑郁病人失匹配负波（MMN）和关联性负变（CNV）的影响。
方法： 选取2024年1—12月安徽医科大学附属宿州医院收治的帕金森病伴抑郁病人70例，根据随机数表法分为rTMS联合组和单纯用药组，每组35例，另选取同期于安徽医科大学附属宿州医院门诊体检者20名作为健康对照组。单纯用药组予以西酞普兰片20 mg/d，rTMS联合组予以同等用量西酞普兰合并右侧额叶背外侧低频rTMS治疗12周。治疗前后给予病人汉密尔顿抑郁量表（HAMD−17）评分及MMN、CNV指标检测; 比较3组受试者一般资料和检查指标。
结果： 2组受试者年龄大小、性别分布差异均无统计学意义（P ＞ 0.05）；治疗12周后，2组病人组HAMD−17评分均明显下降（P ＜ 0.01），且rTMS联合组HAMD−17 评分较单纯用药组明显下降（P ＜ 0.01）。治疗前，2组病人MMN潜伏期和CNV潜伏期较健康对照组延长（P ＜ 0.01），CNV波幅较健康对照组降低（P ＜ 0.01）；治疗12周后病人组MMN潜伏期缩短（P ＜ 0.01），CNV潜伏期缩短（P ＜ 0.01）、波幅升高（P ＜ 0.01），且rTMS联合组MMN及CNV潜伏期缩短较单纯用药组明显（P ＜ 0.01），CNV波幅升高较单纯用药组明显（P ＜ 0.05）。
结论： 西酞普兰与西酞普兰联合rTMS两种治疗方法均能对帕金森病伴抑郁起到治疗作用，且后者优于前者。临床工作中，联合rTM可进一步改善病人精神症状。

Abstract:
Objective To analyze the influence of low-frequency rTMS combined therapy on mismatch negativity (MMN) and contingent negative variation (CNV) in patients with Parkinson's disease complicated with depression.
Methods Seventy patients with Parkinson's disease and depression admitted to Suzhou Hospital Affiliated to Anhui Medical University from Jan 2024 to Dec 2024 were selected, and divided into the rTMS combined group and simple medication group according to the random number table method, with 35 cases in each group. Additionally, 20 healthy individuals who underwent physical examinations at Suzhou Hospital Affiliated to Anhui Medical University during the same period were selected as the control group. The simple medication group were given citalopram tablets at a dose of 20 mg/d, and the rTMS combination group were treated with the same dosage of citalopram combined with low-frequency rTMS on the dorsolateral right frontal lobe for 12 weeks. Before and after the treatment, the Hamilton Depression Scale (HAMD-17) score, MMN and CNV in patients were detected The general information and examination indicators among three groups were compared.
Results There was no statistically significant difference in the age and gender distribution between two groups (P ＞ 0.05). After 12 weeks of treatment, the AMD-17 scores in two groups decreased (P ＜ 0.05), and the HAMD-17 score decreasing in the rTMS combined group was more significantly than that in simple medication group (P ＜ 0.05). Before treatment, the latency of MMN and CNV in both groups was longer than that in healthy control group (P ＜ 0.01), and the amplitude of CNV was lower than that in healthy control group (P ＜ 0.01). After 12 weeks of treatment, the latency of MMN in the patient group shortened (P ＜ 0.05), the latency of CNV shortened (P ＜ 0.05), and the amplitude increased (P ＜ 0.05). Moreover, the shortening of MMN and CNV latency in the rTMS combined group were more significant than that in simple medication group (P ＜ 0.05), and the increasing of CNV amplitude was more significant than that in simple medication group (P ＜ 0.05).
Conclusions Both citalopram and citalopram combined with rTMS can have therapeutic effects on Parkinson's disease complicated with depression, and the latter is superior to the former. In clinical practice, the combination of rTM can further improve the mental symptoms of patients.

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