Efficacy of repetitive transcranial magnetic stimulation combined with cognitive behavior therapy on post-stroke depression
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摘要:
目的 探讨低频重复经颅磁刺激联合认知行为疗法对卒中后抑郁患者的治疗效果。 方法 选取2022年9月—2023年8月丽水市人民医院确诊为脑卒中后抑郁患者80例，使用随机数字表法分为对照组和观察组，各40例。研究过程中脱落5例，最终观察组37例，对照组38例。对照组给予常规治疗，观察组增加低频重复经颅磁刺激(rTMS)治疗和认知行为治疗，治疗持续8周。在治疗前、治疗4周和治疗8周采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、简易精神状态检查表(MMSE)、匹兹堡睡眠质量指数量表(PSQI)、美国国立卫生院卒中量表(NIHSS)对2组患者情绪状态、精神状态、睡眠情况及神经功能康复情况进行评估。 结果 治疗4周及8周后，2组患者SDS、SAS、MMSE、PSQI、NIHSS评分均有明显改善(P < 0.001)，且观察组优于对照组。治疗4周时，观察组MMSE及NIHSS评分较对照组明显改善[(24.67±1.33)分vs. (21.55±1.48)分，F=9.608，P＜0.001；(8.43±1.01)分vs. (9.15±0.97)分，F=3.147，P=0.002]。治疗8周后观察组SDS、SAS、MMSE、PSQI、NIHSS均较对照组明显改善(P < 0.001)。 结论 低频重复经颅磁刺激联合认知行为疗法能够有效提高卒中后抑郁患者的睡眠质量，缓解抑郁及焦虑心理，改善患者的认知行为。 Abstract:Objective To investigate the repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavior therapy (CBT) on post-stroke depression (PSD). Methods Eighty patients diagnosed with post-stroke depression in our hospital from September 2022 to August 2023 were selected. They were divided into a control group and an observation group according to the random number table, with 40 cases in each group. During the research process, 5 cases dropped out. In the end, there were 37 cases in the observation group and 38 cases in the control group. The control group received conventional treatment, while the observation group was additionally treated with low-frequency repetitive transcranial magnetic stimulation (rTMS) and cognitive-behavioral therapy, and the treatment lasted for 8 weeks. Before treatment, at 4 weeks of treatment, and at 8 weeks of treatment, the self-rating depression scale (SDS), self-rating anxiety scale (SAS), mini-mental state examination (MMSE), Pittsburgh sleep quality index (PSQI), and National Institutes of Health stroke scale (NIHSS) were used to assess the emotional state, mental state, sleep condition, and neurological function rehabilitation of the two groups of patients. Results At 4 weeks and after 8 weeks of treatment, SDS, SAS, MMSE, PSQI, and NIHSS scores of patients in both groups were significantly improved (P < 0.001), and the observation group was better than the control group. After 4 weeks of treatment, MMSE and NIHSS in the observation group improved significantly compared with the control group [(24.67±1.33) points vs. (21.55±1.48) points, F=9.608, P < 0.001; (8.43±1.01) points vs. (9.15±0.97) points, F=3.147, P=0.002]. After 8 weeks of treatment, the SDS, SAS, MMSE, PSQI, and NIHSS in the observation group improved significantly compared with the control group (P < 0.001). Conclusion Repetitive transcranial magnetic stimulation combined with cognitive behavior therapy can effectively improve sleep quality, relieve depression in patients with post-stroke depression, and enhance cognitive behavior. -
表 1 2组卒中后抑郁患者一般资料比较
Table 1. Comparison of general information of two groups of post-stroke depression patients
组别 例数 性别(例) 年龄(x±s，岁) 高血压(例) 糖尿病(例) 房颤(例) 卒中侧别(例) 男性 女性 左 右 对照组 38 21 17 55.24±10.90 21 12 6 20 18 观察组 37 25 12 54.76±9.23 20 11 5 21 16 统计量 1.197a 0.206b 0.011a 0.03a 0.078a 0.129a P值 0.274 0.838 0.916 0.862 0.780 0.720 注：a为χ2值，b为t值。 
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表 2 2组卒中后抑郁患者治疗前后SDS评分比较(x±s，分)
Table 2. Comparison of SDS scores of post-stroke depression patients in the two groups before and after treatment
组别 例数 治疗前 治疗4周 治疗8周 F值 P值 观察组 37 52.95±2.57 48.94±2.66 24.16±1.19 13.221 ＜0.001 对照组 38 52.74±2.72 49.44±2.83 45.05±2.18 9.458 ＜0.001 F值 0.342 0.789 51.302 P值 0.733 0.433 ＜0.001 注：F组间=13.221，P＜0.001；F时间=9.458，P＜0.001；F交互=4.012，P=0.015。
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表 3 2组卒中后抑郁患者治疗前后SAS评分比较(x±s，分)
Table 3. Comparison of SAS scores of post-stroke depression patients in the two groups before and after treatment (x±s, points)
组别 例数 治疗前 治疗4周 治疗8周 F值 P值 观察组 37 57.45±2.06 48.05±2.57 23.72±1.12 6.221 ＜0.001 对照组 38 57.28±2.14 48.81±2.09 45.02±1.60 5.145 ＜0.001 F值 0.350 1.403 66.937 P值 0.727 0.165 ＜0.001 注：F组间=6.221，P＜0.001；F时间=5.145，P＜0.001；F交互=3.154，P=0.026。
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表 4 2组卒中后抑郁患者治疗前后MMSE评分比较(x±s，分)
Table 4. Comparison of MMSE scores of post-stroke depression patients in the two groups before and after treatment (x±s, points)
组别 例数 治疗前 治疗4周 治疗8周 F值 P值 观察组 37 17.45±2.35 24.67±1.33 27.89±1.34 12.001 ＜0.001 对照组 38 18.31±1.61 21.55±1.48 24.34±2.15 9.156 ＜0.001 F值 1.844 9.608 8.606 P值 0.069 ＜0.001 ＜0.001 注：F组间=12.001，P＜0.001；F时间=9.156，P＜0.001；F交互=2.981，P=0.038。
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表 5 2组卒中后抑郁患者治疗前后PSQI评分比较(x±s，分)
Table 5. Comparison of PSQI scores of post-stroke depression patients in the two groups before and after treatment (x±s, points)
组别 例数 治疗前 治疗4周 治疗8周 F值 P值 观察组 37 12.32±1.45 10.81±0.93 5.94±0.84 6.148 ＜0.001 对照组 38 12.65±1.46 11.18±1.16 10.92±1.48 8.475 ＜0.001 F值 1.844 1.526 17.982 P值 0.069 0.131 ＜0.001 注：F组间=6.148，P＜0.001；F时间=8.475，P＜0.001；F交互=5.664，P=0.006。
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表 6 2组卒中后抑郁患者治疗前后NIHSS评分比较(x±s，分)
Table 6. re and after treatment (x±s, points)
组别 例数 治疗前 治疗4周 治疗8周 F值 P值 观察组 37 10.89±1.39 8.43±1.01 4.94±1.08 5.332 ＜0.001 对照组 38 10.71±1.39 9.15±0.97 8.26±0.92 4.958 ＜0.001 F值 0.561 3.147 14.313 P值 0.576 0.002 ＜0.001 注：F组间=5.332，P＜0.001；F时间=4.958，P＜0.001；F交互=5.175，P=0.009。
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