超低频经颅磁刺激联合米氮平治疗阿尔茨海默病伴发抑郁症状的疗效观察

Efficiency of infra-low-frequency transcranial magnetic stimulation combined with mirtazapine on depressive symptoms in patients with Alzheimer’s disease

摘要:

目的 探讨超低频经颅磁刺激（TMS）治疗阿尔茨海默病（AD）伴发抑郁症状的疗效及安全性。方法 采用单盲随机对照研究，收集2014年8月至2015年8月在北京老年医院住院的伴有抑郁症状的AD患者47例，随机分为研究组（23例）和对照组（24例），研究组给予超低频TMS联合米氮平治疗，对照组给予伪刺激联合米氮平治疗，两组分别于治疗前、治疗第2周末和治疗第4周末采用老年抑郁量表（GDS）评估抑郁症状，以总有效率评定对抑郁症状的治疗效果。结果 治疗2周末研究组GDS评分较对照组明显下降 [（13.43±2.57） vs （16.08±3.96）]，差异有统计学意义（P＜0.05）；治疗4周末两组GDS评分[（9.48±3.11） vs （9.67±3.95）]，差异无统计学意义（P＞0.05）。疗效评估表明，治疗2周末研究组治疗总有效率高于对照组（60.87% vs 29.17%)，差异有统计学意义（χ2＝4.776，P＝0.029）；治疗4周末疗效差异无统计学意义（χ2＝3.297，P＝0.348）。结论 超低频TMS联合米氮平治疗比单纯米氮平治疗起效时间更早，早期疗效更好。

Abstract:

Objective To investigate the efficiency and safety of infra-low-frequency transcranial magnetic stimulation (TMS) in the treatment of depressive symptoms in Alzheimer’s disease (AD) patients. Methods A randomized, controlled and single-blinded trial was conducted on 47 AD patients with depressive symptoms admitted in our hospital from August 2014 to August 2015. The patients were randomly divided into the treatment group (n＝23) and the control group (n＝24). The patients of the former group was treated by mirtazapine combined with infra-low-frequency TMS for 4 weeks, while those of the latter group received sham infra-low-frequency TMS and mirtazapine treatment. The geriatric depression scale (GDS) was used to assess the depressive symptoms before, and after 2 and 4 weeks treatment to evaluate the curative effect by the total efficacy. Results After 2 weeks’ treatment, GDS score was significantly lower in the treatment group than in the control group [(13.43±2.57) vs (16.08±3.96), P＜0.05], but there was no significant difference in the score between the 2 groups [(9.48±3.11) vs (9.67±3.95), P＞0.05] in 4 weeks. There existed significant difference in the total efficacy between the 2 groups after 2 weeks’ treatment (Chi square＝4.776, P＝0.029), but no difference after 4 weeks (Chi square＝3.297, P＝0.348). Conclusion Infra-low-frequency TMS combined with mirtazapine has a shorter onset time and better short-term efficacy than medication alone in the treatment of depressive symptoms in AD patients.