重复经颅磁刺激治疗卒中后抑郁疗效的脑功能磁共振评价

摘要

目的：探讨磁共振波谱成像(MRS)及扩散张量成像(DTI)用于评价重复经颅磁刺激治疗卒中后抑郁疗效的价值。方法将40例脑卒中后抑郁患者根据随机数表法分为观察组和对照组各20例，另选择20例作为健康志愿者。对照组应用文拉法辛治疗，150 mg/d，缓释片顿服。观察组给予文拉法辛合并重复经颅磁刺激(rTMS)治疗。比较两组患者治疗前后的汉密尔顿抑郁量表(HAMD)评分、MRS、DTI指标的变化及其与健康志愿者的差异。结果(1)治疗后，两组患者的HAMD评分均明显降低，且观察组患者改善更显著，差异均具有统计学意义(P<0.05)；(2)治疗前，两组患者的额叶、颞叶及基底节区各向异性分数(FA)值均明显低于健康志愿者，差异均具有统计学意义(P<0.05)。治疗后10 d，观察组额叶及颞叶FA值明显升高，与治疗前及对照组比较差异均具有统计学意义(P<0.05)；(3)治疗前，两组额叶、颞叶及基底节区NAA/(Cho+Cr)、NAA/Cr值均明显低于健康志愿者，Cho/Cr显著高于健康志愿者，差异均具有统计学意义(P<0.05)。治疗后10 d，观察组额叶及颞叶NAA/(Cho+Cr)、NAA/Cr值明显升高，Cho/Cr明显降低，与治疗前及对照组比较差异均具有统计学意义( P<0.05)。结论重复经颅磁刺激治疗卒中后抑郁疗效可靠，应用MRS及DTI可以对其进行评价。%Objective To investigate the value of magnetic resonance spectroscopy (MRS) and diffusion ten-sor imaging (DTI) for evaluating the effect of repetitive transcranial magnetic stimulation in the treatment of post-stroke depression. Methods Forty patients with post-stroke depression were randomly divided into observation group (20 cases) and control group (20 cases). Twenty healthy volunteers were selected as healthy control group. The control group was treated with Vin Rafa Sin treatment (150 mg/d) and sustained-release tablets orally. The observation group was given venlafaxine combined with repetitive transcranial magnetic stimulation (rTMS) treatment. Changes before and after treatment in HAMD score, MRS, DTI indexes were compared between the observation group and con-trol group, and also with healthy control group. Results (1) After treatment, HAMD scores in the observation group and control group were significantly decreased, and the improvement in the observation group was more significant (P<0.05). (2) Before treatment, fractional anisotropy (FA) values of frontal lobe, temporal lobe and basal ganglia in the observation group and control group were significantly lower than those in healthy control group, and the differenc-es were statistically significant (P<0.05). 10 d after treatment, FA values of frontal and temporal lobe in the observa-tion group were significantly increased, showing statistically significant difference with those before treatment and those in the control group (P<0.05). (3) Before treatment, NAA/(Cho+Cr), NAA/Cr of frontal lobe, temporal lobe and basal ganglia in the observation group and control group were significantly lower than those in healthy control group, while Cho/Cr was significantly higher (P<0.05). 10 d after treatment, NAA/(Cho+Cr), the NAA/Cr values of the fron-tal and temporal lobes in the observation group increased significantly, and Cho/Cr reduced significantly, showing sta-tistically significant difference with those before treatment and those in the control group (P<0.05). Conclusion Re-petitive transcranial magnetic stimulation has reliable curative effect on post-stroke depression, and MRS and DTI can evaluate the effect well.