| 李丹,夏仲,朱文礼,梁丹丹,缪文文,宋传福.经颅交流电刺激联合舍曲林对抑郁障碍患者认知功能的影响[J].四川精神卫生杂志,2025,(3):204-210.Li Dan,Xia Zhong,Zhu Wenli,Liang Dandan,Miao Wenwen,Song Chuanfu,Effects of transcranial alternating current stimulation combined with sertraline on cognitive function in patients with depressive disorder[J].SICHUAN MENTAL HEALTH,2025,(3):204-210 |
| 经颅交流电刺激联合舍曲林对抑郁障碍患者认知功能的影响 |
| Effects of transcranial alternating current stimulation combined with sertraline on cognitive function in patients with depressive disorder |
| 投稿时间：2025-01-07 |
| DOI：10.11886/scjsws20250107001 |
| 中文关键词: 经颅交流电刺激 抑郁障碍 认知功能 |
| 英文关键词:Transcranial alternating current stimulation Depressive disorder Cognitive function |
| 基金项目:安徽省临床医学研究转化专项项目（项目名称：经颅交流电刺激对抑郁症亚型临床评价研究；项目编号：202204295107020065） |
|
| 摘要点击次数: |
| 全文下载次数: |
| 中文摘要: |
| 背景 认知功能与个体的生活质量和社会功能密切相关，约有20%~35%的抑郁障碍患者在临床症状缓解后仍存在一定程度的认知功能障碍。现有研究表明，经颅交流电刺激（tACS）对单一认知域功能（如记忆功能）具有改善作用，但对执行功能、注意功能及信息处理速度等认知维度的影响尚不清楚。目的 探讨tACS对抑郁障碍患者多维认知功能及情绪症状的影响，以期为抑郁障碍的治疗提供参考。方法 选取2022年11月—2024年10月在芜湖市第四人民医院住院治疗的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）中抑郁障碍诊断标准的49例患者为研究对象，通过Excel随机分为研究组（n=23）和对照组（n=26）。两组均接受舍曲林治疗，起始剂量为50 mg/d，随后根据患者个体差异、疗效和不良反应逐步调整剂量，维持剂量为100~200 mg/d。研究组在此基础上接受为期4周、每周5次、每次20 min的tACS治疗；对照组接受同参数的tACS伪刺激20 min（30秒后无电流输出）。于基线期、治疗第4周和第12周采用汉密尔顿抑郁量表17项版（HAMD-17）评定抑郁症状、汉密尔顿焦虑量表（HAMA）评定焦虑症状、MATRICS认知成套测验（MCCB）评定认知功能。结果 重复测量方差分析结果显示，两组HAMD-17评分的时间效应和时间与组间的交互效应均有统计学意义（F=260.437、25.309，P均<0.01）。治疗第12周，研究组HAMD-17评分低于对照组（t=4.236，P<0.01）。两组HAMA评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=248.082、4.506、9.500，P<0.05或0.01）。治疗第4周和第12周，研究组HAMA评分均低于对照组（t=4.580、2.608，P<0.05或0.01）。两组MCCB的注意/警觉性、词语学习和总体综合评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=70.331、27.882、51.679、5.560、10.948、7.860、8.490、3.874、5.025，P<0.05或0.01）。治疗第4周，研究组MCCB的注意/警觉性、词语学习和总体综合分数评分高于对照组（t=-2.149、-3.530、-2.740，P均<0.05）；治疗第12周，研究组MCCB的注意/警觉性、词语学习和总体综合分数评分均高于对照组（t=-3.534、-3.576、-3.838，P均<0.01）。结论 tACS联合舍曲林治疗短期内对抑郁障碍患者的注意/警觉性、词语学习能力、总体认知功能和焦虑症状的改善作用可能优于单纯药物治疗；从12周的结果来看，tACS联合舍曲林治疗不仅延续了上述认知领域和焦虑症状的改善优势，对抑郁症状的改善可能也优于单一药物治疗。 |
| 英文摘要: |
| Background Cognitive function is closely related to an individual's quality of life and social functioning， with approximately 20%~35% of patients with depressive disorder experiencing some degree of cognitive impairment even after clinical symptom remission. Existing evidence suggests that tACS can improve specific cognitive domains， such as memory function， while its effects on other cognitive dimensions， such as executive functioning， attention， and information processing speed， remain unclear.Objective To explore the effects of tACS on the multidimensional cognitive functions and emotional problems of patients with depressive disorder， thus to provide references for the treatment of depressive disorder.Methods Forty-nine patients with depressive disorder who were hospitalized in the Fourth People's Hospital of Wuhu from November 2022 to October 2024 and met the diagnostic criteria for depressive disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， were selected as study participants. Subjects were randomly divided into study group （n=23） and control group （n=26） based on Microsoft Excel. Both groups received sertraline treatment. The initial dose was 50 mg/day， which gradually titrated upward based on individual variability， drug tolerance， and therapeutic response， with a maintenance dose ranging from 100 to 200 mg/day. In addition， the study group underwent tACS therapy for 4 weeks， with 5 sessions per week， each lasting 20 minutes. The control group received sham stimulation， in which the stimulus was interrupted after the first 30 seconds. At baseline， the 4th week， and the 12th week of treatment， patients were assessed using the Hamilton Depression Scale-17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， and MATRICS Consensus Cognitive Battery （MCCB）.Results Repeated measures analysis of variance indicated that both the time effect and the time×group interaction effect for HAMD-17 scores were statistically significant between the two groups （F=260.437， 25.309， P<0.01）. At week 12 of treatment， the HAMD-17 score in the study group was lower than that in the control group （t=4.236， P<0.01）. For HAMA scores， the time effect， group effect， and time×group interaction effect were all statistically significant between the two groups （F=248.082， 4.506， 9.500， P<0.05 or 0.01）. At weeks 4 and 12， study group reported lower HAMA scores compared with control group （t=4.580， 2.608， P<0.05 or 0.01）. Regarding the MCCB scores for attention/vigilance， verbal learning， and overall composite， the time effect， group effect， and time×group interaction effect were all statistically significant between the two groups （F=70.331， 27.882， 51.679， 5.560， 10.948， 7.860， 8.490， 3.874， 5.025， P<0.05 or 0.01）. After intervention， the study group showed significantly higher MCCB scores for attention/vigilance， verbal learning， and overall composite at both week 4 （t=-2.149， -3.530， -2.740， P<0.05） and week 12 （t=-3.534， -3.576， -3.838， P<0.01） when compared to the control group.Conclusion The combined tACS and sertraline therapy may demonstrate superior efficacy to pharmacotherapy alone in the short term for improving attention/vigilance， verbal learning， overall cognitive function， and anxiety symptoms in patients with depressive disorders. Based on the 12-week outcomes， the combined tACS and sertraline therapy not only sustaine its previously observed advantages in improving cognitive domains and anxiety symptoms， but also demonstrate potentially superior efficacy over monotherapy in alleviating depressive symptoms. ［Fund by Clinical Medical Research Transformation Special Project of Anhui Province （number， 202204295107020065）］ |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |