摘要： 研究背景 目前抑郁障碍患病率呈逐年升高之趋势，综合性医院就诊的抑郁障碍患者多以躯体化症状为主诉，尤以睡眠障碍最为常见，改善睡眠质量成为迫切的需要。本研究探讨重复经颅磁刺激（rTMS）对改善抑郁障碍患者睡眠质量的疗效。方法 以躯体化症状就诊的抑郁障碍患者随机分为单纯药物治疗组（药物治疗组）和rTMS 联合药物治疗组（联合治疗组），分别采用汉密尔顿焦虑量表（HAMA）和抑郁量表（HAMD）评价两种治疗方法的疗效。结果 两种治疗方法在不同观察时间点，各项评分差异均有统计学意义（P = 0.000），且治疗方法与观察时间点之间存在交互作用（均P = 0.000）。与药物治疗组相比，联合治疗组患者治疗1、2 和4 周时HAMA 评分、HAMD 总评分和躯体化症状评分降低（均P = 0.000）；治疗1 周时睡眠障碍评分降低（P = 0.001）；治疗1 和2 周时抑郁症状评分降低（均P =0.000）。与治疗前相比，药物治疗组患者各项评分除治疗后1 周差异无统计学意义（P > 0.05）外，其余各观察时间点差异均有统计学意义（P = 0.000）；联合治疗组患者治疗后各项评分差异均有统计学意义（P = 0.000）。治疗后1、2 和4 周，两组治疗总有效率比较，联合治疗组［63.64%（14/22）、86.36%（19/22）、90.91%（20/22）］高于药物治疗组［20%（4/20）、55%（11/20）、75%（15/20）］，差异有统计学意义（均P = 0.000）。结论 重复经颅磁刺激联合药物治疗抑郁障碍患者起效早、效果好，尤其对睡眠质量的改善优于单纯药物治疗，可以提高抑郁障碍患者的治疗依从性。

关键词: 经颅磁刺激, 抑郁, 焦虑, 睡眠障碍

Abstract: Background  The prevalence of depressive disorder is increasing. Patients with depression often go to general hospital with chief complaint about somatization symptoms, including sleep disorders as one of the most common chief complaints. Therefore, improvement of sleep quality becomes the most important problem. The aim of this study is to explore the effect of repetitive transcranial magnetic stimulation (rTMS) on the improvement of sleep quality in patients with depression. Methods  Forty-two depressive patients were admitted to neurology department of general hospital with somatization symptoms. Patients with Hamilton Depression Rating Scale (HAMD) score ≥ 7 and Hamilton Anxiety Rating Scale (HAMA) score > 14 points were randomly divided into two groups, durg treatment group (given drug only) and combined group (given drug plus rTMS treatment). HAMD total score, HAMA score, sleep disorder, depression, and somatization symptoms were assessed before treatment and 1, 2, 4, and 8 weeks after treatment, respectively, and were compared between two groups. Results  The scores in every item were significantly different in both groups at different observation time points (P = 0.000). There were interactions of treatment methods with observation time points (P = 0.000, for all). Compared with drug treatment group, total score of HAMD, score of HAMA and somatization symptoms at 1, 2 and 4 weeks after treatment were decreased (P = 0.000, for all); the score of sleep disorders was decreased at 1 week after treatment (P = 0.001); and the scores of depression at 1 and 2 weeks after treatment were decreased (P = 0.000, for all) in combined group. In comparison with pre-treatment, the differences of scores in every item were significant at different observation time points (P = 0.000), excepting 1 week after treatment in drug treatment group (P > 0.05), but were all significant in combined group (P = 0.000). The total effective rates at 1, 2 and 4 weeks after treatment in combined group [63.64% (14/22), 86.36% (19/22) and 90.91% (20/22)] were all significantly higher than those in drug treatment goup [20% (4/20), 55% (11/20), and 75% (15/20)] (P = 0.000, for all). Conclusion  Repetitive transcranial magnetic stimulation combined with drug treatment for patients with depression is better than simple drug therapy in early initiation of efficacy, achievemet of good effect, and improvement of sleep quality, and can raise the compliance with treatment.

Key words: Transcranial magnetic stimulation, Depression, Anxiety, Sleep disorders