低频重复经颅磁刺激联合氟伏沙明治疗儿童青少年首发强迫障碍的临床双盲随机对照研究
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青岛市 2020 年度医药科研指导计划(2020-WJZD161)


A clinical double-blind randomized controlled study of low-frequency repetitive transcranial magnetic stimulation combined with fluvoxamine in the treatment of children and adolescents with first-episode obsessive-compulsive disorder
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    摘要:

    目的 探讨低频重复经颅磁刺激(rTMS)联合氟伏沙明治疗儿童青少年首发强迫障碍的临 床疗效。方法 选取2021年6月至2022年3月在青岛市精神卫生中心门诊和住院的58例首发强迫障碍 患儿为研究对象,采用随机数字表法分为试验组和对照组,每组 29 例。试验组采用低频 rTMS 联合氟伏 沙明治疗,对照组采取伪刺激联合氟伏沙明治疗,两组均观察治疗 8 周。采用耶鲁 - 布朗强迫障碍量表 (Y-BOCS)、汉密尔顿焦虑量表(HAMA)、不良反应症状量表(TESS)对两组患儿进行评估。采用重复测量 方差分析比较治疗前及治疗第 2、4、6、8 周末两组患儿的强迫症状严重程度、焦虑情况,并比较两组患 儿的治疗总有效率和不良反应发生率。结果 两组患儿治疗前的Y-BOCS、HAMA 评分比较,差异无统 计学意义(P> 0.05)。试验组患儿治疗第 2、4、6、8 周末的 Y-BOCS 评分与对照组比较[(26.10±5.11)分 比(30.24±3.79)分、(22.48±5.09)分比(25.76±4.60)分、(17.34±5.15)分比(20.31±5.65)分、(12.59±5.82)分比 (16.31±6.71)分],差异均有统计学意义(均P< 0.05);HAMA 评分与对照组比较[分别为(19.41±4.02)分 比(22.55±3.88)分、(15.62±4.53)分比(18.90±3.39)分、(11.66±3.11)分比(15.62±3.23)分、(8.31±2.19)分 比(12.55±2.68)分],差异均有统计学意义(均P< 0.01)。重复测量方差分析结果显示,两组患儿的 Y-BOCS、HAMA 评分存在组间、时间和交互效应,差异均有统计学意义(均P< 0.05)。进一步分析显示, 试验组在治疗第 2 周末起效,而对照组在治疗第 4 周末起效。试验组的治疗总有效率为 93.11%(27/29), 高于对照组的 72.41%(21/29),差异有统计学意义(Z=1.980,P< 0.05)。两组患儿的不良反应发生率比较 [37.93%(11/29)比 27.59%(8/29)],差异无统计学意义(χ2 =0.704,P> 0.05)。结论 低频 rTMS 联合氟伏 沙明治疗儿童青少年首发强迫障碍能够改善患儿的强迫症状和焦虑症状,治疗2周可起效,有效率较高。

    Abstract:

    Objective To investigate the clinical efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with fluvoxamine in the treatment of children and adolescents with firstepisode obsessive-compulsive disorder (OCD). Methods A total of 58 children with first-episode OCD who met the diagnostic criteria of the American Diagnostic Statistical Manual of Mental Disorders Fifth Edition (DSM-5) from June 2021 to March 2022 in outpatient and inpatient department of Qingdao Mental Health Center were selected. All children were randomly and double-blindly divided into experimental group and control group, with 29 cases in each group. The experimental group was treated with low-frequency rTMS combined with fluvoxamine, and the control group was treated with pseudo-stimulation combined with fluvoxamine. Both groups were observed and treated for 8 weeks. The Yale-Brown Obsessive-Compulsive Disorder Scale (Y-BOCS), Hamilton Anxiety Scale (HAMA), and Treatment Emergent Symptoms Scale (TESS) were used to evaluate he efficacy. The severity of OCD and anxiety of the two groups were analyzed and compared by repeated measures analysis of variance (ANOVA) before treatment, and at the end of 2nd, 4th, 6th and 8th week of the treatment. The total effective rate and the incidence of adverse reactions between the two groups were compared. Results The differences in scores of Y-BOCS and HAMA before treatment between the two groups were not statistically significant (P > 0.05). The differences in the score of Y-BOCS between the experiment group and the control group at the end of 2nd, 4th, 6th and 8th week [(26.10±5.11) vs (30.24±3.79), (22.48±5.09) vs (25.76±4.60), (17.34±5.15) vs (20.31±5.65), (12.59±5.82) vs (16.31±6.71)] were statistically significant (P<0.05). The differences in the score of HAMA between the experiment group and the control group at the end of 2nd, 4th, 6th and 8th week [(19.41±4.02) vs (22.55±3.88), (15.62±4.53) vs (18.90±3.39), (11.66±3.11) vs (15.62±3.23), (8.31±2.19) vs (12.55±2.68)] were statistically significant (P< 0.01). The results of repeated measurement ANOVA showed that the Y-BOCS and HAMA scores of the two groups had inter group, time and interaction effects, and the differences were statistically significant (P< 0.05). Further analysis found that the experimental group had an effect at the 2nd week of treatment (P< 0.001), while the control group had an effect at the 4th week of treatment. The total effective rate [93.11%(27/29)] of the experimental group was higher than that of the control group [72.41%(21/29)], and the difference was statistically significant (Z=1.980, P< 0.05). There was no significant difference in the incidence of adverse reactions between the two groups [37.93% (11/29) vs 27.59% (8/29)] (χ2 =0.704,P > 0.05). Conclusions Low-frequency rTMS combined with fluvoxamine in the treatment of children and adolescents with first-episode OCD can significantly improve the obsessivecompulsive symptoms and anxiety symptoms of children, with a high treatment efficiency, and obvious curative effects can be achieved within 2 weeks.

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刘雨薇,王婷婷,程亚玲,田博.低频重复经颅磁刺激联合氟伏沙明治疗儿童青少年首发强迫障碍的临床双盲随机对照研究[J].神经疾病与精神卫生,2022,22(11).
DOI :10.3969/j. issn.1009-6574.2022.11.009.

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  • 在线发布日期: 2022-12-22