本文關鍵詞： 食管癌 抑郁 經顱磁刺激 腦白質 感興趣區(qū)域 彌散張量成像 部分各向異性　出處：《川北醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的：研究重復經顱磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)治療食管癌相關性抑郁患者的臨床效果,并采用彌散張量成像(Diffusion Tensor Imaging,DTI)評價其影像學表現(xiàn)。方法：收集2015年11月-2016年12月期間于南充市中心醫(yī)院腫瘤科及心胸外科住院的食管癌患者。選取符合要求的食管癌相關性抑郁患者分成多次重復經顱磁刺激組(m-rTMS組)和單次重復經顱磁刺激組(s-rTMS組)。m-rTMS組食管癌抑郁癥患者給予連續(xù)5天的rTMS治療(刺激頻率：10Hz,刺激強度：110%靜息運動閾值,刺激部位：左側背外側前額葉皮層);s-rTMS組患者只治療1次。兩組患者在rTMS治療前及治療療程結束后均行抑郁他評量表-漢密爾頓抑郁量表(Hamilton Depression Scale,HAMD)、焦慮自評量表(Self-Rating Anxiety Scale,SAS)、抑郁自評量表(Self-rating Depression Scale,SDS)臨床評分,并進行DTI圖像采集。對比分析單次、多次rTMS治療前后HAMD、SDS、SAS臨床評分間的差異;對比兩組患者rTMS治療前后抑郁相關腦區(qū)DTI各向異性參數(Fractional Anisotropy,FA)值的變化。結果：m-rTMS組共納入10例(男性6例,女性4例),s-rTMS組12例(男性8例,女性4例)。治療前兩組患者基本資料及臨床評分差異無統(tǒng)計學差異。1、兩組受試者治療后HAMD評分顯著降低,差異有統(tǒng)計學意義(m-rTMS組：P=0.000;s-rTMS組：P=0.000);SAS評分降低,差異有統(tǒng)計學意義(m-rTMS組：P=0.000;s-rTMS組：P=0.001);SDS評分降低,差異有統(tǒng)計學意義(m-rTMS組：P=0.001;s-rTMS組：P=0.000)。并且,m-rTMS組及s-rTMS組治療后組間HAMD、SAS、SDS三組評分差異有統(tǒng)計學意義(P=0.001/0.004/0.003)。2、兩組患者經rTMS治療后FA值升高的腦區(qū)包括雙側海馬、丘腦及扣帶回,左側紋狀體、右側前額葉、左側顳上回、左側顳中回,差異有統(tǒng)計學意義(P0.05)。結論：高頻rTMS治療能改善患者的抑郁狀態(tài),且相關腦區(qū)FA值及臨床評分改變明顯;通過DTI監(jiān)測到抑郁患者腦白質感興趣區(qū)域內部分FA值降低,可能與抑郁發(fā)生有關,而部分腦區(qū)FA值增加,可能與治療后神經纖維的潛在補償性再生有關;DTI作為一種新的研究腦白質形態(tài)結構的方法,能夠從組織微結構層面檢測抑郁腦區(qū)變化。
[Abstract]:Objective: to study the clinical effect of repeated transcranial magnetic stimulation (TMS) on patients with esophageal cancer associated depression. The imaging findings were evaluated by diffusive Zhang Liang imaging with diffusion Tensor imaging. Methods: from November 2015 to December 2016, the patients with esophageal cancer were collected from the oncology department and cardiothoracic surgery department of Nanchong central hospital. Patients with cancer-related depression were divided into multiple repetitive transcranial magnetic stimulation group (m-rTMS group) and single repeated transcranial magnetic stimulation group (TMS group) and single repeated transcranial magnetic stimulation group (TMS group). Patients with esophageal cancer depression were treated with rTMS for 5 consecutive days (stimulation frequency: 10 Hz, stimulation intensity: 110% resting exercise threshold). Stimulation site: patients in left dorsolateral prefrontal cortex were treated only once. The patients in both groups were treated with Hamilton Depression scale before rTMS treatment and after the course of treatment. Scale scale, Self-rating Depression scale scale (SDSs), Self-rating Depression scale (SDSs), self rating Depression scale (SDSs), and self rating Depression scale (SDSs), DTI images were collected and the differences between the clinical scores of rTMS before and after rTMS treatment were compared and analyzed. Results 10 cases (6 males and 4 females) were included in 10 cases (male 6, female 4) in depression-related brain region (12 cases, male 8 cases) in the 10 cases of 10 cases (male 6 cases, female 4 cases) in the depression-related brain region before and after rTMS treatment, and the changes of the DTI anisotropy parameter in the depression-related brain region were compared between the two groups before and after the treatment. There was no significant difference in basic data and clinical scores between the two groups before and after treatment. The HAMD scores of the two groups decreased significantly after treatment, and the differences were statistically significant (P < 0.01). The difference was statistically significant (P < 0. 000). The SDS score of 1: P0. 001g / ml TMS group was significantly lower than that of the control group (P = 0. 000). The difference was statistically significant between the two groups. There were significant differences in the scores of Hamd, SASS-SDS between the two groups after treatment. The increased FA values of the two groups after rTMS treatment included bilateral hippocampus, thalamus and cingulate gyrus, left striatum, left striatum. The difference of right prefrontal lobe, left superior temporal gyrus and left middle temporal gyrus was statistically significant (P 0.05). Conclusion: high frequency rTMS treatment can improve the depression state of the patients, and the FA value and clinical score of the related brain area are obviously changed. The decrease of FA value in the area of white matter interest in depression patients was detected by DTI, which may be related to the occurrence of depression, while the FA value in some areas of brain increased. DTI may be related to the potential compensatory regeneration of nerve fibers after treatment. As a new method to study the morphology of white matter, DTI can be used to detect the changes of depressive brain area in tissue microstructure.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1;R749.4

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