基于大脑半球功能非对称理论对舍曲林联合重复经颅磁刺激治疗持续性躯体形式疼痛障碍的机制研究

关键词：持续性躯体形式疼痛障碍  经颅磁刺激  运动阈值

Keywords:persist somatoform pain disorder  repeated transcranial magnetic stimulation  motor threshold

摘要：

      摘要 目的：探讨大脑半球功能偏侧化与持续性躯体形式疼痛障碍的关系。 方法：将37例持续性躯体形式疼痛障碍（PSPD）患者随机分为A、B两组，20例健康受试者设为C组。B组单纯给予舍曲林治疗，每次75mg，每晚1次，疗程6周。A组从开始观察第1天起，药物治疗同B组，并在服用药物的基础上联合重复经颅磁刺激（rTMS）治疗，每日治疗1次，连续治疗5次后，间隔2日，总共治疗15次。分析各组汉密尔顿抑郁量表（HAMD）、数字疼痛评分量表（NRS）及运动阈值（MT）变化，并进行分析比较。 结果：PSPD患者双侧大脑半球MT值间比较无显著性差异（P＞0.05），正常受试者右侧大脑半球MT值高于左侧大脑半球MT值（P＜0.05）；且PSPD患者左侧大脑半球MT值低于正常受试者左侧大脑半球MT值（P＜0.05），PSPD患者右侧大脑半球MT值与正常受试比较无显著性差异（P＞0.05）；经过3周、6周治疗后A组左侧大脑半球MT值降低（P＜0.05），右侧大脑半球MT值升高（P＜0.05）；B组仅在治疗后6周右半球MT值降低。经过3周、6周治疗后，A、B两组HAMD、NRS评分均显著低于治疗前（P＜0.001），且A组HAMD评分低于B组评分（P＜0.05）；治疗后3周A组NRS评分低于B组（P＜0.05），治疗后6周A、B两组NRS评分无显著性差异。 结论：大脑半球功能异常偏侧化可能对PSPD的发病产生重要影响；舍曲林及舍曲林联合rTMS均能缓解PSPD患者疼痛症状、改善PSPD患者的不良情绪，且后者优于前者。

Abstract:

      Abstract Objective: To study the mechanism of human brain function asymmetry in the pathogenesis of persistent somatoform pain disorder (PSPD). Method: Totally 37 cases of PSPD patients were divided into the group A and group B randomly. 20 cases of healthy participants were divided into C group. The B group was treated with Sertraline every night, six weeks a course. The A group was treated with Sertraline combined with rTMS. Result: There is no statistical difference between bilateral cerebral hemisphere MT (P＞0.05) of PSPD patients. In control group the right hemisphere MT is higher than the left (P＜0.05). The left hemisphere MT of control group is higher than that of left hemisphere MT of PSPD patient group (P＜0.05), but no statistical difference to the right hemisphere MT (P＞0.05). 3, 6 weeks after treatment, the right hemisphere MT of A group was lower than pre-treatment (P＜0.05), the left hemisphere MT was higher than pre-treatment (P＜0.05). Only on 6 weeks after treatment, the right hemisphere MT of B group was lower than pre-treatment (P＜0.05). 3, 6 weeks after the treatment, the score of HAMD, NRS were all significant lower than those pre-treatment (P＜0.001), and score of HAMD for A group were significant lower than B group (P＜0.05). 3 weeks after the treatment, A group NRS was lower than that of B group; but after the 6 weeks treatment, the NRS scores of the two groups had no significant difference (P＞0.05). Conclusion: The hemispheric lateralization dysfunction may be an important impact of PSPD. Both antidepressant medications and antidepressants combined with rTMS can alleviate PSPD patients' pain symptoms and unhealthy feelings, and the latter is better than the former.