加速间歇性爆发性θ波刺激治疗卒中后抑郁的效果

doi:10.3969/j.issn.1006-9771.2025.07.009

摘要/Abstract

摘要：

目的探讨加速间歇性爆发性θ波刺激(aiTBS)治疗卒中后抑郁(PSD)患者的效果。

方法 2021年7月至2023年7月，北京博爱医院48例住院PSD患者，随机分为对照组(n = 16)、高频重复经颅磁刺激(HF-rTMS)组(n = 16)和aiTBS组(n = 16)，每组16例。aiTBS组接受左侧背外侧前额叶皮质(DLPFC)aiTBS治疗，HF-rTMS组接受左侧DLPFC 10 Hz rTMS治疗，对照组则接受左侧假刺激治疗，连续3周。治疗前后及随访1个月均采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和贝克抑郁自评量表(BDI)进行评估。

结果各组均脱落1例。HAMD、HAMA和BDI评分的组间、组内和交互效应均显著(F > 3.235, P < 0.05)。事后检验显示，HF-rTMS组和aiTBS组的HAMD、HMMA和BDI评分均低于对照组(P < 0.05)，HF-rTMS组与aiTBS组比较无显著性差异(P > 0.05)。各组间抑郁改善有效率比较有显著性差异(χ²= 7.834, P = 0.019)，aiTBS组有效率高于对照组(P < 0.017)，HF-rTMS组与aiTBS组比较无显著性差异(P > 0.017)。

结论 aiTBS可有效改善PSD患者的抑郁和焦虑症状，与HF-rTMS相比治疗时间更短。

关键词: 卒中后抑郁, 间歇性爆发性θ波刺激, 汉密尔顿抑郁量表, 汉密尔顿焦虑量表, 贝克抑郁自评量表

Abstract:

Objective To explore the effect of accelerated intermittent theta burst stimulation (aiTBS) on post-stroke depression (PSD).

Methods From July, 2021 to July, 2023, 48 PSD patients in Beijing Bo'ai Hospital were randomly assigned to control group (n = 16), high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) group (n = 16) and aiTBS group (n = 16). aiTBS group received left-sided aiTBS treatment at dorsolateral prefrontal cortex (DLPFC), HF-rTMS group received left-sided 10 Hz rTMS treatment at DLPFC, and the control group received left-sided sham stimulation treatment, for three weeks. They were evaluated with the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and Beck Depression Inventory (BDI) before and after treatment, and one month of follow-up.

Results One case dropped down in each group. The inter-group effect, intra-group effect and interaction effect of HAMD， HAMA and BDI scores were all significant (F > 3.235, P < 0.05). The post-hoc test results showed that the scores of HAMD, HMMA and BDI were lower in HF-rTMS group and aiTBS group than in the control group (P< 0.05), and no significant difference was found between HF-rTMS group and aiTBS group (P > 0.05). There was significant difference in the effective rate of depression improvement among three groups (χ²= 7.834, P = 0.019), the effective rate was higher in aiTBS group than in the control group (P < 0.017), and no significant difference was found between HF-rTMS group and aiTBS group (P > 0.017).

Conclusion aiTBS can improve the depression and anxiety symptoms of patients with PSD, with shorter treatment time, compared with HF-rTMS.

Key words: post-stroke depression, intermittent theta burst stimulation, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Beck Depression Inventory

中图分类号:

R743.3

山磊, 刘影, 张欣, 迟茜茜, 朱晓敏. 加速间歇性爆发性θ波刺激治疗卒中后抑郁的效果[J]. 《中国康复理论与实践》, 2025, 31(7): 822-829.

SHAN Lei, LIU Ying, ZHANG Xin, CHI Qianqian, ZHU Xiaomin. Effect of accelerated intermittent theta burst stimulation on post-stroke depression[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 822-829.

图/表 5

表1

表2

表3

表4

表5

参考文献 50

[1]	TAYLOR-ROWAN M, MOMOH O, AYERBE L, et al. Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis[J]. Psychol Med, 2019, 49(4): 685-696.
[2]	LIU L, XU M, MARSHALL I J, et al. Prevalence and natural history of depression after stroke: a systematic review and meta-analysis of observational studies[J]. PLoS Med, 2023, 20(3): e1004200.
[3]	XIAO W, LIU Y, HUANG J, et al. Analysis of factors associated with depressive symptoms in stroke patients based on a national cross-sectional study[J]. Sci Rep, 2024, 14(1): 9268. doi: 10.1038/s41598-024-59837-3 pmid: 38649386
[4]	BLAKE J J, GRACEY F, WHITMORE S, et al. Comparing the symptomatology of post-stroke depression with depression in the general population: a systematic review[J]. Neuropsychol Rev, 2024, 34(3): 768-790.
[5]	ALLIDA S M, HSIEH C F, COX K L, et al. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke[J]. Cochrane Database Syst Rev, 2023, 7(7): CD003437.
[6]	FRANK D, GRUENBAUM B F, ZLOTNIK A, et al. Pathophysiology and current drug treatments for post-stroke depression: a review[J]. Int J Mol Sci, 2022, 23(23): 15114.
[7]	GUO J, WANG J, SUN W, et al. The advances of post-stroke depression: 2021 update[J]. J Neurol, 2022, 269(3): 1236-1249.
[8]	ZHANG J, SONG Z, GUI C, et al. Treatments to post-stroke depression, which is more effective to HAMD improvement? A network meta-analysis[J]. Front Pharmacol, 2022, 13: 1035895.
[9]	FENG R F, MA R, WANG P, et al. Efficacy of escitalopram for poststroke depression: a systematic review and meta-analysis[J]. Sci Rep, 2022, 12(1): 3304.
[10]	LEGG L A, RUDBERG A S, HUA X, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery[J]. Cochrane Database Syst Rev, 2021, 11(11): CD009286.
[11]	MEDEIROS G C, ROY D, KONTOS N, et al. Post-stroke depression: a 2020 updated review[J]. Gen Hosp Psychiatry, 2020, 66: 70-80.
[12]	BALRAM V, INGLETON R, PARSONS D, et al. Non-pharmacological interventions to treat mood disturbances post-stroke: a systematic review[J]. Top Stroke Rehabil, 2025, 32(2): 188-207.
[13]	LEFAUCHEUR J P, ALEMAN A, BAEKEN C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018)[J]. Clin Neurophysiol, 2020, 131(5): 1168-1169.
[14]	ZHAO Y, HE Z, LUO W, et al. Effect of intermittent theta burst stimulation on suicidal ideation and depressive symptoms in adolescent depression with suicide attempt: a randomized sham-controlled study[J]. J Affect Disord, 2023, 325: 618-626.
[15]	HARTWIGSEN G, VOLZ L J. Probing rapid network reorganization of motor and language functions via neuromodulation and neuroimaging[J]. Neuroimage, 2021, 224: 117449.
[16]	符家武, 吴昊, 李君良, 等. microRNA-137基因多态性与缺血性卒中后抑郁的相关性[J]. 中国康复理论与实践, 2020, 26(5): 588-591. doi: 10.3969/j.issn.1006-9771.2020.05.019
	FU J W, WU H, LI J L, et al. Association between microRNA-137 gene polymorphismsand ischemic post-stroke depression[J]. Chin J Rehabil Theory Pract, 2020, 26(5): 588-591.
[17]	STRAFELLA R, MOMI D, ZOMORRODI R, et al. Identifying neurophysiological markers of intermittent theta burst stimulation in treatment-resistant depression using transcranial magnetic stimulation-electroencephalography[J]. Biol Psychiatry, 2023, 94(6): 454-465.
[18]	ZHAO H, JIANG C, ZHAO M, et al. Comparisons of accelerated continuous and intermittent theta burst stimulation for treatment-resistant depression and suicidal ideation[J]. Biol Psychiatry, 2024, 96(1): 26-33.
[19]	LI C T, CHENG C M, CHEN M H, et al. Antidepressant efficacy of prolonged intermittent theta burst stimulation monotherapy for recurrent depression and comparison of methods for coil positioning: a randomized, double-blind, sham-controlled study[J]. Biol Psychiatry, 2020, 87(5): 443-450.
[20]	CAI D B, QIN Z J, LAN X J, et al. Accelerated intermittent theta burst stimulation for major depressive disorder or bipolar depression: a systematic review and meta-analysis[J]. Asian J Psychiatr, 2023, 85: 103618.
[21]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chin J Neurol, 2019, 52(12): 994-1005.
[22]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志, 2024, 57(6): 523-559.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol, 2024, 57(6): 523-559.
[23]	王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识[J]. 中国卒中杂志, 2016, 11(8): 685-693.
[24]	REN J, REN W, ZHOU Y, et al. Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: a randomized sham-controlled trial[J]. Brain Stimul. 2023, 16(5): 1313-1321.
[25]	汤毓华, 张明园. 汉密顿抑郁量表(HAMD)[J]. 上海精神医学, 1984(2): 61-64.
[26]	汤毓华, 张明园. 汉密顿焦虑量表(HAMA)[J]. 上海精神医学, 1984(2): 64-65.
[27]	王振, 苑成梅, 黄佳, 等. 贝克抑郁量表第2版中文版在抑郁症患者中的信效度[J]. 中国心理卫生杂志, 2011, 25(6): 476-480.
	WANG Z, YUAN C M, HUANG J, et al. Reliability and validity of the Chinese version of Beck Depression Inventory-Ⅱ among depression patients[J]. Chin Mental Health J, 2011, 25(6): 476-480.
[28]	KWEON J, VIGNE M, FUKUDA A M, et al. NMDA and GABA receptor-mediated plasticity induced by 10-Hz repetitive transcranial magnetic stimulation[J]. [ahead of print]. Res Sq, 2024. doi: 10.21203/rs.3.rs-4630964/v1.
[29]	LEE C W, WU H F, CHU M C, et al. Mechanism of intermittent theta-burst stimulation in synaptic pathology in the prefrontal cortex in an antidepressant-resistant depression rat model[J]. Cereb Cortex, 2021, 31(1): 575-590
[30]	ZHANG J J, BAI Z, MEHLER D M, et al. Modulating low-frequency oscillations in post-stroke brains using priming intermittent theta burst stimulation[J]. Eur J Phys Rehabil Med, 2024, 60(4): 591-593.
[31]	MYROV V, SIEBENHÜHNER F, JUVONEN J J, et al. Rhythmicity of neuronal oscillations delineates their cortical and spectral architecture[J]. Commun Biol, 2024, 7(1): 405. doi: 10.1038/s42003-024-06083-y pmid: 38570628
[32]	KISHI T, SAKUMA K, MATSUDA Y, et al. Intermittent theta burst stimulation vs. high-frequency repetitive transcranial magnetic stimulation for major depressive disorder: a systematic review and meta-analysis[J]. Psychiatry Res, 2023, 328: 115452
[33]	SHELINE Y I, MAKHOUL W, BATZDORF A S, et al. Accelerated intermittent theta-burst stimulation and treatment-refractory bipolar depression: a randomized clinical trial[J]. JAMA Psychiatry, 2024, 81(9): 936-941.
[34]	COLE E, O'SULLIVAN S J, TIK M, et al. Accelerated theta burst stimulation: safety, efficacy, and future advancements[J]. Biol Psychiatry, 2024, 95(6): 523-535.
[35]	TSE N Y, GOLDSWORTHY M R, RIDDING M C, et al. The effect of stimulation interval on plasticity following repeated blocks of intermittent theta burst stimulation[J]. Sci Rep, 2018, 8(1): 8526. doi: 10.1038/s41598-018-26791-w pmid: 29867191
[36]	WANG H, SONG P, HOU Y, et al. 820-nm transcranial near-infrared stimulation on the left DLPFC relieved anxiety: a randomized, double-blind, sham-controlled study[J]. Brain Res Bull, 2023, 200: 110682.
[37]	SONG P, TONG H, ZHANG L, et al. Repetitive transcranial magnetic stimulation modulates frontal and temporal time-varying EEG network in generalized anxiety disorder: a pilot study[J]. Front Psychiatry, 2022, 12: 779201.
[38]	ZHANG Y, LI L, BIAN Y, et al. Theta-burst stimulation of TMS treatment for anxiety and depression: a fNIRS study[J]. J Affect Disord, 2023, 325: 713-720.
[39]	CAPARELLI E C, ABULSEOUD O A, GU H, et al. Low frequency repetitive transcranial magnetic stimulation to the right dorsolateral prefrontal cortex engages thalamus, striatum, and the default mode network[J]. Front Neurosci, 2022, 16: 997259.
[40]	STEIN D J, FERNANDES MEDEIROS L, CAUMO W, et al. Transcranial direct current stimulation in patients with anxiety: current perspectives[J]. Neuropsychiatr Dis Treat, 2020, 16: 161-169.
[41]	KAZEMI R, ROSTAMI R, HADIPOUR A L, et al. Effect of DLPFC rTMS on anhedonia and alpha asymmetry in depressed patients[J]. Sci Rep, 2025, 15(1): 899.
[42]	OKONOGI T, SASAKI T. Theta-range oscillations in stress-induced mental disorders as an oscillotherapeutic target[J]. Front Behav Neurosci, 2021, 15: 698753.
[43]	ROXBURGH A D, WHITE D J, GRILLON C, et al. A neural oscillatory signature of sustained anxiety[J]. Cogn Affect Behav Neurosci, 2023, 23(6): 1534-1544. doi: 10.3758/s13415-023-01132-1 pmid: 37880568
[44]	STRUCKMANN W, BODÉN R, GINGNELL M, et al. Modulation of dorsolateral prefrontal cortex functional connectivity after intermittent theta-burst stimulation in depression: combining findings from fNIRS and fMRI[J]. Neuroimage Clin, 2022, 34: 103028.
[45]	COLE J, SOHN M N, HARRIS A D, et al. Efficacy of adjunctive D-cycloserine to intermittent theta-burst stimulation for major depressive disorder: a randomized clinical trial[J]. JAMA Psychiatry, 2022, 79(12): 1153-1161. doi: 10.1001/jamapsychiatry.2022.3255 pmid: 36223114
[46]	COLE E J, PHILLIPS A L, BENTZLEY B S, et al. Stanford neuromodulation therapy (SNT): a double-blind randomized controlled trial[J]. Am J Psychiatry, 2022, 179(2): 132-141.
[47]	MITTAL N, THAKKAR B, HODGES C B, et al. Effect of neuroanatomy on corticomotor excitability during and after transcranial magnetic stimulation and intermittent theta burst stimulation[J]. Hum Brain Mapp, 2022, 43(14): 4492-4507. doi: 10.1002/hbm.25968 pmid: 35678552
[48]	LUO X, CHE X, LI H. Concurrent TMS-EEG and EEG reveal neuroplastic and oscillatory changes associated with self-compassion and negative emotions[J]. Int J Clin Health Psychol, 2023, 23(1): 100343.
[49]	SINGH A, ERWIN-GRABNER T, SUTCLIFFE G, et al. Default mode network alterations after intermittent theta burst stimulation in healthy subjects[J]. Transl Psychiatry, 2020, 10(1): 75.
[50]	韩奇, 施聚峰, 马俊, 等. 认知行为疗法联合重复经颅磁刺激改善脑卒中患者睡眠及焦虑抑郁情绪[J]. 神经损伤与功能重建, 2021, 16(11): 669-671.

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	NHISS	MMSE
对照组	16	11/5	58.62±6.29	49.32±9.90	9/7	5.19±2.14	24.6±3.48
HF-rTMS组	16	10/6	57.41±7.45	50.92±8.55	8/8	7.12±3.67	22.1±2.90
aiTBS组	16	9/7	57.52±10.30	45.13±6.68	10/6	6.50±2.68	24.3±4.29
χ²/F值		0.533	0.123	2.189	0.183	1.862	2.223
P值		0.765	0.884	0.124	0.514	0.167	0.120

变量	组别	n	治疗前		治疗后		随访
变量	组别	n	均值	标准差	均值	标准差	均值	标准差
HAMD	对照组	15	24.87	2.10	18.87	5.08	18.27	5.50
	HF-rTMS组	15	25.87	2.26	13.93	6.70	12.33	6.88
	aiTBS组	15	25.27	3.71	12.93	6.19	11.00	6.88
HAMA	对照组	15	14.33	3.66	12.40	4.48	11.53	4.16
	HF-rTMS组	15	14.26	3.01	8.67	4.05	7.07	4.49
	aiTBS组	15	15.00	2.65	8.20	3.53	7.13	3.83
BDI	对照组	15	21.53	5.85	18.40	5.44	17.27	5.36
	HF-rTMS组	15	19.86	3.50	13.20	3.36	10.87	2.47
	aiTBS组	15	21.66	4.62	12.73	4.86	10.20	3.80

变量		平方和	自由度	均方	F值	P值
HAMD	组内	3527.530	2	1763.763	124.970	< 0.001
	组间	449.659	2	224.830	4.069	0.024
	组内×组间	309.590	4	77.396	5.484	0.006
HAMA	组内	895.244	2	732.955	80.924	< 0.001
	组间	218.978	2	109.489	3.235	0.049
	组内×组间	141.511	4	57.929	6.397	0.002
BDI	组内	1664.459	2	832.230	128.706	< 0.001
	组间	558.681	2	279.341	5.861	0.006
	组内×组间	225.052	4	56.263	8.701	< 0.001

变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	下限	上限
HAMD	对照组	aiTBS组	4.267	0.009	1.104	7.429
	对照组	HF-rTMS组	3.289	0.042	0.126	6.451
	aiTBS组	HF-rTMS组	0.978	0.536	-4.140	2.185
HAMA	对照组	aiTBS组	2.644	0.037	0.169	5.119
	对照组	HF-rTMS组	2.755	0.030	0.281	5.231
	aiTBS组	HF-rTMS组	0.111	0.928	-2.364	2.586
BDI	对照组	aiTBS组	4.200	0.006	1.263	7.137
	对照组	HF-rTMS组	4.422	0.004	1.485	7.359
	aiTBS组	HF-rTMS组	0.222	0.879	-2.715	3.159