目的 探讨海马区胆碱(CHo)/肌酸(Cr)比值在青少年抑郁障碍接受重复经颅磁刺激(rTMS)治疗中的预测价值,以提高rTMS治疗的针对性和有效性。方法 招募 2024年 5月—2025 年 3月在乌鲁木齐市友爱医院临床心理科病房住院或门诊治疗的青少年抑郁障碍患者31例作为研究对象。所有入组患者均接受单一舍曲林治疗,以控制药物混杂效应。在 2 周 rTMS 治疗前、后分别采用汉密尔顿抑郁量表-24(HAMD-24)对入组患者的抑郁症状严重程度进行评估,应用氢质子磁共振波谱(1H-MRS)扫描检测Cho、N-乙酰天门冬氨酸(NAA)、Cr水平。按照HAMD减分率为依据分组,减分率≥50%划为有效组,反之则为无效组。结果 有效组和无效组在HAMD的睡眠障碍因子(t=-2.144,P<0.05)和绝望感因子(t=-2.053,P<0.05)及海马区Cho/Cr比值(t=-2.935,P<0.05)之间差异有统计学意义;在logistic回归分析中,Cho/Cr比值(OR=1.62,95%CI:1.00~2.63)对rTMS抗抑郁疗效的影响具有统计学意义(P<0.05);构建ROC曲线后,Cho/Cr比值的曲线下面积(AUC)为0.735(P<0.05),根据最大Youden指数推算出最佳截断值为1.13,其敏感性为94.7%,特异性为58.3%,这表明在接受rTMS治疗的青少年抑郁障碍患者中,若Cho/Cr比值大于1.13,则可能对rTMS治疗有较好的应答。结论 海马区Cho/Cr比值可能作为青少年抑郁障碍患者接受rTMS治疗疗效的潜在预测指标,为临床提供了个体化治疗的依据。
Abstract
Objective To explore the preliminary value of 1H-MRS in predicting the prognosis of adolescents with depressive disorder before receiving repetitive transcranial magnetic stimulation (rTMS), so as to improve the targeting and effectiveness of rTMS treatment. Methods A total of 31 adolescents with depressive disorder treated at Urumqi Youai Hospital from May 2024 to March 2025 were recruited.All patients received standardized sertraline monotherapy to control for confounding drug effects.Before and after 2 weeks of rTMS treatment, the 24-item Hamilton Depression Scale (HAMD-24) was used to assess symptom severity, and 1H-MRS was applied to detect hippocampal levels of choline (Cho), N-acetylaspartate (NAA), and creatine (Cr).Patients were classified into an effective group (reduction rate ≥50%) or an ineffective group based on HAMD score reduction. Results There were statistically significant differences between the two groups in the sleep disturbance factor (t=-2.144, P<0.05) and hopelessness factor (t=-2.053, P<0.05) of HAMD, as well as the Cho/Cr ratio in the hippocampus (t=-2.935, P<0.05).In the logistic regression analysis, the Cho/Cr ratio (OR=1.62, 95%CI:1.00 - 2.63) had a statistically significant impact on the antidepressant efficacy of rTMS (P<0.05).After constructing the ROC curve, the area under the curve (AUC) of the Cho/Cr ratio was 0.735 (P<0.05).According to the maximum Youden index, the optimal cut-off value was calculated as 1.13, with a sensitivity of 94.7% and a specificity of 58.3%.This indicates that among adolescent patients with depressive disorder receiving rTMS treatment, those with a Cho/Cr ratio greater than 1.13 may have a better response to rTMS treatment. Conclusions The hippocampal Cho/Cr ratio may serve as a potential predictive indicator for rTMS efficacy in adolescents with depressive disorder, providing preliminary evidence for individualized clinical treatment.
关键词
青少年 /
脑代谢物质 /
重复经颅磁刺激 /
抑郁障碍
Key words
adolescent /
cerebral metabolites /
repetitive transcranial magnetic stimulation /
depressive disorder
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