李明锋 钟琼

*基金项目：赣州市指导性科技计划项目（20222ZDX9785）

【摘要】 目的：探究重复经颅磁刺激（rTMS）联合舍曲林应用于首发抑郁症伴躯体疼痛的青少年患者认知功能的效果。方法：选取2022年10月—2023年9月赣州市第三人民医院收治的首发抑郁症伴躯体疼痛青少年共计80例，采用随机数字表法将上述研究对象分为观察组（n=40）及对照组（n=40）。对照组接受舍曲林治疗，观察组在对照组方案的基础之上联合rTMS进行治疗。记录并比较两组治疗效果、数字评价量表（NRS）评分、汉密尔顿抑郁量表-17项（HAMD-17）评分、汉密尔顿焦虑量表（HAMA）评分、蒙特利尔认知评估量表（MoCA）评分、临床记忆量表（CMS）评分及不良反应发生率。结果：观察组治疗总有效率为95.00%，显著高于对照组的77.50%（P<0.05）。治疗后，两组NRS、HAMD-17、HAMA评分相比治疗前均降低，且观察组均低于对照组（P<0.05）；两组MoCA评分、CMS评分相比治疗前均升高，且观察组均高于对照组（P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论：rTMS联合舍曲林治疗能够缓解青少年抑郁症患者躯体疼痛、改善认知功能。

【关键词】 首发抑郁症 重复经颅磁刺激 舍曲林 躯体疼痛 认知功能

Effect of rTMS Combined with Sertraline on Cognitive Function in Adolescent Patients with First-episode Depression and Somatic Pain/LI Mingfeng， ZHONG Qiong. //Medical Innovation of China， 2024， 21（14）： 0-086

[Abstract] Objective： To explore the effects of repetitive transcranial magnetic stimulation （rTMS） combined with Sertraline on cognitive function in adolescents with first-episode depression and somatic pain. Method： A total of 80 adolescents with first-episode depression and somatic pain admitted to the Third People's Hospital of Ganzhou were enrolled from October 2022 to September 2023. According to random number table method， they were divided into observation group （n=40） and control group （n=40）. The control group was treated with Sertraline， while observation group was additionally treated with rTMS. Clinical effect， scores of numerical rating scale （NRS）， Hamilton depression scale 17-item （HAMD-17）， Hamilton anxiety scale （HAMA）， Montreal cognitive assessment （MoCA） and clinical memory scale （CMS）， and the incidence of adverse reactions in the two groups were recorded and compared. Result： The total effective rate of treatment in observation group was 95.00%， which was significantly higher than 77.50% in control group （P<0.05）. After treatment， scores of NRS， HAMD-17

and HAMA in both groups were decreased compared to those before treatment， those in the observation group were lower than those in control group （P<0.05）; the scores of MoCA and CMS in both groups were increased compared to those before treatment， those in the observation group were higher than those in the control group （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion： rTMS combined with Sertraline can relieve somatic pain and improve cognitive function in adolescents with depression.

[Key words] First-episode depression Repetitive transcranial magnetic stimulation Sertraline Somatic pain Cognitive function

First-author's address： Department of Psychosomatic Medicine， the Third People's Hospital of Ganzhou， Ganzhou 341000， China

doi：10.3969/j.issn.1674-4985.2024.14.020

抑郁症患者产生躯体疼痛的原因同抑郁状态下脑部神经生化异常存在关联，神经递质紊乱为其主要诱发原因。神经递质紊乱可引起患者疼痛阈值的下降，因此在正常生理状态下不会察觉到的痛感，在此时即可引起明显的疼痛[1-2]。在正常情况下，大脑会自动屏蔽掉部分较为轻微的痛感。然而在抑郁症患者，上传部位出现异常的激活与活跃，会有更多不良信号释放进入大脑。另外，抑郁症可以导致患者意志活动减退，因为运动量减少、食欲不振等各种原因引起免疫功能低下，亦可能造成机体疼痛[3]。……