高频重复经颅磁刺激对重度抑郁患者血清mir-124、mir-214及炎性因子水平的影响

付可登 李松华 胡媛媛 陈蒙恩

[摘要] 目的 探討高频重复经颅磁刺激（HF-rTMS）对重度抑郁患者血清微小RNA-124（mir-124）、微小RNA-214（mir-214）及炎性因子白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平的影响。 方法 选取2017年6月～2019年6月本院精神科收治的重度抑郁患者70例，按照随机数字表法将其分为对照组35例和研究组35例。两组均在口服盐酸度洛西汀肠溶胶囊基础上，对照组接受伪HF-rTMS治疗，研究组接受真HF-rTMS治疗，每周治疗5 d;两组均连续治疗8周。分别于治疗前后评估汉密尔顿抑郁量表24项（HAMD-24）评分及临床总体印象量表（CGI）评分，测定血清mir-124、mir-214及IL-6、TNF-α水平，并记录不良反应情况。采用实时荧光定量PCR（qRT-PCR）检测血清mir-124、mir-214水平，采用酶联免疫吸附法（ELISA）测定血清IL-6、TNF-α水平。 结果 治疗后两组HAMD-24、CGI评分均显著低于治疗前（P<0.05），且研究组明显低于对照组（P<0.05）。治疗后两组血清mir-124、mir-214水平均显著低于治疗前（P<0.05），且研究组明显低于对照组（P<0.05）。治疗后两组血清IL-6、TNF-α水平均显著低于治疗前（P<0.05），且研究组明显低于对照组（P<0.05）。两组不良反应发生率相比，差异无统计学意义（P>0.05）。 结论 应用HF-rTMS可显著改善重度抑郁患者精神状况，降低血清mir-124、mir-214水平，减轻炎症反应。

[关键词] 抑郁症;经颅磁刺激;度洛西汀;微小RNA-124;微小RNA-214;炎性因子

[中图分类号] R743.3          [文献标识码] B          [文章编号] 1673-9701（2020）16-0103-04

Effects of high-frequency repetitive transcranial magnetic stimulation on serum levels of mir-124， mir-214 and inflammatory factors in patients with severe depression

FU Kedeng   LI Songhua   HU Yuanyuan   CHEN Meng'en

Department of Psychiatry， Ningbo Psychiatric Hospital， Ningbo   315032， China

[Abstract] Objective To investigate the effects of high frequency repetitive transcranial magnetic stimulation（HF-rTMS） on serum microRNA-124 （mir-124）， microRNA-214 （mir-214） and inflammatory factor interleukin- 6 （IL-6）， tumor necrosis factor-α （TNF-α） levels. Methods A total of 70 patients with severe depression treated in our psychiatry department from June 2017 to June 2019 were selected and divided into the control group and the study group by the random number table method，with 35 cases in each group.On the basis of oral duloxetine hydrochloride enteric-coated capsules in both groups， the control group received pseudo-HF-rTMS treatment，and the study group received true HF-rTMS treatment. The treatment was carried out for 5 days per week， and both groups were treated continuously for 8 weeks.The Hamilton Depression Scale （HAMD-24） score and the Clinical Global Impression Scale（CGI） score were evaluated before and after treatment; serum mir-124， mir-214 and IL-6， TNF-α levels were measured， and adverse reactions were documented. Real-time fluorescence quantitative PCR （qRT-PCR） was used to detect serum mir-124 and mir-214 levels， and enzyme-linked immunosorbent assay （ELISA） was used to determine serum IL-6 and TNF-α level. Results The HAMD-24 and CGI scores of the two groups after treatment were significantly lower than those before treatment（P<0.05）， and the study group was significantly lower than the control group（P<0.05）.The levels of serum mir-124 and mir-214 in the two groups after treatment were significantly lower than those before treatment（P<0.05）， and the study group was significantly lower than the control group（P<0.05）. The levels of serum IL-6 and TNF-α in the two groups after treatment were significantly lower than those before treatment（P<0.05）， and the study group was significantly lower than that 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 The application of HF-rTMS can significantly improve the mental status of patients with severe depression，decrease serum levels of mir-124 and mir-214，and relieve inflammation.

[Key words] Depression; Transcranial magnetic stimulation; Duloxetine; microRNA-124; MicroRNA-214; Inflammatory factors

抑郁症是一种常见的情感障碍或心境障碍，发病原因复杂，临床主要表现为情绪低落，重度抑郁患者可出现自杀念头或行为。高频重复经颅磁刺激（high frequency repetitive transcranial magnetic stimulation，HF-rTMS）是一种无痛、安全可靠的抗抑郁治疗手段[1]。研究发现HF-rTMS治疗可能使西酞普兰、帕罗西汀等抗抑郁药物更快发挥作用，明显改善患者临床症状[2]。且有研究报道[3]，HF-rTMS治疗重度抑郁发作急性期患者效果显著，可显著降低汉密尔顿抑郁量表17项（hamilton depression scale-17 items，HAMD-17）评分。但HF-rTMS治疗对重度抑郁患者血清微小RNA-124（microRNA-124，mir-124）、微小RNA-214（microRNA-214，mir-214）及炎性因子水平的影响尚不清楚。鉴于……