山东医药

目的 观察艾灸联合重复经颅磁刺激（rTMS）治疗抑郁发作的效果及不良反应，为临床治疗抑郁发作提供理论依据和实践指导。方法 抑郁发作患者134例，采用四臂随机对照试验分为4组，其中常规治疗组34例、艾灸组34例、rTMS组33例、联合治疗组33例。常规治疗组仅服用草酸艾司西酞普兰片，艾灸组在服用草酸艾司西酞普兰片的基础上联合艾灸治疗，rTMS组在服用草酸艾司西酞普兰片的基础上联合rTMS治疗，联合治疗组在服用草酸艾司西酞普兰片的基础上联合艾灸、rTMS治疗，连续治疗4周。分别于治疗前和治疗4周后，使用汉密尔顿抑郁量表（HAMD-24）、宗氏抑郁自评量表（SDS）评估患者抑郁发作情况，使用临床疗效总评量表-疾病严重程度（CGI-S）评估患者病情严重程度，并依据HAMD-24评分计算临床应答率。分别于治疗前和治疗4周后，采用不良反应量表（TESS）评估患者不良反应发生情况，包括恶心呕吐、嗜睡、头痛、失眠等，并计算不良反应总发生率。结果 与治疗前相比，4组患者治疗4周后HAMD-24、SDS及CGI-S评分均降低（P均<0.05）;rTMS组治疗4周后HAMD-24、CGI-S评分均低于常规治疗组和艾灸组，SDS评分低于艾灸组（P均<0.05）；联合治疗组治疗4周后HAMD-24、SDS、CGI-S评分均低于常规治疗组和艾灸组，CGI-S评分低于rTMS组（P均<0.05）。常规治疗组、艾灸组、rTMS组、联合治疗组的临床应答率分别为20.59%、23.53%、57.58%、72.73%，其中rTMS组临床应答率高于常规治疗组和艾灸组（P均<0.05），联合治疗组临床应答率高于常规治疗组、艾灸组和rTMS组（P均<0.05）。各组不良反应总发生率相比差异无统计学意义（P均>0.05）。结论 艾灸与rTMS联合疗法能有效降低抑郁发作患者的HAMD、SDS、CGI-S评分，提高临床应答率，且不升高不良反应发生率。

Objective To observe the efficacy and adverse reactions of moxibustion combined with repetitive transcranial magnetic stimulation(rTMS) in the treatment of depressive episodes, and to provide theoretical basis and practical guidance for the clinical treatment of depressive episodes. Methods A total of 134 patients with depressive episodes were divided into four groups using a four-arm randomized controlled trial, including the conventional treatment group of 34 cases, the moxibustion group of 34 cases, the rTMS group of 33 cases, and the combined treatment group of 33 cases. Patients in the conventional treatment group only took escitalopram oxalate tablets. Patients in the moxibustion group received moxibustion treatment in addition to taking escitalopram oxalate tablets. Patients in the rTMS group received rTMS treatment in addition to taking escitalopram oxalate tablets. Patients in the combined treatment group received both moxibustion and rTMS treatment in addition to taking escitalopram oxalate tablets. The treatment lasted for 4 consecutive weeks. Before treatment and 4 weeks after treatment, the Hamilton rating scale for depression(HAMD-24) and the Zung Self-Rating Depression Scale(SDS) were used to evaluate the depressive episodes of patients. The Clinical Global Impression-Severity of Illness(CGI-S) was used to evaluate the severity of the patients' condition, and the clinical response rate was calculated based on the HAMD-24 score. Before treatment and 4 weeks after treatment, the Treatment Emergent Symptom Scale(TESS) was used to evaluate the occurrence of adverse reactions in patients, including nausea and vomiting, drowsiness, headache, insomnia, etc., and the total incidence of adverse reactions was calculated. Results Compared with those before treatment, the scores of HAMD-24, SDS, and CGI-S in the four groups decreased after 4 weeks of treatment(all P<0. 05). After 4 weeks of treatment, the HAMD-24 and CGI-S scores in the rTMS group were lower than those in the conventional treatment group and the moxibustion group, and the SDS score was lower than that in the moxibustion group(all P<0. 05). After 4 weeks of treatment, the HAMD-24, SDS, and CGI-S scores in the combined treatment group were lower than those in the conventional treatment group and the moxibustion group, and the CGI-S score was lower than that in the rTMS group(all P<0. 05). The clinical response rates of the conventional treatment group, moxibustion group, rTMS group, and combined treatment group were 20. 59%, 23. 53%, 57. 58%, and 72. 73% respectively. The clinical response rate was higher in the rTMS group than in the conventional treatment group and the moxibustion group(all P<0. 05), and the clinical response rate was higher in the combined treatment group than in the conventional treatment group, moxibustion group, and rTMS group(all P<0. 05). There was no significant difference in the total incidence of adverse reactions among the groups(all P>0. 05). Conclusion The combined therapy of moxibustion and rTMS can effectively reduce the HAMD, SDS, and CGI-S scores of patients with depressive episodes, improve the clinical response rate, and does not increase the incidence of adverse reactions.