Correlation Between Changes Of Serum 5-HT,BDNF And NPY Levels And Curative Effect Of Depression After Treatment

Objective:Depression is associated with serum 5-hydroxytryptamine(5-HT),brain-derived neurotrophic factor(BDNF)and neuropeptide Y(NPY)levels,while repetitive transcranial magnetic stimulation(rTMS)combined with paroxetine hydrochloride treatment appear to mend these changes.This study was aimed to assess 5-HT and NPY,BDNF levels in depressed patients before and after rTMS combined with paroxetine hydrochloride treatment,and explore the possibility to use them as indicators of effective curative interventions.Methods:A total of 216 patients with depression hospitalized in Beijing Huilongguan Hospital from February 2017 to March 2019 were included,including 110 patients who met the inclusion criteria.According to the order of patients before and after admission,110 patients were randomly assigned to the control group and the intervention group,55 in each group.The control group was treated with paroxetine hydrochloride,and the intervention group was treated with rTMS based on the control group.During the trial,10 patients were separated from the experiment in the control group and 45 patients in the intervention group,and 9 patients were separated from the experiment in the intervention group.A total of 45 patients in the control group and 46 patients in the intervention group continued to participate in the trial.In order to reduce the difference between the patients themselves and the raters in the evaluation of depression symptoms,the consistency of HAMD and PHQ-9 scales before and after treatment was tested.The patients in the control group were given paroxetine hydrochloride 20 mg/time after breakfast,and the dosage was adjusted to 40-60 mg/time,once a day according to the patient’s condition for 4 weeks.The patients in the intervention group were treated with rTMS on the basis of the treatment plan of the control group.During the treatment,the patients were placed in the supine or semi supine position,with their eyes closed tightly and in a quiet state for 5 minutes.The magnetic stimulation coil was aimed at the left dorsolateral prefrontal lobe.The coil diameter was 12 cm,the stimulation frequency was 1 Hz,the continuous stimulation was 10 seconds,the interval was 2 seconds,the stimulation intensity was 80%of the motor threshold,and the stimulation time was 30 minutes,A total of 1500 pulses,once a day,five times a week,were suspended for 2 days at the weekend for 4 weeks.During the trial period,20 rTMS treatments were received.HAMD and PHQ-9 were used to evaluate the patients’ condition after 1 week,2 weeks and 4 weeks of treatment;6ml fasting venous blood was collected before and 4 weeks after treatment.The serum NPY,BDNF and 5-HT levels were detected by enzyme-linked immunosorbent assay(ELISA).The change trend of serum indexes was observed to further explore the relationship between them and clinical efficacy;The incidence of adverse reactions was compared between the two groups.Result:Both groups had 4 weeks of treatment(P=0.967)and≧50%(P=0.173),Following the PHQ-9 minus rate of≧40%as the valid standard,Statistical differences in treatment efficacy(P<0.001);The severity of depression in the intervention group was better than in the control group(P<0.001);After 1 week of treatment in the intervention group,the HAMD score showed statistical improvement of block and despair compared with the control group(P<0.001);The HAMD score of 2 weeks of treatment in the intervention group showed a statistical improvement in anxiety somatization and despair compared with the control group(P<0.05);There was no statistical difference in all HAMD factor improvement after 4 weeks of treatment(P>0.05);The concentration of 5-HT,BDNF,NPY increased significantly after 4 weeks of treatment,The intervention group has increased more significantly(P<0.001);The elevation of serum BDNF and 5-HT concentrations a positive correlation between clinical recovery by HAMD and treatment,BDNF for every 1μg/L increase,Recovery probability improved by 37%(OR=1.3 7),9%for 1 ng/L increase of 5-HT(OR=1.09),correlation has significant statistical significance(P 0.001 and 0.022 respectively);A positive correlation between the elevation of serum 5-HT concentrations and the clinical efficacy judged by PHQ-9,That is,the probability of efficacy increases by 5%for each 1 ng/L increase of 5-HT(OR=1.05),The correlation has statistical significance(P=0.028).There was no statistical difference in adverse reactions between the two groups(P=0.479).Conclusions:Low frequency rTMS combined with paroxetine in the treatment of depression can effectively improve the symptoms of patients with depression in the early stage,but the curative effect of rTMS combined with paroxetine in the treatment of depression is better than that of paroxetine;Serum 5-HT,BDNF and NPY levels increased more significantly after rTMS combined with paroxetine treatment;According to the results of HAMD,the changes of 5-HT and BDNF were correlated with clinical cure.According to the results of PHQ-9,the change of 5-HT concentration is related to clinical improvement.