间歇性θ短阵快速脉冲刺激对戒断期酒精依赖患者渴求、情绪和认知功能影响的随机对照研究

doi:10.3969/j.issn.1674-8115.2025.03.012

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (3): 349-356.doi: 10.3969/j.issn.1674-8115.2025.03.012

间歇性θ短阵快速脉冲刺激对戒断期酒精依赖患者渴求、情绪和认知功能影响的随机对照研究

王海红¹(), 袁辰馨², 甘鸿³, 江海峰¹, 赵燕¹, 杜江¹(), 张毅¹()

^1.上海交通大学医学院附属精神卫生中心精神科，上海 201100
^2.南京航空航天大学心理健康教育中心，南京 210016
^3.苏州大学附属广济医院成瘾科，苏州 215008

收稿日期:2024-06-01 接受日期:2024-12-30 出版日期:2025-03-28 发布日期:2025-03-28
通讯作者: 杜　江，主任医师，博士；电子信箱：dujiangdou@163.com
张　毅，主任医师，硕士；电子信箱：jeanzy@163.com。
作者简介:王海红（1980—），女，主治医师，硕士；电子信箱：haihong1119@126.com。
基金资助:
上海市精神卫生中心项目(2019-YJ11);上海市卫生健康委员会卫生行业临床研究专项(20234Y0013)

A randomized controlled study on the effect of intermittent theta burst stimulation on craving, mood, and cognitive function in alcohol-dependent patients during the withdrawal period

WANG Haihong¹(), YUAN Chenxin², GAN Hong³, JIANG Haifeng¹, ZHAO Yan¹, DU Jiang¹(), ZHANG Yi¹()

^1.Psychiatry Department, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 201100, China
^2.Mental Health Education Center, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
^3.Addiction Department, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215008, China

Received:2024-06-01 Accepted:2024-12-30 Online:2025-03-28 Published:2025-03-28
Contact: DU Jiang, E-mail: dujiangdou@163.com
ZHANG Yi, E-mail: jeanzy@163.com.
Supported by:
Project of Shanghai Mental Health Center(2019-YJ11);Shanghai Municipal Health Commission Special Project for Clinical Research in the Health Industry(20234Y0013)

摘要/Abstract

摘要：

目的·探讨左侧背外侧前额叶（dorsolateral prefrontal cortex，DLPFC）间歇性θ短阵快速脉冲刺激（intermittent theta burst stimulation，iTBS）降低戒断期酒精依赖患者对酒精渴求的疗效，以及对患者情绪和认知功能的影响。方法·招募上海交通大学医学院附属精神卫生中心成瘾科戒断期酒精依赖住院患者41例，随机分配至试验组（20例）和对照组（21例）。2组患者均接受酒精依赖患者的常规住院治疗，在此基础上试验组接受左侧DLPFC的iTBS真刺激，对照组接受相同参数的伪刺激。干预疗程为2周，共10次刺激。使用视觉模拟量表（Visual Analogue Scale，VAS）、贝克抑郁量表（Beck Depression Inventory，BDI）和贝克焦虑量表（Beck Anxiety Inventory，BAI）分别测量患者干预前后的渴求、焦虑、抑郁状况。使用计算机化认知评估工具CogState软件包行为学任务中的检出任务（detection task，DET）、识别任务（identification task，IDN）、双卡学习任务（two back task，TWOB）、Groton迷宫学习任务（the Groton maze learning task，GML）和国际购物清单任务（international shopping list task，ISL）分别评估患者干预前后的认知加工速度、注意力/警觉、工作记忆、空间问题解决/错误监管能力、言语学习记忆等认知功能。结果·重复测量方差分析显示，2组患者VAS评分的时间效应（F=126.713，P<0.001，偏η²=0.765）和交互效应（F=7.080，P=0.011，偏η²=0.154）具有统计学意义，TWOB得分的时间效应（F=9.114，P=0.004，偏η²=0.189）、组别效应（F=5.557，P=0.024，偏η²=0.125）和交互效应（F=4.977，P=0.032，偏η²=0.113）均具有统计学意义，BDI（F=45.273，P<0.001，偏η²=0.578）、BAI（F=31.432，P<0.001，偏η²=0.473）、GML（F=8.993，P=0.005，偏η²=0.209）、ISL（F=26.657，P<0.001，偏η²=0.439）得分只有时间效应具有统计学意义，DET、IDN得分的时间效应、组别效应和交互效应均无统计学意义。简单效应分析显示，真刺激组干预后VAS评分低于伪刺激组（F=8.805，P=0.005，偏η²=0.184）、TWOB得分高于伪刺激组（F=11.293，P=0.002，偏η²=0.225）。结论·在常规住院治疗的基础上联合iTBS，可以提高戒断期酒精依赖患者对酒精渴求的疗效，并改善患者的工作记忆。

关键词: 重复经颅磁刺激, 间歇性θ短阵快速脉冲刺激, 酒精依赖, 渴求, 认知功能

Abstract:

Objective ·To explore the effect of intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex (DLPFC) on reducing craving in alcohol-dependent patients during the withdrawal period, as well as its impact on patients' emotions and cognitive functions. Methods ·A total of 41 inpatients with alcohol dependence in the withdrawal period were recruited from the Addiction Department of Mental Health Center, Shanghai Jiao Tong University School of Medicine, and randomly assigned to the experimental group (20 patients) and the control group (21 patients). Both groups received routine inpatient treatment for alcohol-dependence. The experimental group received real iTBS stimulation targeting the left DLPFC on the basis of routine inpatient treatment, while the control group received sham stimulation with the same parameters. The intervention course lasted for 2 weeks, with a total of 10 sessions. The Visual Analogue Scale (VAS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to measure the craving, anxiety, and depression of the patients before and after the intervention. The behavioral tasks of the detection task (DET), identification task (IDN), two back task (TWOB), the Groton maze learning task (GML), and international shopping list task (ISL) in the CogState software package were used to assess the cognitive processing speed, attention/vigilance, working memory, spatial problem-solving/error monitoring ability, and verbal learning and memory of the patients before and after the intervention. Results ·Repeated measures ANOVA showed that the time effect [F=126.713, P<0.001, partial η² (η_p²)=0.765] and interaction effect (F=7.080, P=0.011, η_p²=0.154) of the VAS scores in the two groups of patients were statistically significant. The time effect (F=9.114, P=0.004, η_p²=0.189), group effect (F=5.557, P=0.024, η_p²=0.125), and interaction effect (F=4.977, P=0.032, η_p²=0.113) of the TWOB score were all statistically significant. Only the time effects of BDI (F=45.273, P<0.001, η_p²=0.578), BAI (F=31.432, P<0.001, η_p²=0.473), GML (F=8.993, P=0.005, η_p²=0.209), and ISL (F=26.657, P<0.001, η_p²=0.439) scores were statistically significant. There were no statistically significant effects of time, group, or interaction on the DET and IDN scores. Simple effect analysis showed that the VAS score of the real stimulation group was lower than that of the sham stimulation group after the intervention (F=8.805, P=0.005, η_p²=0.184), and the TWOB score of the real stimulation group was higher than that of the sham stimulation group (F=11.293, P=0.002, η_p²=0.225). Conclusion ·Combining iTBS with routine inpatient treatment can enhance the efficacy of reducing alcohol craving in alcohol-dependent patients during the withdrawal period, and improve their working memory.

Key words: repetitive transcranial magnetic stimulation (rTMS), intermittent theta burst stimulation (iTBS), alcohol dependence, craving, cognitive function

中图分类号:

R749

王海红, 袁辰馨, 甘鸿, 江海峰, 赵燕, 杜江, 张毅. 间歇性θ短阵快速脉冲刺激对戒断期酒精依赖患者渴求、情绪和认知功能影响的随机对照研究[J]. 上海交通大学学报（医学版）, 2025, 45(3): 349-356.

WANG Haihong, YUAN Chenxin, GAN Hong, JIANG Haifeng, ZHAO Yan, DU Jiang, ZHANG Yi. A randomized controlled study on the effect of intermittent theta burst stimulation on craving, mood, and cognitive function in alcohol-dependent patients during the withdrawal period[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 349-356.

图/表 2

参考文献 28

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Indicator	iTBS group (n=20)	Sham group (n=21)	χ²/t value	P value
Gender/n (%)			0.257	0.612
Male	16 (80.0)	19 (90.5)
Female	4 (20.0)	2 (9.5)
Age/year	38.15±8.88	38.71±6.73	0.230	0.819
Education/year	13.05±2.72	13.00±3.07	-0.055	0.956
Marital status/n (%)
Married	16 (80.0)	14 (66.7)
Unmarried	2 (10.0)	4 (19.0)	0.976	0.614
Divorced	2 (10.0)	3 (14.3)
Employment status/n (%)			0.197	0.657
Employed	13 (65.0)	16 (76.2)
Unemployed	7 (35.0)	5 (23.8)
Retired	0 (0)	0 (0)
Age of drinking for the first time/year	25.15±7.07	21.86±3.94	-1.829	0.078
Drinking/year	13.33±11.05	17.76±7.50	1.512	0.139
Alcohol consumption/standard unit	16.03±6.25	14.82±7.85	-0.542	0.591
CIWA-Ar/point	4.55±1.85	4.33±1.62	-0.399	0.692

Indicator	iTBS group (n=20)	Sham group (n=21)	χ²/t value	P value
Gender/n (%)			0.257	0.612
Male	16 (80.0)	19 (90.5)
Female	4 (20.0)	2 (9.5)
Age/year	38.15±8.88	38.71±6.73	0.230	0.819
Education/year	13.05±2.72	13.00±3.07	-0.055	0.956
Marital status/n (%)
Married	16 (80.0)	14 (66.7)
Unmarried	2 (10.0)	4 (19.0)	0.976	0.614
Divorced	2 (10.0)	3 (14.3)
Employment status/n (%)			0.197	0.657
Employed	13 (65.0)	16 (76.2)
Unemployed	7 (35.0)	5 (23.8)
Retired	0 (0)	0 (0)
Age of drinking for the first time/year	25.15±7.07	21.86±3.94	-1.829	0.078
Drinking/year	13.33±11.05	17.76±7.50	1.512	0.139
Alcohol consumption/standard unit	16.03±6.25	14.82±7.85	-0.542	0.591
CIWA-Ar/point	4.55±1.85	4.33±1.62	-0.399	0.692

Indicate	Time effect			Group effect			Time×Group interaction effect
Indicate	F	P	η²_p	F	P	η²_p	F	P	η²_p
VAS	126.713	<0.001	0.765	0.168	0.684	0.004	7.080	0.011	0.154
BDI	45.273	<0.001	0.578	0.261	0.613	0.008	2.059	0.161	0.059
BAI	31.432	<0.001	0.473	0.224	0.639	0.006	3.585	0.067	0.093
DET	1.089	0.305	0.033	0.131	0.720	0.004	1.351	0.254	0.041
IDN	0.907	0.348	0.028	0.638	0.430	0.020	0.454	0.505	0.014
TWOB	9.114	0.004	0.189	5.557	0.024	0.125	4.977	0.032	0.113
GML	8.993	0.005	0.209	0.007	0.932	<0.001	0.009	0.925	<0.001
ISL	26.657	<0.001	0.439	1.216	0.278	0.035	0.106	0.746	0.003

Indicate	Time effect			Group effect			Time×Group interaction effect
Indicate	F	P	η²_p	F	P	η²_p	F	P	η²_p
VAS	126.713	<0.001	0.765	0.168	0.684	0.004	7.080	0.011	0.154
BDI	45.273	<0.001	0.578	0.261	0.613	0.008	2.059	0.161	0.059
BAI	31.432	<0.001	0.473	0.224	0.639	0.006	3.585	0.067	0.093
DET	1.089	0.305	0.033	0.131	0.720	0.004	1.351	0.254	0.041
IDN	0.907	0.348	0.028	0.638	0.430	0.020	0.454	0.505	0.014
TWOB	9.114	0.004	0.189	5.557	0.024	0.125	4.977	0.032	0.113
GML	8.993	0.005	0.209	0.007	0.932	<0.001	0.009	0.925	<0.001
ISL	26.657	<0.001	0.439	1.216	0.278	0.035	0.106	0.746	0.003

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间歇性θ短阵快速脉冲刺激对戒断期酒精依赖患者渴求、情绪和认知功能影响的随机对照研究

A randomized controlled study on the effect of intermittent theta burst stimulation on craving, mood, and cognitive function in alcohol-dependent patients during the withdrawal period

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