| ABSTRACTObjective: To compare the efficacy between sham group(Paroxetine) and r TMS(repetitive transcranial magnetic stimulation)group(Paroxetine+high-frequency repetitive transcranial magnetic stimulation) and analyze the changes of renin, angiotensin II,cortisol and the improvement of symptoms in PTSD patients after treatment, then explore the relationship between the improvement of PTSD symptoms and the changes of endocrine hormones.Methods: A total of 60 first episode of PTSD patients or PTSD patients absent of psychiatric department at least three months were enrolled as experimental group. The next day at 8:00am 3ml blood sample was drawn in experimental group members to test the plasma level of renin, angiotensin II and cortisol, at the same time using the PTSD Checklist Civilian Version(PCL-C) to measure their symptoms. With sex and age as control variables, 60 healthy people were enrolled as control group. The next day at 8:00am 3ml blood sample was drawn in control group members to test the plasma level of renin, angiotensin II and cortisol. Using random digits table, the experimental group members were randomly divided into sham group(n=30) and r TMS group(n=30). The sham group members received paroxetine therapy and the r TMS group members were given paroxetine therapy and combined with high-frequency repetitive transcranial magnetic stimulation therapy. After 4 weeks of treatment, the next day at 8:00am 3ml blood sample was drawn in sham group and r TMS group to test the plasma level of renin, angiotensin II and cortisol, at the same time using the PTSD Checklist Civilian Version to measure their symptoms again.Results:1 There was no significant difference between the experimental group and control group in age, gender, Residence status, marriage, Sibling status, education level.2 Compared with control group, the plasma level of cortisol in experimental group were significantly lower,but the plasma level of renin and angiotensin II had no significant differences.3 The plasma level of cortisol could predict PTSD. With plasma level of cortisol =332.880nmol/L as a cut-off value to predict PTSD, the Youden index was 0.267 at its maximum, and the sensitivity and specificity were 96.7% and 30.0%.4 There were no significant differences between the sham group and r TMS group in age, course of disease,dose of paroxetine hydrochloride, gender, Residence status, marriage, Sibling status, education level.5 After 4 weeks of treatment, the total score of PTSD Checklist Civilian Version was significantly lower and the plasma level of cortisol was much higher in sham group and r TMS group, but no significant difference was found in the plasma level of renin and angiotensin II.6 Compared with sham group, the inefficiency was much lower and the rate of obviously improvement was significantly higher in r TMS group, but the rate of improvement and cure had no significant difference.7 Before treatment, there was no significant difference between the sham group and r TMS group in the total score of PTSD Checklist Civilian Version and the plasma level of renin,angiotensin II, cortisol,but after 4 weeks of treatment the total score of PTSD Checklist Civilian Version in r TMS group was significantly lower than that of sham group and the plasma level of cortisol in r TMS group was significantly higher than that of sham group. Compared with sham group, the reducing rate of PCL-C score and the change of cortisol plasma level in r TMS group were significantly higher,but the changes of renin and angiotensin II plasma level had no significant difference.8 In r TMS group the change of cortisol plasma level was positively correlated with the reducing rate of PCL-C score and the change of cortisol plasma level could explain 29.2% reducing rate of PCL-C score, but there was no correlation between the change of cortisol plasma level and the reducing rate of PCL-C score in sham group.9 During the r TMS therapy, the change of cortisol plasma level could predict the efficacy of PTSD patients. With the change of cortisol plasma level =97.370nmol/L as a cut-off value to predict the efficacy of PTSD patients,the Youden index was 0.540 at its maximum, and the sensitivity and specificity were 77.8% and 76.2%.Conclusions:1 Plasma cortisol deficiency induced by the nonfunction of HPA axis may be the one pathomechanism of PTSD.2 high-frequency transcranial magnetic stimulation therapy combined with paroxetine can significantly improve the efficacy of PTSD patients.3 The possible mechanisms of high-frequency transcranial magnetic stimulation improving the efficacy of of PTSD patients is that it activates the HPA axis, so that the patients plasma cortisol is able to recover. |
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