| Objective: To investigate the effect of modified electroconvulsive therapy(MECT)on the relationship between intestinal flora and vagus nerve excitation in patients with major depressive disorder,and further to analyze whether MECT improves the pro-inflammatory and neurotoxicity through gut microbiota to achieve the treatment of depression.Methods: 449 patients with depression in accordance with DSM-? diagnostic criteria were recruited into our study,the subjects were divided into two groups on the basis of therapeutic schemes: MECT group was treated by MECT combined with selective serotonin reuptake inhibitors(SSRIs)or selective norepinephrine reuptake inhibitors(SNRIs),and the control group was only treated by SSRIs or SNRIs(32 patients in MECT group and 17 patients in control group);and all patients in the group were treated with one or more of the combined drugs of SSRIs or SNRIs.Hamilton Depression Scale(HAMD)was used to before the treatment and at the end of the 2nd week of the treatment.MECT group was treated with MECT once a day and a day at intervals after each treatment with 7 times in the course.The HAMD scales and blood samples were collected before the 1st MECT treatment and at the end of two-week treatment.Stool samples were collected before 1st treatment,2nd treatment and at the end of 2-week treatment;The levels of plasma IL-6,HIF-2? and TNF-? in the two groups were measured by enzyme-linked immunosorbent assay and NOS was measured using enzyme-linked immunosorbent measurement by NOS assay kit before the 1st treatment and after 2-week treament(i.e.,two weeks after treatment in the control group).Results:(1)Taking groups as units,each dimensions and the total scores of HAMD scale and PSQI scale before treatment in the two groups were performed by the independent sample t-test.Each dimensions and total score of HAMD and PSQI between the two groups was not statistically significant before treatment(P>0.05).(2)The scores of HAMD after treatment in the two groups were compared with the scores before treatment,and there were statistically significant differences in the total scores and every dimensions of HAMD except HAMD C6 in two groups after treatment were compared with the scores before treatment in the two groups(P<0.05);There was statistical significance in the comparison of the total scores of HAMD between the two groups at the end of 2-week treatment(P<0.05).(3)There weresignificant differences in the PSQI global scores and components of PSQI in MECT group after 2-week MECT treatment except for PSQI C6(P<0.05).The PSQI global scores in the two groups at the end of the 2th week were calculated.It was found that the differences between other dimensions and the global scores were statistically significant except for PSQI C5 and PSQI C6(P<0.05).(4)The results showed that there was no significant differences of the levels of IL-6 and iNOS between the two groups before the treatment(no significant difference in the baseline level);The changes of IL-6 and iNOS levels in the two groups after the treatment were calculated with the levels before treatment in the two groups.The results showed that the changes of IL-6 and iNOS levels in MECT group after treatment were statistically significant compared with the same group before treatment(P<0.05).(5)The iNOS level of plasma was positively correlated with the total score of HAMD and the score of HAMD C1 C5 C7 before the 7th treatment in the MECT group,and c NOS level was negatively correlated with the total score of HAMD and the score of HAMD C1 C5 C7 before the 7th treatment(P<0.05).(6)There was a negative correlation between the level of IL-6 in MECT group and the level of HAMD C6 at the end of the 2nd week(P<0.05);(7)There was a linear positive correlation between the ‘difference of iNOS level change' and ‘difference of HAMD total score' in MECT group in the duration of ‘pre-treatment' to ‘at the end of treatment'(P<0.05);(8)The results showed that the changes of symptoms in MECT group were often accompanied by the changes of the above-mentioned abundance of bacteroides,firmicutes,fusobacteria,proteobacteria and actinobacteria;(9)The results showed that the bacilli of MECT patients increased after the first treatment(P<0.05),and the actinomycetaceae(P<0.05)increased after the first treatment(P<0.05).On the other hand,lachnospiraceae entertae sedis and ocillibater in MECT group increased significantly after two weeks of treatment(P<0.05).(10)There was a negative correlation between the Bacteroides,Firmicutes and TNF-? at the end of the 2nd week(P<0.05).Conclusion:(1)MECT can effectively relieve the symptoms of depression patients;(2)MECT can effectively improve the relative abundance of intestinal flora in patients with depression;(3)MECT might improve depressive symptoms by affecting intestinal flora.(4)The plasma TNF-? and IL-6 level before treatment might be one of the important indexes to predict the therapeutic effect of MECT... |
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