低频重复经颅刺激对原发性失眠患者的临床效果及神经内分泌的影响

倪喆; 刘露

doi:10.16766/j.cnki.issn.1674-4152.002277

低频重复经颅刺激对原发性失眠患者的临床效果及神经内分泌的影响

doi: 10.16766/j.cnki.issn.1674-4152.002277

倪喆^1, ,,
刘露²

1.
杭州市第七人民医院心理测量室，浙江杭州 310013
2.
杭州市第七人民医院特检科，浙江杭州 310013

基金项目:

浙江省医药卫生科技计划项目 2020KY223

详细信息

通讯作者:
倪喆，E-mail：nizhe777@qq.com

中图分类号: R749.7 R454
计量
- 文章访问数: 134
- HTML全文浏览量: 48
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-08
- 网络出版日期: 2022-03-03

Clinical effect and neuroendocrine effect of low-frequency repetitive transcranial stimulation on patients with primary insomnia

NI Zhe^{1
, ,},
LIU Lu²

1.
Psychological Measurement Room, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的探究低频重复经颅刺激(repetitive transcranial magnetic stimulation, rTMS)对原发性失眠(Primary insomnia，PI)患者的临床效果及神经内分泌的影响，探究rTMS的作用机制，为临床推广应用提供依据。方法选取杭州市第七人民医院2019年7月—2020年7月收治的PI患者100例作为研究对象，按随机数字表法分成观察组(50例)及对照组(50例)，对照组采用交变磁场疗法，观察组采用rTMS疗法，比较2组患者治疗前后匹茨堡睡眠质量量表(PSQI)评分，甘氨酸、谷氨酸及γ－氨基丁酸(GABA)水平。结果 2组患者PSQI评分存在组间效应(P < 0.05)，观察组治疗效果优于对照组，治疗总有效率高于观察组(96.00% vs. 74.00%，χ²=9.490, P=0.002)；2组患者各神经递质水平存在组间效应(均P < 0.05)，即观察组改善效果优于对照组，皆存在时间效应(P < 0.05)，且分组与时间存在交互效应(P < 0.05)，显示2组患者的各神经递质水平皆随时间有变化趋势，且时间因素作用效果观察组更显著。结论 rTMS对于PI患者的治疗效果较为明显，可改善患者的睡眠状态同时调节神经内分泌水平，具有一定的临床推广应用价值。
- 低频重复经颅刺激治疗 /
- 原发性失眠 /
- 神经内分泌 /
- 神经递质
Abstract: Objective To explore the clinical effects and neuroendocrine effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with primary insomnia (PI) and the mechanism of rTMS for clinical application. Methods A total of 100 patients with PI admitted to our hospital from July 2019 to July 2020 were selected as the research objects and randomly divided into the observation group (50 cases) and control group (50 cases) using the random number table method. The control group was treated with alternating magnetic field therapy, and the observation group was treated with rTMS therapy. The PSQI scores, glycine, glutamate and GABA levels were compared between the two groups before and after treatment. Results The PSQI score of the two groups had an inter-group effect (P < 0.05). The treatment effect of the observation group was better than that of the control group, and the total effective rate of treatment was higher than that of the observation group (96.00% vs. 74.00%; χ²=9.490, P=0.002). An inter-group effect on neurotransmitter levels was observed (all P < 0.05), the improvement effect of the observation group was better than that of the control group. In addition, a time effect (P < 0.05) and an interaction effect between grouping and time (P < 0.05) were observed between the two groups. The levels of each neurotransmitter of the patients could change over time, and the effect of the time factor was more significant in the observation group. Conclusion rTMS has evident therapeutic effects on patients with PI. Furthermore, improving the sleep state of patients can simultaneously regulate neuroendocrine levels, which has certain clinical application value.
- Low-frequency repetitive transcranial stimulation treatment /
- Primary insomnia /
- Neuroendocrine /
- Neurotransmitter

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表 1 2组原发性失眠患者一般资料比较

组别	例数	年龄(x±s，岁)	性别[例(%)]		病程(x±s，月)
组别	例数	年龄(x±s，岁)	男性	女性	病程(x±s，月)
观察组	50	43.18±2.37	26(52.0)	24(48.0)	7.78±1.02
对照组	50	44.09±2.28	28(56.0)	22(44.0)	8.01±1.11
统计量		1.957^a	0.161^b		1. 079^a
P值		0.053	0.688		0.283
注：^a为t值，^b为χ²值。

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表 2 2组原发性失眠患者治疗前后PSQI评分比较(x±s，分)

组别	例数	治疗前	治疗后
观察组	50	16.15±1.53	10.03±2.16^a
对照组	50	16.29±1.65	15.01±1.58^a
t值		0.440	13.158
P值		0.661	< 0.001
注：与同组治疗前比较，^aP < 0.05。

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表 3 2组原发性失眠患者治疗前后神经内分泌指标水平比较(x±s)

组别	例数	GABA(ng/mL)		甘氨酸(nmol/L)		谷氨酸(nmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	50	2.14±0.55	3.38±1.13	1.97±0.22	2.88±0.38	21.88±2.09	13.38±1.58
对照组	50	2.13±0.49	2.57±1.08	1.89±0.34	2.23±0.31	22.01±2.38	18.14±1.36
t值		0.096	3. 664	1.397	9.372	0.290	16.247
P值		0.924	< 0.001	0.166	< 0.001	0.772	< 0.001

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表 4 2组原发性失眠患者治疗有效率比较[例(%)]

组别	例数	治愈	显效	有效	无效	总有效
观察组	50	18(36.00)	21(42.00)	9(18.00)	2(4.00)	48(96.00)
对照组	50	11(22.00)	14(28.00)	12(24.00)	13(26.00)	37(74.00)
注：2组总有效率比较，χ²=9.490, P=0.002。

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