重复经颅磁刺激对急进高原失眠官兵血清中神经递质的影响

Effects of rTMS on neurotransmitter levels in patients with acute high-altitude insomnia

目的:探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对急进高原失眠官兵睡眠质量的改善作用及其对神经递质的影响。方法:收集60名急进高原失眠官兵作为研究对象,随机分为rTMS治疗组和对照组,rTMS组给予低频重复经颅磁刺激连续治疗7 d,对治疗前后匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)、多导睡眠监测(polysomnography,PSG)指标、血清中5-羟色胺(5-hydroxytryptamine,5-HT)、谷氨酸(glutamic acid,Glu)、多巴胺(dopamine,DA)和去甲肾上腺素(norepinephrine,NE)水平进行对比。结果:rTMS治疗后PSQI指数显著下降(P<0.05),睡眠潜伏期、觉醒次数、总觉醒时间显著减少(P<0.05),总睡眠时间、睡眠效率显著增加(P<0.05),Ⅰ期睡眠减少,Ⅲ+Ⅳ期和REM期有所延长,但无统计学差异(P>0.05);血清中5-HT、Glu的表达在rTMS治疗后显著增加(P<0.05),DA、NE显著减少(P<0.05)。结论:低频重复经颅磁刺激可能通过调整睡眠节律,提高血清中5-HT、Glu,减少DA、NE的表达,发挥改善急进高原官兵失眠的作用。

Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on patients with acute altitude insomnia.Methods:Sixty Chinese soldiers on the plateau diagnosed by insomnia according to International classification of sleep disorders were recruited into this study.They were randomly divided into rTMS treatment group and control group.Participants received 7 daily sessions of sequential bilateral 1 Hz rTMS over the frontal lobe.Before and after the whole procedure of rTMS,patients were assessed by Pittsburgh sleep quality index(PSQI)and polysomnography(PSG)for the severity of sleep disturbance.Meanwhile,serum concentration of 5-hydroxytryptamine(5-HT),glutamic acid(Glu),norepinephrine(NE),dopamine(DA)in patients was measured by ELISA.Results:After rTMS treatment,the PSQI score was markedly decreased compared with pre-rTMS.PSG showed no statistical difference in total recording time between the two groups(P>0.05),the sleep latency,the number of awakenings and the total wakefulness time of the rTMS group were significantly reduced(P<0.05).Total sleep time and sleep efficiency increased(P<0.05).Ⅰperiod sleep less,Ⅲ+Ⅳperiod and REM period was extended,but no statistical difference(P>0.05).The concentrations of serum 5-HT,Glu were significantly higher,the concentrations of serum DA,NE were significantly decline.Conclusion:The rTMS significantly improves acute altitude insomnia probably by adjusting sleep rhythm,increasing the level of 5-HT,Glu and reduceing NE,DA in the brain.