重复经颅磁刺激联合右佐匹克隆治疗慢性失眠障碍的临床疗效及脑电变化

Clinical effect and electroencephalographic oscillation changes of the repetitive transcranial magnetic stimulation and eszopiclone treatment of chronic insomnia disorder

目的观察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合右佐匹克隆治疗慢性失眠障碍的临床疗效及其对脑电活动的影响。方法将慢性失眠障碍患者90例随机分为rTMS组、药物组、联合组,每组30例。rTMS组为双侧前额叶背外侧区进行rTMS治疗;药物组为右佐匹克隆3 mg/d治疗;联合组为rTMS+右佐匹克隆治疗。连续治疗2周,于治疗前、治疗后及随访时评估匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、清醒期脑电活动变化(α、β、θ、δ)及睡眠参数。统计学方法采用SPSS 23.0广义线性模型分析各评估指标变化。结果与治疗前比较,治疗后联合组PSQI评分下降[(7.2±1.7)分,(13.2±2.9)分],其改善程度较rTMS组[(9.2±2.5)分,(12.1±2.8)分]和药物组[(7.5±2.8)分,(11.4±2.9)分]明显,多重比较显示,联合组>药物组>rTMS组;随访时联合组>rTMS组>药物组(P<0.05)。治疗后和随访时rTMS组和联合组HAMA、HAMD评分均下降,两组间改善率差异无统计学意义,但均高于药物组(均P<0.05)。治疗后和随访时rTMS组和联合组β功率下降,α功率提高,δ及θ功率差异无统计学意义;药物组β、δ及θ功率增加(P<0.05),α功率差异无统计学意义。多重比较结果显示,rTMS组和联合组β、δ及θ频段功率均低于药物组,α功率高于药物组(P<0.05)。与治疗前比较,随访时联合组和rTMS组睡眠潜伏期缩短、总睡眠时间、睡眠效率、N3期及快速眼动期睡眠增加,均差异有统计学意义(P<0.05),药物组各睡眠参数变化差异无统计学意义(P>0.05)。结论rTMS联合右佐匹克隆可明显改善慢性失眠障碍患者睡眠质量,疗效优于单用rTMS和右佐匹克隆,并通过调控脑电活动降低皮质兴奋性,可作为慢性失眠障碍患者治疗的较理想方案。

Objective To observe the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with eszopiclone in the treatment of chronic insomnia disorder and its influence on brain electrical activity.Methods Ninety patients with chronic insomnia were randomly divided into rTMS group,drug group and combination group,with 30 cases each group.The rTMS group was treated with bilateral dorsolateral prefrontal lobe(left 5 Hz 400 pulse,right 1 Hz 1200 pulse),the drug group was treated with eszopiclone(3mg/d)and the combination group was treated with rTMS+eszopiclone.Continuous treatment for 2 weeks,Pittsburgh sleep quality index(PSQI),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and changes in brain electricity activity(α,β,θ,δ)and sleep parameters were evaluated before treatment,after treatment and during follow-up.The SPSS generalized linear model statistical method was used to analyze the changes of each evaluation index.Results Compared with before treatment,the PSQI score of the combination group decreased(7.2±1.7 vs 13.2±2.9),and the improvement was better than that of the rTMS group(9.2±2.5 vs 12.1±2.8)and the drug group(7.5±2.8 vs 11.4±2.9)(P<0.05).Multiple comparisons results showed that combination group>drug group>rTMS group;and combination group>rTMS group>drug group during follow-up.After treatment and during follow-up,the HAMA and HAMD scores of the rTMS group and the combination group decreased.There was no statistical difference in the improvement rate between the two groups,but they were all higher than the drug group(P<0.05).After treatment and during follow-up,theβpower of the rTMS group and the combination group decreased,and theαpower increased,but there was no statistical difference in theδandθpower.Theβ,δandθpower in the drug group increased(P<0.05),but theαpower had no statistical difference.Multiple comparisons results showed that the power ofβ,δandθbands in the rTMS group and the combination group were lower than the drug group,αpower was higher than that in the drug group(P<0.05).Compared with before treatment During follow-up,the sleep latency of the combination group and rTMS group was shorten,and the total sleep time,sleep efficiency,deep sleep(N3)and rapid eye movement(REM)increased(P<0.05),but there was no statistical difference in the changes of sleep parameters in the drug group.Conclusions rTMS combined with Eszopiclone can significantly improve the sleep quality of patients with chronic insomnia,which is better than that of rTMS and Eszopiclone alone,and it can reduce cortical excitability by regulating brain electrical activity.It can be an ideal treatment for patients with chronic insomnia disorder.