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

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

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%,χ^(2)=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。

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%;χ^(2)=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.