重复经颅磁刺激联合艾司唑仑对脑卒中失眠患者的疗效及其对血清细胞因子和神经递质的影响

Repetitive transcranial magnetic stimulation combined with estazolam for treatment of patients with stroke and insomnia:efficacy and influence on cytokines and neurotransmitters

目的探讨重复经颅磁刺激(rTMS)联合艾司唑仑对脑卒中失眠患者的疗效及其对血清细胞因子和神经递质影响。方法入选佛山市中医院2019年4月至2021年4月脑卒中失眠患者120例,运用随机数字表法将其随机分为观察组(60例)与对照组(60例)。两组入院均遵循中国脑血管病防控指南要求的常规治疗和康复治疗。对照组口服艾司唑仑,观察组在艾司唑仑基础上采取rTMS治疗。两组治疗疗程均4周。比较两组治疗4周的疗效,治疗前与治疗4周后匹兹堡睡眠质量指数(PSQI)和美国国立卫生研究院卒中量表(NIHSS)评分、功能综合评定量表(FCA)评分、血清细胞因子[白细胞介素-1β(IL-1β)、IL-6和肿瘤坏死因子-α(TNF-α)]及神经递质[去甲肾上腺素(NE)和多巴胺(DA)]变化。结果观察组治疗总有效率高于对照组(93.33%比75.00,χ^(2)=7.566,P<0.05)。治疗4周,两组脑卒中失眠患者PSQI评分、NIHSS评分、IL-1β、IL-6、TNF-α、NE和DA水平均较治疗前降低,而FCA评分较治疗前增加,差异均有统计学意义(均P<0.05);治疗4周,观察组脑卒中失眠患者PSQI评分(7.84±1.65)分、NIHSS评分(7.23±1.76)分、IL-1β(1.72±0.39)ng/L、IL-6(4.72±0.89)ng/L、TNF-α(0.84±0.20)μg/L、NE(2.03±0.43)μmol/L和DA(379.65±20.12)nmol/L低于对照组的(10.94±1.32)分、(9.46±1.81)分、(2.49±0.34)ng/L、(6.65±1.02)ng/L、(1.42±0.27)μg/ml、(3.62±0.58)μmol/L和(425.73±28.74)nmol/L,而FCA评分(39.84±4.12)分高于对照组的(28.89±4.67)分,差异均有统计学意义(均P<0.05)。结论rTMS联合艾司唑仑对脑卒中失眠患者疗效显著,且可改善细胞因子和神经递质水平。

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with estazolam in patients with stroke and insomnia and its influence on cytokines and neurotransmitters.Methods A total of 120 patients with stroke and insomnia at Foshan Hospital of Traditional Chinese Medicine from April 2019 to April 2021 were randomly divided into either an observation group(60 cases)or a control group(60 cases)using a random number table.Both groups received the routine treatment and rehabilitation treatment according to the Chinese guidelines for the prevention and control of cerebrovascular diseases.The control group was treated with estazolam orally,and the observation group was treated with rTMS on the basis of estazolam.The treatment course of both groups was 4 weeks.The efficacy of 4 weeks of treatment between the two groups,as well as the scores of the Pittsburgh Sleep Quality Index(PSQI),the National Institutes of Health Stroke Scale(NIHSS),and comprehensive functional assessments,cytokines[interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],and neurotransmitters[norepinephrine(NE)and dopamine(DA)]before treatment and at 4 weeks after treatment were compared.Results The total effective rate in the observation group was higher than that of the control group(93.3%vs 75.0%,χ^(2)=7.566,P<0.05).After 4 weeks of treatment,the PSQI score,NIHSS score,IL-1β,IL-6,TNF-α,NE,and DA were all significantly lower than those before treatment in the two groups,while the FCA score was higher than that before treatment(P<0.05);the PSQI score(7.84±1.65),NIHSS score(7.23±1.76),IL-1β(1.72±0.39)ng/L,IL-6(4.72±0.89)ng/L,TNF-α(0.84±0.20)μg/L,NE(2.03±0.43)μmol/L,and DA(379.65±20.12)nmol/L in the observation group were all lower than those in the control group[10.94±1.32,9.46±1.81,(2.49±0.34)ng/L,(6.65±1.02)ng/L,(1.42±0.27)ng/ml,(3.62±0.58)μmol/L,and(425.73±28.74)nmol/L,respectively],and the score of FCA(39.84±4.12)was higher than that of the control group(28.89±4.67)(P<0.05).Conclusion rTMS combined with estazolam has significant efficacy in patients with stroke and insomnia,and can improve the levels of cytokines and neurotransmitters.