小脑靶点rTMS治疗PPPD的临床随机对照研究

A randomized controlled clinical study of cerebellar rTMS in the treatment of PPPD

目的分析小脑靶点重复经颅磁刺激(r TMS)治疗持续性姿势-感知性头晕(PPPD)的临床疗效。方法选择2021年7月至2022年12月就诊于大连市第三人民医院眩晕专科门诊并符合PPPD诊断标准的患者68例,以1∶1比例随机分为rTMS组和假刺激组,每组各34例。以头晕残障量表(DHI)评分为主要评价指标,汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)为次要指标。分别比较两组受试者在治疗前、治疗后即刻、治疗后2周、治疗后4周上述量表得分。结果重复测量方差分析结果显示,DHI、HAMA、HAMD、PSQI 4个量表的分组因素、时间因素,以及二者的交互作用均有统计学意义(P<0.05);进一步两两比较结果显示,治疗前两组的DHI、HAMA、HAMD、PSQI量表分数差异均无统计学意义(P>0.05),治疗后即刻、治疗后2周、治疗后4周r TMS组各量表分数均明显低于假刺激组,差异有统计学意义(P<0.05)。结论rTMS治疗PPPD安全、有效,值得临床推广应用。

Objective To analyze the clinical efficacy of repeated transcranial magnetic stimulation (rTMS) over the cerebellum in the treatment of persistent postural-perceptual dizziness (PPPD).Methods A total of 68 patients, who met the diagnostic criteria for PPPD in the vertigo specialist clinic of Dalian Third People's Hospital from July 2021 to December 2022, were selected and randomly divided into rTMS group and false stimulation group equally with 34 patients in each group. The dizziness handicap inventory (DHI) was used as the main index, and the Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD) and Pittsburgh sleep quality index (PSQI) were the secondary indexes. They were compared between the two groups before treatment, immediately after treatment, 2 weeks after treatment and 4 weeks after treatment.Results Repeated measures ANOVA analysis revealed that the grouping factor, time factor and interaction of DHI, HAMA, HAMD and PSQI were statistically significant (P<0.05). Further paired comparison showed that there was no statistical significance in DHI, HAMA, HAMD and PSQI scores between the two groups before treatment (P>0.05). The scores in the rTMS group were significantly lower or decreased than those in the false stimulation group immediately after treatment, two weeks after treatment and four weeks after treatment (P<0.05).Conclusion rTMS in the treatment of PPPD is safe, effective and worthy of clinical application.