低频rTMS对脑梗死合并睡眠障碍患者血清5-HIAA、神经肽、NSE及5-HT水平的影响

Effect of low-frequency rTMS on serum levels of 5-HIAA,neuropeptide,NSE,and 5-HT in patients with cerebral infarction and sleep disorders

目的探讨低频重复经颅磁刺激(rTMS)对脑梗死合并睡眠障碍患者血清5-羟吲哚乙酸(5-HIAA)、神经肽、神经元特异性烯醇化酶(NSE)及5-羟色胺(5-HT)水平的影响。方法前瞻性选取2022年1月至2023年6月齐齐哈尔医学院第五附属医院(大庆龙南医院)收治的92例脑梗死合并睡眠障碍患者作为研究对象,按照随机数字表法分为观察组及对照组,每组各46例。对照组接受单独常规干预,观察组低频rTMS联合常规干预。观察两组疗效,治疗前和治疗后4周的匹兹堡睡眠质量指数(PSQI)、美国国立卫生研究院卒中量表(NIHSS)评分以及血清5-HIAA、神经肽、NSE、5-HT水平,并观察比较两组患者不良反应发生情况。结果观察组总有效率为95.65%,高于对照组(82.61%),差异有统计学意义(P<0.05)。治疗后4周,两组PSQI、NIHSS评分均低于治疗前,观察组的PSQI、NIHSS评分分别为(6.05±1.12)、(10.12±2.15)分,均低于对照组[(7.35±1.56)、(14.26±2.58)分],差异均有统计学意义(P<0.05)。治疗后4周,两组5-HIAA、神经肽、5-HT水平均较治疗前升高,NSE均较治疗前降低,且观察组治疗后4周的血清5-HIAA、神经肽、5-HT水平分别为(2349.56±548.56)ng/L、(7.76±1.54)μg/mL、(37.89±5.89)ng/mL,均高于对照组[(2012.58±359.85)ng/L、(6.45±1.42)μg/mL、(31.26±5.81)ng/mL],NSE水平为(17.02±2.25)μg/L,低于对照组[(21.12±2.59)μg/L],差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论低频rTMS治疗脑梗死合并睡眠障碍疗效显著,不仅能有效改善患者睡眠质量、神经缺损症状,还能改善其血清5-HIAA、神经肽、NSE、5-HT水平,安全性较高。

Objective To investigate the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)on serum levels of 5-hydroxyindoleacetic acid(5-HIAA),neuropeptide,neuron-specific enolase(NSE)and 5-hydroxytryptamine(5-HT)in patients with cerebral infarction complicated with sleep disorders.Methods Ninety-two patients with cerebral infarction and sleep disorders admitted to the Fifth Affiliated Hospital of Qiqihar Medical College(Daqing Longnan Hospital)from January 2022 to June 2023 were prospectively selected as the study subjects.They were divided into the observation group and the control group according to the random number table method,with 46 cases in each group.The therapeutic effects,Pittsburgh sleep quality index(PSQI),National Institutes of Health stroke scale(NIHSS)scores and serum levels of 5-HIAA,neuropeptide,NSE and 5-HT before treatment and after 4 weeks of treatment were observed in the two groups,and adverse reactions were observed.Results The total effective rate of the observation group was 95.65%,which was higher than that of the control group(82.61%),and the difference was statistically significant(P<0.05).After 4 weeks of treatment,the PSQI and NIHSS scores of both groups were lower than before treatment,the PSQI and NIHSS scores of the observation group were(6.05±1.12)and(10.12±2.15)points,respectively,which were lower than those of the control group[(7.35±1.56)and(14.26±2.58)points],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the levels of serum 5-HIAA,neuropeptide,and 5-HT in two groups were higher than those before treatment,and the levels of NSE were higher than those before treatment,in addition,the levels of serum 5-HIAA,neuropeptide,and 5-HT in the observation group were(2349.56±548.56)ng/L,(7.76±1.54)μg/mL,(37.89±5.89)ng/mL,respectively,which were higher than those in the control group[(2012.58±359.85)ng/L,(6.45±1.42)μg/mL,(31.26±5.81)ng/mL],and the level of NSE was(17.02±2.25)μg/L,which was lower than that in the control group[(21.12±2.59)μg/L],and the differences were statistically significant(P<0.05).There was no statistically significant difference in total incidence of adverse reactions was similar between the two groups(P>0.05).Conclusion Low frequency rTMS has a significant therapeutic effect on cerebral infarction combined with sleep disorders.It can not only effectively improve the sleep quality and neurological deficit symptoms of patients,but also improve their serum levels of 5-HIAA,neuropeptide,NSE,and 5-HT,with high safety.