超低频经颅磁刺激对帕金森病睡眠障碍患者的疗效观察  

Efficacy of ultra-low frequency transcranial magnetic stimulation in patients with Parkinson’s disease sleep disorders

作　　者：田祥奇 王皓 徐新荣 方雨晴 毛飞 赵张宁[1] 赵海龙 吴丙云[1] 李秀华[1] TIAN Xiangqi;WANG Hao;XU Xinrong;FANG Yuqing;MAO Fei;ZHAO Zhangning;ZHAO Hailong;WU Bingyun;LI Xiuhua(Department of Neurology,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Institute of Neuroimmunology,Shandong Key Laboratory of Rheumatic Disease and Translational Medicine,Jinan 250014,Shandong,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)神经病学,山东省神经免疫研究所,山东省风湿免疫病转化医学重点实验室,山东济南250014

出　　处：《山东大学学报（医学版）》2022年第12期19-25,共7页Journal of Shandong University:Health Sciences

基　　金：济南市临床医学科技创新计划(202019111)

摘　　要：目的 观察超低频经颅磁刺激(ULF-TMS)治疗帕金森病睡眠障碍(PDSD)患者的疗效,探讨ULF-TMS改善PDSD的可能机制。方法 选取PDSD患者90例,按随机数字表法分为γ-氨基丁酸(GABA)组、5-羟色胺(5-HT)组和对照组,每组30例。GABA组给予GABA特征磁刺激治疗,5-HT组给予5-HT特征磁刺激治疗,对照组给予假刺激治疗,1次/d,治疗时间为35 min/次,连续治疗7 d。所有患者均常规服用抗帕金森药物。分别监测各组患者治疗前1 d、治疗结束第1天、治疗结束第30天匹兹堡睡眠质量指数量表(PSQI)、帕金森病睡眠量表(PDSS)、Epworth嗜睡量表(ESS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分变化。结果 重复测量方差分析结果显示:在治疗前1 d、治疗结束第1天、治疗结束第30天各组患者PSQI、PDSS、ESS、HAMD、HAMA评分的时点因素、时点和组别交互作用均差异有统计学意义(P<0.001),组别因素差异无统计学意义(P>0.05)。进一步两两比较结果显示:与同组治疗前1 d相比,GABA组和5-HT组患者治疗结束第1天PSQI、ESS、HAMD、HAMA评分均降低(P<0.05),PDSS评分均升高(P<0.05),各组患者治疗结束第30天PSQI、PDSS、ESS、HAMD、HAMA评分与同组治疗前1 d相比较均差异无统计学意义(P>0.05)。各组患者治疗结束第1天PSQI、ESS、HAMD、HAMA评分相比较,GABA组和5-HT组均低于对照组(P<0.05),各组治疗结束第1天PDSS评分比较,GABA组和5-HT组均高于对照组(P<0.05),治疗结束第30天各组PSQI、PDSS、ESS、HAMD、HAMA评分两两间比较均差异无统计学意义(P>0.05)。结论 超低频经颅磁刺激可以短期改善PDSD患者的睡眠质量及情绪障碍。Objective To observe the efficacy of ultra-low frequency transcranial magnetic stimulation(ULF-TMS) in the treatment of patients with Parkinson’s disease sleep disorder(PDSD), and to explore the possible mechanism. Methods A total of 90 PDSD patients were randomly divided into gamma aminobutyric acid(GABA) group, 5-hydroxytryptamine(5-HT) group and control group, with 30 cases in each group, receiving GABA characteristic magnetic stimulation, 5-HT characteristic magnetic stimulation and sham stimulation, respectively, once a day for 35 minutes for 7 days. All patients routinely took anti-Parkinson drugs. The scores of Pittsburgh Sleep Quality Index(PSQI), Parkinson’s Disease Sleep Scale(PDSS), Epworth Sleepiness Scale(ESS), Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale(HAMA) were monitored 1 day before treatment, 1 day and 30 days after treatment. Results There were significant differences in the time point factors, time point and group interaction of PSQI, PDSS, ESS, HAMD and HAMA scores at the three time points(P<0.001), but there were no significant differences in group factors(P>0.05). Pairwise comparison showed that in the same group, the scores of PSQI, ESS, HAMD and HAMA in the GABA and 5-HT groups decreased(P<0.05), while PDSS score increased(P<0.05) on the day 1 after treatment compared with those 1 day before treatment, but there were no significant differences in PSQI, PDSS, ESS, HAMD and HAMA scores 1 day before treatment and 30 days after treatment(P>0.05). The scores of PSQI, ESS, HAMD and HAMA in GABA and 5-HT groups were lower than those in the control group on day 1 after treatment(P<0.05), while the score of PDSS were higher(P<0.05). The scores of PSQI, PDSS, ESS, HAMD and HAMA were not significantly different 30 days after treatment(P>0.05). Conclusion ULF-TMS can improve sleep quality and mood disorder in PDSD patients in the short term.

关 键 词：超低频经颅磁刺激 帕金森病 睡眠障碍 Γ-氨基丁酸 5-羟色胺 情绪障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R740[医药卫生—临床医学]