低频重复经颅磁刺激对尿毒症失眠患者的临床研究  

Clinical research of low-frequency repetitive transcranial magnetic stimulation on uremia patients with insomnia

作　　者：袁珊[1] 谢席胜[1] 冯胜刚[1] 张红玉 郭志伟[1] YUAN Shan;XIE Xisheng;FENG Shenggang;ZHANG Hongyu;GUO Zhiwei(Nanchong Central Hospital,The Second Clinical College of North Sichuan Medical College,Nanchong637000,Sichuan,China)

机构地区：[1]川北医学院第二临床医学院·南充市中心医院肾病内科

出　　处：《西部医学》2019年第11期1730-1735,共6页Medical Journal of West China

基　　金：四川省科技厅科研课题(2013JY0130)

摘　　要：目的研究重复经颅磁刺激(rTMS)对尿毒症失眠患者的疗效及静息态功能磁共振成像(rs-fMRI)下大脑自发神经活动低频振幅(ALFF)的变化。方法选取2015年3月~2016年6月在南充市中心医院血液净化中心进行维持性血液透析的尿毒症失眠患者31例,分为rTMS治疗组(n=21)与空白对照组(n=10)。rTMS治疗组接受rTMS治疗,在治疗前后采用匹兹堡睡眠质量指数量表(PSQI)、阿森斯失眠量表(AIS)进行评分及rs-fMRI图像采集。空白对照组不接受rTMS治疗,不采集rs-fMRI图像,其余与rTMS治疗组相同。对比分析rTMS治疗组治疗前后睡眠量表评分及低频振幅(ALFF)的差异。结果 rTMS组治疗15d后,与治疗前及空白对照组入组15d后相比,尿毒症失眠患者睡眠情况明显改善。rTMS组治疗前后ALFF值比较,差异有统计学意义(P<0.05),其中双侧眶额叶、双侧杏仁核、左侧海马、左侧前扣带回的ALFF值增高,双侧脑岛的ALFF值降低。结论低频可rTMS通过影响大脑相关脑区神经活动强弱来治疗尿毒症患者的失眠,改善睡眠结构。Objective To research the curative efficacy of repetitive transcranial magnetic stimulation(rTMS) on change of spontaneous brain activity in patients with uremic insomnia by using Amplitude of Low Frequency Frequency(ALFF) and clinical assessments.Methods 31 patients assigned to rTMS treatment group(21 cases) and blank control group(10 cases). The patients in the rTMS treatment group received 1 Hz rTMS treatment for 15 days and the Pittsburgh Sleep Quality Index(PSQI) and Athens Insomnia Scale(AIS) score and ALFF were assessed before and after treatment. The patients in the blank control group,the Pittsburgh Sleep Quality Index(PSQI) and Athens Insomnia Scale(AIS) were assessed before and after 15 days. Results In the rTMS group,after treatment for 15 days of PSQI and AIS total score pair wise comparison. The results indicate that after treatment 15 days, the difference was statistically significant(P<0.05). The ALFF were significantly increased in the bilateral frontal lobe, bilateral amygdala, left hippocampus, and left anterior cingulate gyrus. The ALFF value significantly decreased in the bilateral insula(P<0.05).Conclusion Low frequency rTMS is effective in the treatment of uremic patients with insomnia.

关 键 词：尿毒症 失眠 重复经颅磁刺激 静息态功能磁共振 低频振幅 

分 类 号：R692.5[医药卫生—泌尿科学]