不同部位重复经颅磁刺激治疗慢性失眠疗效与认知功能改善的观察性研究  

Observation on the effects of repeated transcranial magnetic stimulation over different locations on chronic insomnia and cognitive function improvement

作　　者：陆艺[1] 刘金同[1] 郑重 乔冬冬[1] 米国琳[1] 郭永军 陈勇[1] LU Yi;LIU Jintong;ZHENG Zhong(Shandong Mental Health Center, Jinan 250014, China)

机构地区：[1]山东省精神卫生中心,山东济南250014 [2]四川大学华西医院

出　　处：《精神医学杂志》2021年第5期440-444,共5页Journal of Psychiatry

基　　金：山东省精神卫生中心科技发展计划项目(编号:2019YJ02)。

摘　　要：目的分析不同部位重复经颅磁刺激(rTMS)治疗慢性失眠的疗效及对患者认知功能的改善作用。方法选取160例慢性失眠患者,分为假刺激组、Cz组、左侧组、右侧组各40例。假刺激组做rTMS假刺激治疗,左侧组、右侧组、Cz组分别在左侧前额叶背外侧(DLPFC)、右侧DLPFC、Cz点后1cm三个不同部位行rTMS治疗。观察不同部位rTMS治疗慢性失眠的疗效。采用匹兹堡睡眠质量指数(PSQI)、睡眠个人信念和态度量表(DBAS)、蒙特利尔认知评估量表(MoCA)、符号数字转换测验(SDMT)、听觉诱发事件相关电位(ERPs)评价患者认知功能的改善作用。结果治疗后Cz组、左侧组、右侧组DBAS总分及各分量表评分、SDMT、MoCA评分均较治疗前升高(P<0.05)。治疗后,Cz组、左侧组、右侧组PSQI评分均低于假刺激组,DBAS总分及各分量表评分、SDMT、MoCA评分均高于假刺激组(P<0.05);左侧组、右侧组PSQI、DBAS后果分量表评分均低于Cz组,DBAS总分及除后果分量表外其他各分量表评分、MoCA、SDMT评分均高于Cz组(P<0.05);右侧组DBAS期望、控制和预测分量表评分均高于左侧组(P<0.05)。治疗后Cz组、左侧组、右侧组ERPs P3峰潜伏期均较治疗前缩短,P3波幅均较治疗前升高(P<0.05)。治疗后,与假刺激组比较,Cz组、左侧组、右侧组ERPs P3峰潜伏期均缩短,P3波幅均升高(P<0.05);与Cz组比较,左侧组、右侧组ERPs P3峰潜伏期均缩短,P3波幅均升高(P<0.05)。治疗后Cz组、左侧组、右侧组治疗总有效率均高于假刺激组(P<0.05);左侧组、右侧组治疗总有效率均高于Cz组(P<0.05);左侧组、右侧组治疗总有效率差异无统计学意义(P>0.05)。结论rTMS治疗部位在左侧DLPFC、右侧DLPFC治疗慢性失眠疗效优于其他区域,可明显改善患者睡眠质量、睡眠信念和态度、认知功能。Objective To explore the effects of repeated transcranial magnetic stimulation(rTMS)over different locations on chronic insomnia and cognitive function improvement.Methods 160 patients with chronic insomnia were selected and divided into shame stimulation group,Cz group,left group and right group,40 cases per group.The sham stimulation group was treated with rTMS sham stimulation.The left group,right group and Cz group were treated with rTMS over left dorsolateral prefrontal cortex(DLPFC),right DLPFC and 1 cm behind Cz point,respectively.The effects of rTMS over different locations on chronic insomnia were observed.All subjects were assessed with Pittsburgh Sleep Quality Index(PSQI),Disfunctional Beliefs and Attitudes Scale(DBAS),Montreal Cognitive Assessment(MoCA),Stroop,Symbol Digit Modalities Test(SDMT),and auditory evoked event-related potentials(ERPs)for cognitive function.Results After treatment,the total scores and all factor scores of DBAS,the total scores of SDMT,MoCA in Cz group,left group and right group all increased significantly compared with those before treatment(P<0.05).After treatment,Cz group,left group and right group showed lower total scores of PSQI,and higher total scores and all factor scores of DBAS as well as higher total scores of MoCA,SDMT than sham stimulation group(P<0.05);left group and right group showed lower total scores of PSQI and lower consequence factor scores of DBAS,higher total scores and all factor scores(except consequence factor score)of DBAS as well as higher total scores of MoCA,SDMT than Cz group(P<0.05);right group showed higher factor scores of expectation,control and prediction of DBAS than left group(P<0.05).After treatment,ERPs P3 peak latencies shortened and P3 amplitudes increased in Cz group,left group,right group compared with those before treatment(P<0.05).After treatment,Cz group,left group and right group showed shortened ERPs P3 peak latencies and increased P3 amplitudes than sham stimulation group(P<0.05);left group and right group showed shortened ERPs

关 键 词：重复经颅磁刺激 前额叶背外侧 慢性失眠 认知功能 

分 类 号：R740[医药卫生—神经病学与精神病学]