低频重复经颅磁刺激对缺血性脑卒中后失眠患者睡眠质量及HPA轴相关激素的影响  

Effects of low-frequency repetitive transcranial magnetic stimulation on sleep quality and HPA axis-related hormones in patients with insomnia after ischemic stroke

作　　者：田慧军 王翼 杜娜 王婷婷 Tian Huijun;Wang Yi;Du Na;Wang Tingting(Department of Neurology,Langfang Aidebao Hospital,Langfang 065008,China;Second Department of Health Care,No.971 Hospital of PLA navy,Qingdao 266000,China)

机构地区：[1]河北廊坊爱德堡医院神经内科,廊坊065008 [2]海军第九七一医院保健二科,青岛266000

出　　处：《中华航海医学与高气压医学杂志》2024年第4期486-490,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的探讨低频重复经颅磁刺激(rTMS)对缺血性脑卒中后失眠患者睡眠质量及下丘脑-垂体-肾上腺轴(HPA)相关激素的影响。方法选取64例缺血性脑卒中后失眠患者,按随机数字表法分为观察组(n=32)和对照组(n=32),2组患者均接受常规内科治疗,观察组在对照组基础上加用低频rTMS治疗2周。观察并比较2组患者治疗前、治疗2周后匹兹堡睡眠质量指数(PSQI)及血清促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(CORT)水平的变化。结果观察组临床总有效率(84.4%)高于对照组(68.8%),差异有统计学意义(P<0.05)。治疗后,2组PQSI总分、入睡时间、睡眠质量、睡眠效率、睡眠时间、睡眠障碍、催眠药物和日间功能障碍得分均较治疗前下降,且观察组低于对照组,差异均有统计学意义(P<0.01);观察组血清CRH、ACTH、CORT水平低于治疗前,对照组CRH、CORT水平低于治疗前,且观察组各指标水平均低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论rTMS可有效改善缺血性脑卒中后失眠患者的睡眠质量,并降低HPA轴相关激素的水平,从而改善患者的过度觉醒状态,有利于病情康复。ObjectiveTo investigate the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)on sleep quality and hormones related to the hypothalamic-pituitary-adrenal(HPA)axis in patients with insomnia after ischemic stroke.MethodsSixty-four patients with insomnia after ischemic stroke were selected and divided into treatment group(n=32)and control group(n=32)according to the random number table method.Patients in both groups received conventional medical treatment;and in addition to the treatment in the control group,the treatment group was treated with low-frequency rTMS for a total of 2 weeks.The scores of Pittsburgh Sleep Quality Index(PSQI),and the levels of serum corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),and cortisol(CORT)before and after treatment were observed and compared between the two groups.ResultsThe overall clinical efficiency of the treatment group(84.4%)was significantly higher than that of the control group(68.8%)(P<0.05).After treatment,the total PQSI score,sleep onset latency,sleep quality,sleep efficiency,sleep duration,sleep disorder,hypnotic drugs,and daytime dysfunction decreased in both groups compared with those before treatment;and the indexes in treatment group were lower than those of control group(P<0.01).After treatment,serum levels of CRH,ACTH,and CORT decreased in the treatment group,CRH and CORT levels in control group also decreased,and the serum levels of each index in the treatment group were significantly lower than those in the control group(P<0.05 or P<0.01).ConclusionThe rTMS treatment for insomnia after ischemic stroke can effectively improve the sleep quality of patients and reduce the serum levels of HPA axis-related hormones,thus improving the hyperarousal state of patients and facilitating their recovery.

关 键 词：重复经颅磁刺激 缺血性脑卒中 失眠 下丘脑⁃垂体⁃肾上腺轴 睡眠质量 

分 类 号：R743.3[医药卫生—神经病学与精神病学]