低频重复经颅磁刺激与持续θ暴发刺激治疗失眠症疗效的对比研究

瞿砚舟 吴泓蔚 陈洁

[摘要] 目的 比较低频重复经颅磁刺激（rTMS）与持续θ暴发刺激（cTBS）治疗失眠症的疗效差异。 方法 选取2018年1～12月丽水市人民医院神经内科收治的60例失眠症患者，随机分为低频rTMS组（32例）和cTBS组（28例），低频rTMS组以1 Hz低频rTMS刺激右侧背外侧前额叶（r-DLPFC）和顶枕区域，cTBS组以cTBS模式刺激相同位点，疗程2周。治疗前后评估匹兹堡睡眠质量指数（PSQI）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）。结果 低频rTMS组及cTBS组治疗前后PSQI、HAMA、HAMD均下降，差异有统计学意义（P<0.01）;低频rTMS组各量表减分率略高于cTBS组，但差异无统计学意义（P>0.05）。 结论 持续θ暴发刺激治疗失眠症疗效不低于低频重复经颅磁刺激。

[关键词] 失眠症;重复经颅磁刺激;θ暴发刺激;右侧背外侧前额叶;顶枕区域

[中图分类号] R454.1          [文献标识码] A          [文章编号] 1673-9701（2020）15-0007-04

Comparative study on the effects of low frequency repetitive transcranial magnetic stimulation and continuous θ burst stimulation in the treatment of insomnia

QU Yanzhou   WU Hongwei   CHEN Jie   LAN Likang

Department of Neurology， Lishui People's Hospital in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To compare the differences in the curative effect of low frequency repetitive transcranial magnetic stimulation（rTMS） and continuous θ burst stimulation（cTBS） in the treatment of insomnia. Methods 60 patients with insomnia who were treated in our hospital from January to December 2018 were selected and randomly divided into low-frequency rTMS group（32 cases） and cTBS group（28 cases）. The low frequency rTMS group was given the stimulation on the right dorsal lateral prefrontal cortex（r-DLPFC） and parietal occipital region with low frequency rTMS at 1 Hz. The cTBS group was given the stimulation at the same site with cTBS mode; the course of treatment was 2 weeks. The Pittsburgh Sleep Quality Index（PSQI）， Hamilton Anxiety Scale（HAMA）， and Hamilton Depression Scale（HAMD） were evaluated before and after treatment. Results The PSQI， HAMA， and HAMD in the low-frequency rTMS group and the cTBS group were decreased before and after treatment（P<0.01）. The reduction rate of each scale in the low-frequency rTMS group was slightly higher than that in the cTBS group， but the difference was not statistically significant（P>0.05）. Conclusion The curative effect of continuous θ burst stimulation on insomnia is not lower than that of low frequency repeated transcranial magnetic stimulation.

[Key words] Insomnia; Repetitive transcranial magnetic stimulation; θ burst stimulation; Right dorsal lateral prefrontal cortex; Parietal occipital region

失眠癥是以频繁而持续的入睡困难和（或）睡眠维持困难并导致睡眠不满感为特征的睡眠障碍，可孤立存在或与精神障碍、躯体疾病、物质滥用共病。随着社会节奏加快和社会压力增大，失眠症发生率进一步增高，在成人中，符合失眠症标准者约10%～15%，且呈慢性化病程，近半数严重失眠症患者症状可持续10年以上，严重影响患者的生活质量和工作效率，甚至诱发交通事故等意外而危及个人和公共安全，对个人和社会都造成严重负担[1]。经颅磁刺激（Transcranial magnetic stimulation，TMS）技术，由Barker等[2]于1985年创立，是利用时变磁场在大脑皮层中产生感应电流，进而改变神经细胞的动作电位，以此来影响脑内代谢和神经电活动的生物刺激过程，是一项无创、操作简单、安全性好，可治疗多种神经、精神疾病的治疗技术。……