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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 395 -399. doi: 10.3877/cma.j.issn.1674-0785.2022.05.004

临床研究

重复经颅磁刺激联合艾司唑仑对脑卒中失眠患者的疗效及其对血清细胞因子和神经递质的影响
杨轩1,(), 石晴2, 邱海斌1, 黄强3   
  1. 1. 528000 佛山,广东省佛山市中医院肌电图室
    2. 410007 长沙,湖南省脑科医院临床心理科
    3. 528000 佛山,广东省佛山市中医院神经内科
  • 收稿日期:2021-08-05 出版日期:2022-05-15
  • 通信作者: 杨轩
  • 基金资助:
    佛山市医学科研立项课题(20190085)

Repetitive transcranial magnetic stimulation combined with estazolam for treatment of patients with stroke and insomnia: efficacy and influence on cytokines and neurotransmitters

Xuan Yang1,(), Qing Shi2, Haibin Qiu1, Qiang Huang3   

  1. 1. EMG Room, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China
    2. Department of Clinical Psychology, Hunan Brain Hospital, Changsha 410007, China
    3. Department of Neurology, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China
  • Received:2021-08-05 Published:2022-05-15
  • Corresponding author: Xuan Yang
引用本文:

杨轩, 石晴, 邱海斌, 黄强. 重复经颅磁刺激联合艾司唑仑对脑卒中失眠患者的疗效及其对血清细胞因子和神经递质的影响[J/OL]. 中华临床医师杂志(电子版), 2022, 16(05): 395-399.

Xuan Yang, Qing Shi, Haibin Qiu, Qiang Huang. Repetitive transcranial magnetic stimulation combined with estazolam for treatment of patients with stroke and insomnia: efficacy and influence on cytokines and neurotransmitters[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(05): 395-399.

目的

探讨重复经颅磁刺激(rTMS)联合艾司唑仑对脑卒中失眠患者的疗效及其对血清细胞因子和神经递质影响。

方法

入选佛山市中医院2019年4月至2021年4月脑卒中失眠患者120例,运用随机数字表法将其随机分为观察组(60例)与对照组(60例)。两组入院均遵循中国脑血管病防控指南要求的常规治疗和康复治疗。对照组口服艾司唑仑,观察组在艾司唑仑基础上采取rTMS治疗。两组治疗疗程均4周。比较两组治疗4周的疗效,治疗前与治疗4周后匹兹堡睡眠质量指数(PSQI)和美国国立卫生研究院卒中量表(NIHSS)评分、功能综合评定量表(FCA)评分、血清细胞因子[白细胞介素-1β(IL-1β)、IL-6和肿瘤坏死因子-α(TNF-α)]及神经递质[去甲肾上腺素(NE)和多巴胺(DA)]变化。

结果

观察组治疗总有效率高于对照组(93.33%比75.00,χ2=7.566,P<0.05)。治疗4周,两组脑卒中失眠患者PSQI评分、NIHSS评分、IL-1β、IL-6、TNF-α、NE和DA水平均较治疗前降低,而FCA评分较治疗前增加,差异均有统计学意义(均P<0.05);治疗4周,观察组脑卒中失眠患者PSQI评分(7.84±1.65)分、NIHSS评分(7.23±1.76)分、IL-1β(1.72±0.39)ng/L、IL-6(4.72±0.89)ng/L、TNF-α(0.84±0.20)μg/L、NE(2.03±0.43)μmol/L和DA(379.65±20.12)nmol/L低于对照组的(10.94±1.32)分、(9.46±1.81)分、(2.49±0.34)ng/L、(6.65±1.02)ng/L、(1.42±0.27)μg/ml、(3.62±0.58)μmol/L和(425.73±28.74)nmol/L,而FCA评分(39.84±4.12)分高于对照组的(28.89±4.67)分,差异均有统计学意义(均P<0.05)。

结论

rTMS联合艾司唑仑对脑卒中失眠患者疗效显著,且可改善细胞因子和神经递质水平。

Objective

To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with estazolam in patients with stroke and insomnia and its influence on cytokines and neurotransmitters.

Methods

A total of 120 patients with stroke and insomnia at Foshan Hospital of Traditional Chinese Medicine from April 2019 to April 2021 were randomly divided into either an observation group (60 cases) or a control group (60 cases) using a random number table. Both groups received the routine treatment and rehabilitation treatment according to the Chinese guidelines for the prevention and control of cerebrovascular diseases. The control group was treated with estazolam orally, and the observation group was treated with rTMS on the basis of estazolam. The treatment course of both groups was 4 weeks. The efficacy of 4 weeks of treatment between the two groups, as well as the scores of the Pittsburgh Sleep Quality Index (PSQI), the National Institutes of Health Stroke Scale (NIHSS), and comprehensive functional assessments, cytokines [interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)], and neurotransmitters [norepinephrine (NE) and dopamine (DA)] before treatment and at 4 weeks after treatment were compared.

Results

The total effective rate in the observation group was higher than that of the control group (93.3% vs 75.0%, χ2=7.566, P<0.05). After 4 weeks of treatment, the PSQI score, NIHSS score, IL-1β, IL-6, TNF-α, NE, and DA were all significantly lower than those before treatment in the two groups, while the FCA score was higher than that before treatment (P<0.05); the PSQI score (7.84±1.65), NIHSS score (7.23±1.76), IL-1β (1.72±0.39) ng/L, IL-6 (4.72±0.89) ng/L, TNF-α (0.84±0.20)μg/L, NE (2.03±0.43) μmol/L, and DA (379.65±20.12) nmol/L in the observation group were all lower than those in the control group [10.94±1.32, 9.46±1.81, (2.49±0.34) ng/L, (6.65±1.02) ng/L, (1.42±0.27) ng/ml, (3.62±0.58) μmol/L, and (425.73±28.74) nmol/L, respectively], and the score of FCA (39.84±4.12) was higher than that of the control group (28.89±4.67) (P<0.05).

Conclusion

rTMS combined with estazolam has significant efficacy in patients with stroke and insomnia, and can improve the levels of cytokines and neurotransmitters.

表1 两组脑卒中失眠患者各功能及血清细胞因子和神经递质比较(
xˉ
±s
1
Azpiazu D, Gonzalo S, Villa-Bellosta R. Tissue non-specific alkaline phosphatase and vascular calcification: a potential therapeutic target[J]. Curr Cardiol Rev, 2019, 15(2):91-95. DOI: 10.2174/1573403X14666181031141226.
2
Guo J, Yu H, Cui T. Applications of fluorescent materials in the detection of alkaline phosphatase activity[J]. J Biomed Mater Res B Appl Biomater, 2021, 109(2):214-226. DOI: 10.1002/jbm.b.34693.
3
刘晶晶, 张小健, 刘宏伟, 等. 三七合枕清眠安汤联合通督益脑安神针治疗卒中后失眠气滞血瘀证疗效观察[J]. 现代中西医结合杂志, 2020, 29(18):1963-1967. DOI: 10.3969/j.issn.1008-8849.2020.18.006.
4
张瀚元, 刘玉欢, 李铁, 等. 靳三针联合重复经颅磁刺激治疗心脾两虚型失眠的临床效果[J]. 中国医药导报, 2021, 18(6):144-148.
5
徐丹, 田峻, 陈晨, 等. 低频重复经颅磁刺激治疗脑卒中后失眠的疗效[J]. 中国神经免疫学和神经病学杂志, 2021, 28(1):58-60,66. DOI: 10.3969/j.issn.1006-2963.2021.01.010.
6
吴伟, 吴波, 焉传祝, 等. 第18次中国脑血管病大会2018会议纪要[J]. 中华神经科杂志, 2019, 52(3):238-240. DOI: 10.3760/cma.j.issn.1006-7876.2019.03.013.
7
中国睡眠研究会. 中国失眠症诊断和治疗指南[J]. 中华医学杂志, 2017, 97(24):1844-1856. DOI: 10.3760/cma.j.issn.0376-2491.2017.24.002.
8
Jackson EK, Cheng D, Ritov VB, et al. Alkaline phosphatase activity is a key determinant of vascular responsiveness to norepinephrine[J]. Hypertension, 2020, 76(4):1308-1318. DOI: 10.1161/HYPERTENSIONAHA.120.15822.
9
张修红, 陈金雄, 郑关毅, 等. 甘麦芪仙磁石汤联合艾司唑仑片治疗老年慢性失眠心脾两虚证临床观察[J]. 中国中西医结合杂志, 2020, 40(6):666-671. DOI: 10.7661/j.cjim.20191104.190.
10
李六水, 付二连, 夏路风, 等. 七叶神安片与艾司唑仑治疗原发性失眠症近期疗效比较[J]. 安徽中医药大学学报, 2017, 36(2):18-21. DOI: 10.3969/j.issn.2095-7246.2017.02.006.
11
黄伟, 滕海英, 毛媛媛. 舒肝解郁胶囊联合艾司唑仑治疗卒中后睡眠障碍的疗效观察[J]. 中西医结合心脑血管病杂志, 2018, 16(8):1105-1107. DOI: 10.12102/j.issn.1672-1349.2018.08.035.
12
Gredal H, Thomsen BB, Boza-Serrano A, et al. Interleukin-6 is increased in plasma and cerebrospinal fluid of community-dwelling domestic dogs with acute ischaemic stroke[J]. Neuroreport, 2017, 28(3):134-140. DOI: 10.1097/WNR.0000000000000728.
13
McCann SK, Cramond F, Macleod MR, et al. Systematic review and meta-analysis of the efficacy of interleukin-1 receptor antagonist in animal models of stroke: an update[J]. Transl Stroke Res, 2016, 7(5):395-406. DOI: 10.1007/s12975-016-0489-z.
14
陈鹏, 陈智康, 李明芬, 等. 重复经颅磁刺激对脑卒中后失眠的临床研究[J]. 湖北医药学院学报, 2018, (3):262-264. DOI: 10.13819/j.issn.1006-9674.2018.03.017.
15
游毅, 陈卉, 李土明, 等. 针刺联合低频疗法治疗缺血性脑卒中后失眠[J]. 吉林中医药, 2019, 39(11):1476-1480. DOI: 10.13463/j.cnki.jlzyy.2019.11.022.
16
陈丽萍, 韩棉梅, 傅思媚. 电针联合重复经颅磁刺激治疗脑卒中后抑郁伴失眠的临床研究[J]. 广州医药, 2021, 52(2):6-10,27. DOI: 10.3969/j.issn.1000-8535.2021.02.002.
17
杨柳, 刘玉山, 吴宁渤, 等. 低频重复经颅磁刺激对缺血性脑卒中后抑郁患者血清神经递质、细胞因子的影响[J]. 海南医学院学报, 2017, 23(10):1434-1437. DOI: 10.13210/j.cnki.jhmu.20170406.009.
18
陈前, 李丽. 推拿配合经颅磁刺激治疗脑卒中后失眠临床研究[J]. 山东中医杂志, 2017, 36(5):387-389.
19
赵娜, 胡万华, 吴志敏, 等. 血清细胞因子与脑卒中后失眠的相关性研究[J]. 中国微生态学杂志, 2017, 29(4):438-440. DOI: 10.13381/j.cnki.cjm.201704015.
20
李梦雪, 张之毓, 王倩. 通督调神针法治疗脑卒中后失眠的疗效及其对神经递质水平的影响[J]. 世界中医药, 2020, 15(1):112-115. DOI: 10.3969/j.issn.1673-7202.2020.01.022.
21
李秀泉. 右佐匹克隆与艾司唑仑对脑卒中后失眠患者神经递质、神经细胞因子及应激状态的影响[J]. 海南医学院学报, 2018, 24(11):1131-1134. DOI: 10.13210/j.cnki.jhmu.20180416.003.
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