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

doi:10.3877/cma.j.issn.1674-0785.2022.05.004

Abstract

Abstract:

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.

Key words: Stroke, Repetitive transcranial magnetic stimulation, Estazolam, Insomnia, Efficacy, Cytokines, Neurotransmitters

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]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(05): 395-399.

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References 21

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.

时间		PSQI	NIHSS	FCA	IL-1β（ng/L）	IL-6（ng/L）	TNF-α（μg/L）	NE（μmol/L）	DA（nmol/L）
治疗前	观察组	15.95±2.02	13.72±2.18	19.34±3.81	3.48±0.64	9.65±1.24	2.25±0.29	4.97±0.61	489.93±26.56
	对照组	16.03±1.84	13.56±2.05	18.75±3.65	3.53±0.57	9.79±1.30	2.27±0.35	5.07±0.42	493.42±31.28
	t值	0.227	0.414	0.866	0.452	0.604	0.341	1.046	0.659
	P值	0.821	0.680	0.388	0.652	0.547	0.734	0.298	0.511
治疗4周后	观察组	7.84±1.65	7.23±1.76	39.84±4.12	1.72±0.39	4.72±0.89	0.84±0.20	2.03±0.43	379.65±20.12
治疗4周后	对照组	10.94±1.32	9.46±1.81	28.89±4.67	2.49±0.34	6.65±1.02	1.42±0.27	3.62±0.58	425.73±28.74
	t值	11.364	6.842	13.620	11.528	11.044	13.371	17.058	10.174
	P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

时间		PSQI	NIHSS	FCA	IL-1β（ng/L）	IL-6（ng/L）	TNF-α（μg/L）	NE（μmol/L）	DA（nmol/L）
治疗前	观察组	15.95±2.02	13.72±2.18	19.34±3.81	3.48±0.64	9.65±1.24	2.25±0.29	4.97±0.61	489.93±26.56
	对照组	16.03±1.84	13.56±2.05	18.75±3.65	3.53±0.57	9.79±1.30	2.27±0.35	5.07±0.42	493.42±31.28
	t值	0.227	0.414	0.866	0.452	0.604	0.341	1.046	0.659
	P值	0.821	0.680	0.388	0.652	0.547	0.734	0.298	0.511
治疗4周后	观察组	7.84±1.65	7.23±1.76	39.84±4.12	1.72±0.39	4.72±0.89	0.84±0.20	2.03±0.43	379.65±20.12
治疗4周后	对照组	10.94±1.32	9.46±1.81	28.89±4.67	2.49±0.34	6.65±1.02	1.42±0.27	3.62±0.58	425.73±28.74
	t值	11.364	6.842	13.620	11.528	11.044	13.371	17.058	10.174
	P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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