摘要
目的探究重复经颅磁刺激(rTMS)联合帕罗西汀治疗广泛性焦虑症(GAD)伴失眠患者的临床疗效。方法将80例GAD伴失眠患者按照随机数字表法分为药物组和联合组,每组各40例。药物组患者采用帕罗西汀联合伪刺激治疗,联合组患者采用低频rTMS联合帕罗西汀治疗,观察4周。比较两组患者治疗前及治疗2周、4周汉密顿焦虑量表(HAMA)评分,治疗前后睡眠进程[夜间睡眠潜伏期(SOL)、觉醒次数、睡眠总时间(TST)、睡眠效率(SE)]、睡眠结构[1期睡眠(N1)、2期睡眠(N2)、3期睡眠(N3)和快速眼动期(REM)占TST的百分比]、失眠严重程度指数(ISI)评分以及血清相关生化指标[5-羟色胺(5-HT)、γ-氨基丁酸(GABA)、脑源性神经营养因子(BDNF)、褪黑素(MT)]变化和不良反应发生率。结果治疗2周、4周,两组患者HAMA评分均较治疗前下降,且联合组低于药物组(P<0.01)。与治疗前相比,治疗后两组患者SOL缩短,觉醒次数减少,TST延长,N1占比、REM占比下降,SE、N2占比、N3占比上升(P<0.01);治疗后,联合组患者SOL、觉醒次数、TST、SE、N3占比、REM占比均优于对照组(P<0.05)。治疗后,两组患者ISI评分均较治疗前下降,且联合组低于药物组(P<0.01)。治疗后,两组患者5-HT、GABA、BDNF和MT水平均较治疗前上升,且联合组高于药物组(P<0.01)。两组患者不良反应发生情况比较,差异无统计学意义(P>0.05)。结论低频rTMS联合帕罗西汀治疗GAD伴失眠患者疗效显著,可快速减轻患者焦虑症状和失眠症状,同时改善其血清神经递质水平,提高睡眠质量。
Objective To explore the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with paroxetine in the t reatment of patients with comorbid generalized anxiety disorder(GAD)and insomnia.Methods Eighty patients with comorbid GAD and insomnia were divided into drug and combination group according to random number table,with 40 ones in each.The drug group was treated with paroxetine and pseudo-stimulation,the combination group with low-frequency rTMS plus paroxetine,and were observed for 4 weeks.Such indexes were compared between the two groups as the scores on the Hamilton Anxiety Scale(HAMA)before treatment and in the week 2 and 4 of treatment,pre-and post-treatment sleep process(nocturnal sleep onset latency[SOL],frequency of nocturnal awakenings[FNA],total sleep time[TST],and sleep efficiency[SE]),sleep structure(the percentages of sleep stages N1,N2,N3 and rapid eye movement[REM]sleep in the TST),insomnia severity index(ISI)score,serum related biochemical indicators(5-hydroxytryptamine[5-HT],γ-aminobutyric acid[GABA],brain-derived neurotrophic factor[BDNF],and melatonin[MT]),and the incidence rates of adverse reactions.Results In weeks 2 and 4 of treatment,scores on the HAMA in both groups lowered compared with pre-treatment and those were lower in combination than drug group(P<0.01).Compared with pre-treatment the SOL shortened,FNAs reduced,%N1 and%REM lowered,TST prolonged as well as SE,%N2 and%N3 increased in both groups after treatment(P<0.01).After treatment SOL,FNA,TST,SE,%N3 and%REM were all better in combination than drug group(P<0.05).After treatment scores on the ISI lowered in both groups compared with pre-treatment and that was lower in combination than drug group(P<0.01).After treatment 5-HT,GABA,BDNF and MT levels elevated in both groups compared with pre-treatment and those were higher in combination than drug group(P<0.01).Intergroup difference in the occurrence of adverse reactions wasn't statistically significant(P>0.05).Conclusion Low-frequency rTMS combined with par
作者
张志文
赵振丽
Zhang Zhiwen;Zhao Zhenli(Zhoukou Central Hospital,Zhoukou 466000,Henan,China;不详)
出处
《临床心身疾病杂志》
CAS
2024年第6期6-10,共5页
Journal of Clinical Psychosomatic Diseases
关键词
广泛性焦虑症
失眠
重复经颅磁刺激
帕罗西汀
睡眠质量
generalized anxiety disorder
insomnia
repetitive transcranial magnetic stimulation
paroxetine
sleep quality
