经颅直流电刺激联合右佐匹克隆治疗慢性失眠患者的临床研究

doi:10.11958/20230429

天津医药 ›› 2023, Vol. 51 ›› Issue (11): 1227-1231.doi: 10.11958/20230429

经颅直流电刺激联合右佐匹克隆治疗慢性失眠患者的临床研究

张璐¹^,²(), 张卫¹, 袁长红¹, 李霞¹, 吕余静³, 王玉⁴^,^△()

1.安徽省第二人民医院神经内科（邮编230041）
2.安徽医科大学省第二人民医院临床学院
3.蚌埠医学院研究生院
4.安徽医科大学第一附属医院神经内科

收稿日期:2023-03-27 修回日期:2023-05-29 出版日期:2023-11-15 发布日期:2023-11-07
通讯作者: ^△E-mail：wangyu18b@163.com
作者简介:张璐（1984），女，副主任医师，主要从事睡眠、癫痫、疼痛方面研究。E-mail：zhanglu841204@126.com
基金资助:
安徽省高校科学研究项目(KJ2021A0350)

Clinical study of transcranial direct current stimulation combined with eszopiclone in the treatment of chronic insomnia

ZHANG Lu¹^,²(), ZHANG Wei¹, YUAN Changhong¹, LI Xia¹, LYU Yujing³, WANG Yu⁴^,^△()

1. Department of Neurology, Anhui No.2 Provincial People’s Hospital, Hefei 230041, China
2. Anhui No.2 Provincial People’s Hospital Clinical College, Anhui Medical University
3. Graduate School, Bengbu Medical University
4. Department of Neurology, the First Affiliated Hospital of Anhui Medical University

Received:2023-03-27 Revised:2023-05-29 Published:2023-11-15 Online:2023-11-07
Contact: ^△E-mail：wangyu18b@163.com

张璐, 张卫, 袁长红, 李霞, 吕余静, 王玉. 经颅直流电刺激联合右佐匹克隆治疗慢性失眠患者的临床研究[J]. 天津医药, 2023, 51(11): 1227-1231.

ZHANG Lu, ZHANG Wei, YUAN Changhong, LI Xia, LYU Yujing, WANG Yu. Clinical study of transcranial direct current stimulation combined with eszopiclone in the treatment of chronic insomnia[J]. Tianjin Medical Journal, 2023, 51(11): 1227-1231.

摘要/Abstract

摘要：

目的探究经颅直流电刺激（tDCS）联合右佐匹克隆治疗慢性失眠的临床应用价值。方法 68例慢性失眠患者分为对照组35例（接受tDCS假刺激联合右佐匹克隆治疗）和研究组33例（接受tDCS联合右佐匹克隆治疗），连续治疗4周。比较2组治疗后临床疗效、多导睡眠监测（PSG）结果、血清皮质醇（CORT）、促肾上腺皮质激素（ACTH）水平及匹兹堡睡眠质量指数量表（PSQI）、抑郁症9项筛查量表（PHQ-9）、广泛性焦虑量表-7（GAD-7）评分及不良反应。结果治疗4周，研究组治疗总有效率93.94%（31/33）高于对照组的74.29%（26/35）（P<0.05）。治疗2周、4周，与对照组比较，研究组总睡眠时间（TST）延长，睡眠潜伏期（SL）变短，N3期睡眠比例、睡眠效率（SE）升高，微觉醒指数、N1期睡眠比例、血清CORT、ACTH水平均降低（P<0.05）。治疗4周和治疗后6个月，与对照组比较，研究组PSQI、PHQ-9评分均降低（P<0.05）。治疗2周、4周及治疗后6个月，与对照组比较，研究组GAD-7评分降低（P<0.05）。2组不良反应发生率比较差异无统计学意义（P>0.05）。结论 tDCS联合右佐匹克隆治疗可提高慢性失眠患者睡眠质量，降低焦虑抑郁程度，并具有远期疗效。其机制可能与下调患者血清CORT、ACTH水平有关。

关键词: 慢性失眠, 经颅直流电刺激, 右佐匹克隆, 多导睡眠监测, 睡眠质量

Abstract:

Objective To investigate the clinical application value of transcranial direct current stimulation (tDCS) combined with eszopiclone in treating chronic insomnia. Methods Sixty-eight patients with chronic insomnia were randomized into the control group (n=35, false tDCS combined with eszopiclone) and the study group (n=33, tDCS combined with eszopiclone). Both groups were treated for 4 weeks. Clinical efficacy after treatment, polysomnography (PSG) results, serum cortisol (CORT) and adrenocorticotropic hormone (ACTH) levels, Pittsburgh Sleep Quality Index (PSQI) scores, Patient Health Questionnaire-9 (PHQ-9) scores, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores and adverse reaction were compared between the two groups. Results After 4 weeks of treatment, the total effective rate was higher in the study group (93.94%, 31/33) than that in the control group (74.29%, 26/35, P<0.05). After 2 weeks and 4 weeks of treatment, compared with the control group, the total sleep time (TST) was longer, sleep latency (SL) was shorter, the proportion of stage N3 sleep and sleep efficiency (SE) were higher, microarousal index, the proportion of stage N1 sleep, serum CORT and ACTH levels were lower in the study group (P<0.05). After 4 weeks and 6 months of treatment, PSQI scores and PHQ-9 scores were lower in the study group than those of the control group (P<0.05). After 2 weeks, 4 weeks and 6 months of treatment, GAD-7 scores were lower in the study group than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusion tDCS combined with eszopiclone can improve sleep quality in patients with chronic insomnia, reduce anxiety and depression and have long-term effect. The mechanism may be related to the down regulation of serum CORT and ACTH levels in patients.

Key words: chronic insomnia, transcranial direct current stimulation, eszopiclone, polysomnography, sleep quality

中图分类号:

R749.99

图/表 6

参考文献 22

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组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	病程/月
对照组	35	21/14	30.49±7.01	22.86±2.31	9.89±2.13
研究组	33	17/16	31.09±6.55	23.52±2.14	9.67±2.89
χ²或t		0.496	0.367	1.217	0.357

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	病程/月
对照组	35	21/14	30.49±7.01	22.86±2.31	9.89±2.13
研究组	33	17/16	31.09±6.55	23.52±2.14	9.67±2.89
χ²或t		0.496	0.367	1.217	0.357

组别	n	治愈	有效	无效	总有效率
对照组	35	12（34.29）	14（40.00）	9（25.71）	26（74.29）
研究组	33	21（63.64）	10（30.30）	2（6.06）	31（93.94）
Z或χ²		2.688^＊＊			4.839^＊

组别	n	治愈	有效	无效	总有效率
对照组	35	12（34.29）	14（40.00）	9（25.71）	26（74.29）
研究组	33	21（63.64）	10（30.30）	2（6.06）	31（93.94）
Z或χ²		2.688^＊＊			4.839^＊

组别	n		TST/min									SE/%								微觉醒指数/（次/h）
组别	n		治疗前			治疗2周			治疗4周			治疗前		治疗2周			治疗4周			治疗前		治疗2周			治疗4周
对照组	35		275.34±25.89			313.97±32.06^a			339.94±44.57^ab			60.88±6.30		69.12±5.56^a			76.29±5.54^ab			18.91±2.95		14.80±2.22^a			11.46±2.43^ab
研究组	33		282.39±27.58			334.97±23.04^a			378.64±31.89^ab			62.14±6.53		75.01±6.89^a			85.10±6.23^ab			19.67±2.56		13.39±2.18^a			9.39±2.02^ab
t			1.088			3.085^＊＊			4.135^＊＊			0.812		3.895^＊＊			6.165^＊＊			1.120		2.634^＊			3.799^＊＊
组别		SL/min								N1期睡眠比例/%								N2期睡眠比例/%
组别		治疗前			治疗2周			治疗4周		治疗前			治疗2周			治疗4周		治疗前			治疗2周			治疗4周
对照组		49.94±6.71			40.11±5.40^a			34.74±3.91^ab		12.56±2.93			8.23±1.66^a			5.34±0.38^ab		51.08±7.94			50.40±5.73			50.23±8.23
研究组		52.39±7.13			36.15±4.96^a			29.24±4.66^ab		12.79±2.74			7.32±1.52^a			4.07±0.38^ab		48.74±8.27			49.36±6.04			50.27±6.24
t		1.460			3.147^＊＊			5.284^＊＊		0.342			2.350^＊			13.794^＊＊		1.187			0.726			0.020
组别				N3期睡眠比例/%											R期睡眠比例/%
组别				治疗前			治疗2周				治疗4周				治疗前				治疗2周				治疗4周
对照组				8.86±2.22			12.85±2.92^a				16.21±1.96^ab				27.51±8.38				28.53±7.03				28.21±8.12
研究组				9.15±2.10			15.18±2.76^a				18.51±3.54^ab				29.31±8.72				28.14±6.95				27.14±6.41
t				0.560			3.389^＊＊				3.287^＊＊				0.870				0.230				0.599

经颅直流电刺激联合右佐匹克隆治疗慢性失眠患者的临床研究

Clinical study of transcranial direct current stimulation combined with eszopiclone in the treatment of chronic insomnia

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统计量值	TST	SE	微觉醒指数	SL	N1期	N2期	N3期	R期
F_组间	13.467^＊＊	27.458^＊＊	5.557^＊	5.791^＊	4.382^＊	1.089	12.400^＊＊	0.011
F_时间	193.139^＊＊	201.799^＊＊	269.697^＊＊	288.649^＊＊	372.394^＊＊	0.061	247.422^＊＊	0.192
F_交互	7.465^＊＊	7.919^＊＊	7.374^＊＊	13.387^＊＊	3.554^＊	0.497	4.776^＊	0.668

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组别	n	CORT			ACTH
组别	n	治疗前	治疗2周	治疗4周	治疗前	治疗2周	治疗4周
对照组	35	414.51±51.25	385.26±37.16^a	345.58±47.58^ab	51.73±7.65	40.53±5.43^a	35.09±4.60^ab
研究组	33	394.44±55.39	334.28±47.96^a	284.57±44.72^ab	50.39±7.38	35.38±5.34^a	27.44±5.29^ab
t		1.552	4.916^＊＊	5.441^＊＊	0.731	3.941^＊＊	6.375^＊＊

组别	n	CORT			ACTH
组别	n	治疗前	治疗2周	治疗4周	治疗前	治疗2周	治疗4周
对照组	35	414.51±51.25	385.26±37.16^a	345.58±47.58^ab	51.73±7.65	40.53±5.43^a	35.09±4.60^ab
研究组	33	394.44±55.39	334.28±47.96^a	284.57±44.72^ab	50.39±7.38	35.38±5.34^a	27.44±5.29^ab
t		1.552	4.916^＊＊	5.441^＊＊	0.731	3.941^＊＊	6.375^＊＊

组别		n	PSQI
组别		n	治疗前		治疗4周		治疗后6个月
对照组		35	14.06±2.25		10.20±2.76^a		8.17±3.59^a
研究组		33	13.85±1.86		7.42±2.08^a		5.91±1.94^a
t			0.416		4.661^＊＊		3.260^＊＊
组别	PHQ-9
组别	治疗前			治疗2周		治疗4周		治疗后6个月
对照组	7.14±1.17			5.57±1.07^a		5.17±1.27^ab		4.91±0.92^ab
研究组	7.18±1.01			5.27±0.91^a		3.61±0.97^ab		3.52±0.91^ab
t	0.147			1.239		5.690^＊＊		6.317^＊＊
组别	GAD-7
组别	治疗前			治疗2周		治疗4周		治疗后6个月
对照组	8.49±1.38			6.69±1.11^a		5.91±1.04^ab		6.06±0.87^ab
研究组	8.52±1.23			5.24±1.03^a		3.24±0.79^ab		3.18±0.92^ab
t	0.093			5.558^＊＊		11.870^＊＊		13.250^＊＊

组别		n	PSQI
组别		n	治疗前		治疗4周		治疗后6个月
对照组		35	14.06±2.25		10.20±2.76^a		8.17±3.59^a
研究组		33	13.85±1.86		7.42±2.08^a		5.91±1.94^a
t			0.416		4.661^＊＊		3.260^＊＊
组别	PHQ-9
组别	治疗前			治疗2周		治疗4周		治疗后6个月
对照组	7.14±1.17			5.57±1.07^a		5.17±1.27^ab		4.91±0.92^ab
研究组	7.18±1.01			5.27±0.91^a		3.61±0.97^ab		3.52±0.91^ab
t	0.147			1.239		5.690^＊＊		6.317^＊＊
组别	GAD-7
组别	治疗前			治疗2周		治疗4周		治疗后6个月
对照组	8.49±1.38			6.69±1.11^a		5.91±1.04^ab		6.06±0.87^ab
研究组	8.52±1.23			5.24±1.03^a		3.24±0.79^ab		3.18±0.92^ab
t	0.093			5.558^＊＊		11.870^＊＊		13.250^＊＊