HF-rTMS联合心理行为干预治疗慢性失眠共病焦虑/抑郁患者的临床研究

林丽娟; 陈贵海; 孙会芹; 李成; 张业敏

doi:10.16766/j.cnki.issn.1674-4152.004071

HF-rTMS联合心理行为干预治疗慢性失眠共病焦虑/抑郁患者的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.004071

1.
安徽医科大学附属巢湖医院睡眠障碍科，安徽合肥 238000
2.
安徽医科大学附属巢湖医院神经内科

基金项目:

国家自然科学基金项目 81671316

安徽医科大学校科研基金项目 2020xkj214

详细信息

通讯作者:
张业敏，E-mail：155169117@qq.com

中图分类号: R749.72 R749.055
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出版历程
- 收稿日期: 2025-02-11
- 网络出版日期: 2025-10-25

Clinical study of HF-rTMS combined with psychological behavioral intervention in the treatment of patients with chronic insomnia and comorbid anxiety and depression: based on polysomnography and brain functional status information

1.
Department of Sleep Disorders, Chaohu Hospital, Anhui Medical University, Hefei, Anhui 238000, China

摘要

摘要: 目的探讨高频重复经颅磁刺激(HF-rTMS)联合心理行为干预对慢性失眠共病焦虑/抑郁患者主客观睡眠和脑功能状态(BFS)的影响。方法选取安徽医科大学附属巢湖医院2023年1月—2024年9月慢性失眠共病焦虑/抑郁患者60例为研究对象，采用随机数表法分为对照组和实验组，各30例。对照组患者接受心理行为干预，实验组患者接受心理行为干预联合HF-rTMS(10 Hz，20 min/次，2次/d，共10 d)。评估治疗前后2组主客观睡眠、BFS、汉密尔顿焦虑(HAMA-14)、抑郁量表(HAMD-17)变化。结果 (1) 治疗后实验组的HAMD-17[6.50(5.00, 8.00)分]、HAMA-14[7.00(6.00, 9.75)分]、阿森斯[5.00(4.00, 7.00)分]评分均低于对照组[10.50(8.25, 12.00)分、14.00(9.25, 15.00)分、10.00(9.00, 12.75)分，P＜0.05]。(2)实验组治疗后脑混沌、内专注、困倦、脑惰性、脑疲劳评分显著低于对照组，脑抑制评分显著高于对照组(P＜0.05)。(3)实验组治疗后多导睡眠图指标睡眠总时间、睡眠效率、非快速眼动睡眠相三期占比(NREM3%)均显著高于对照组(P < 0.05)，入睡潜伏期、快速眼动相期入睡潜伏期、入睡后觉醒时间、NREM1%、快速眼动睡眠相占比均显著低于对照组(P < 0.05)。结论心理行为干预对慢性失眠共病焦虑/抑郁患者睡眠质量、焦虑、抑郁均有改善作用，HF-rTMS联合治疗效果更显著。
- 高频重复经颅磁刺激 /
- 心理行为干预 /
- 慢性失眠 /
- 焦虑 /
- 抑郁
Abstract: Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with psychological and behavioral intervention on subjective and objective sleep and brain functional status (BFS) in patients with chronic insomnia comorbidities of anxiety/depression. Methods Sixty patients with chronic insomnia comorbid with anxiety/depression in Chaohu Hospital Affiliated to Anhui Medical University from January 2023 to September 2024 were selected as the research subjects and randomly divided into a control group and an experimental group, with 30 cases in each group. Patients in the control group received psychological and behavioral intervention, while patients in the experimental group received psychological and behavioral intervention combined with HF-rTMS (10 Hz, 20 min each time, twice a day, for a total of 10 days). The changes of subjective and objective sleep, BFS, Hamilton anxiety scale (HAMA-14), and depression scale (HAMD-17) in the two groups before and after treatment were evaluated. Results (1) After treatment, the scores of HAMD-17 [6.50 (5.00, 8.00)], HAMA-14 [7.00 (6.00, 9.75)], and Arthas [5.00 (4.00, 7.00)] in the experimental group were all lower than those in the control group [10.50 (8.25, 12.00), 14.00 (9.25, 15.00), 10.00 (9.00, 12.75), P < 0.05]. (2) After treatment, the scores of brain chaos, internal concentration, drowsiness, brain inertia and brain fatigue in the experimental group were significantly lower than those in the control group, and the brain inhibition score was significantly higher than that in the control group (P < 0.05). (3) After treatment, the polysomnography indicators of the experimental group, such as total sleep time, sleep efficiency, and the proportion of non-rapid eye movement sleep phase Ⅲ (NREM3%), were significantly higher than those of the control group (P < 0.05). The latency to falling asleep, latency to falling asleep during the rapid eye movement phase, the awakening time after falling asleep, NREM1%, and the proportion of rapid eye movement sleep phase were all significantly lower than those in the control group (P < 0.05). Conclusion Psychological and behavioral intervention has an improvement effect on sleep quality, anxiety and depression in patients with chronic insomnia comorbidities of anxiety/depression. The combined treatment effect of HF-rTMS is more significant.
- High-frequency repetitive transcranial magnetic stimulation /
- Psychological and behavioral intervention /
- Chronic insomnia /
- Anxiety /
- Depression

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表 1 2组慢性失眠共病焦虑/抑郁患者一般资料比较

Table 1. Comparison of general data between two groups of patients with chronic insomnia comorbid anxiety/depression

组别	例数	性别(男性/女性，例)	受教育程度(x±s，年)	年龄(x±s，岁)	高血压史(有/无，例)	糖尿病史(有/无，例)
实验组	30	18/12	8.57±2.10	65.37±8.04	9/21	4/26
对照组	30	17/13	9.27±1.91	63.90±7.47	8/22	6/24
统计量		0.069^a	1.352^b	0.732^b	0.082^a	0.480^a
P值		0.793	0.182	0.467	0.774	0.488
注：^a为χ²值，^b为t值。

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表 2 2组慢性失眠共病焦虑/抑郁患者治疗前后HAMD-17、HAMA-14和阿森斯评分比较[M(P₂₅, P₇₅)，分]

Table 2. Comparison of HAMD-17, HAMA-14, and Athens scores before and after treatment between two groups of patients with chronic insomnia comorbid anxiety/depression[M(P₂₅, P₇₅), points]

组别	例数	HAMD-17		HAMA-14		阿森斯评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
实验组	30	10.00(8.25, 13.00)	6.50(5.00, 8.00)^a	15.00(10.25, 19.75)	7.00(6.00, 9.75)^a	15.00(12.00, 16.75)	5.00(4.00, 7.00)^a
对照组	30	11.00(9.00, 13.00)	10.50(8.25, 12.00)	17.00(10.25, 19.75)	14.00(9.25, 15.00)^a	14.00(12.25, 17.75)	10.00(9.00, 12.75)^a
U值		0.506	4.840	0.089	4.468	0.267	5.306
P值		0.613	< 0.001	0.929	< 0.001	0.789	< 0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组慢性失眠共病焦虑/抑郁患者治疗前后脑功能状态评分比较(分)

Table 3. Comparison of brain function scores before and after treatment in two groups of patients with chronic insomnia comorbid anxiety/depression (points)

组别	例数	脑混沌[M(P₂₅, P₇₅)]			内专注(x±s)			脑抑制(x±s)
组别	例数	治疗前	治疗后		治疗前		治疗后	治疗前	治疗后
对照组	30	4.00(2.00, 4.00)	3.00(2.00, 3.00)^b		14.53±2.97		11.37±2.47^b	36.81±4.32	41.00±4.71^b
实验组	30	3.00(2.00, 4.00)	2.00(2.00, 2.00)^b		14.73±3.87		8.40±2.51^b	36.23±4.29	46.75±5.73^b
统计量		0.993^a	3.346^a		0.225^c		29.824^d	0.049^c	30.735^d
P值		0.321	< 0.001		0.823		< 0.001	0.961	< 0.001

组别	例数	困倦(x±s)		脑惰性(x±s)				脑疲劳(x±s)
组别	例数	治疗前	治疗后	治疗前		治疗后		治疗前	治疗后
对照组	30	11.87±2.73	11.00±2.24	143.07±8.46		140.47±6.50		12.33±2.56	10.17±2.56^b
实验组	30	12.27±2.89	8.33±2.29^b	143.00±10.13		132.99±7.01^b		12.41±2.65	7.10±2.80^b
统计量		0.552^c	14.416^d	0.028^c		10.388^d		0.099^c	27.468^d
P值		0.583	< 0.001	0.978		< 0.001		0.921	< 0.001
注：^a为U值, ^c为t值，^d为F值；与同组治疗前比较, ^bP < 0.05。

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表 4 2组慢性失眠共病焦虑/抑郁患者治疗前后多导睡眠图监测参数比较(x ±s)

Table 4. Comparison of polysomnography parameters before and after treatment between two groups patients with chronic insomnia comorbid anxiety/depression (x ±s)

组别	例数	TST(min)		SE(%)		SL(min)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	221.52±59.53	320.21±27.19^b	60.93±3.90	74.63±14.17^b	39.41±8.05	21.60±8.36^b
实验组	30	243.07±57.61	408.37±33.67^b	61.03±3.91	88.10±2.43^b	36.90±9.77	4.43±1.83^b
统计量		1.426^a	39.660^c	0.099^a	85.360^c	1.082^a	62.502^c
P值		0.159	< 0.001	0.921	< 0.001	0.284	< 0.001

组别	例数	RL(min)		WASO(min)		NREM1%
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	111.60±8.25	96.80±15.06^b	84.93±7.25	62.21±14.82^b	9.60±2.59	7.20±2.95^b
实验组	30	111.53±8.25	83.38±4.58^b	86.97±8.55	42.43±7.06^b	9.97±2.66	5.23±2.00^b
统计量		0.031^a	57.730^c	1.010^a	81.525^c	0.541^a	22.227^c
P值		0.975	< 0.001	0.317	< 0.001	0.591	< 0.001

组别	例数	NREM2%		NREM3%		REM%
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	49.87±7.98	46.92±8.04	10.27±2.39	15.27±5.25^b	26.83±4.44	22.27±3.92^b
实验组	30	52.10±5.15	51.47±4.27	9.33±2.23	19.27±4.29^b	27.53±2.13	21.93±3.51^b
统计量		1.288^a	2.206^c	1.562^a	45.283^c	0.949^a	19.283^c
P值		0.203	0.115	0.124	< 0.001	0.347	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较, ^bP < 0.05。

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