目的 探讨肥胖与肺功能参数的相关性。方法 将90例接受肺功能检查的患者依据体质指数（BMI）分为肥胖组（BMI≥25 kg/m²，n=50）和正常体质量组（18.5 kg/m²＜BMI≤24.9 kg/m²，n=40），比较两组各项肺功能参数的差异，包括肺通气功能的参数如［用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、1秒率（FEV₁/FVC）、最大呼气流量（PEF）］以及反映小气道功能的参数［50%最大呼气流量（MEF₅₀），25%最大呼气流量（MEF₂₅）］；比较肥胖组不同性别间上述肺功能参数的差异及其与腰围（WC）与BMI的相关性。结果 肥胖组FVC、FEV₁、FEV₁/FVC、MEF₅₀、MEF₂₅低于正常体质量组（P＜0.01）；肥胖组中男性FVC及FEV₁低于女性（P＜0.01）。相关分析结果显示，肥胖组中WC与BMI均与肺功能多个参数呈负相关趋势，其中WC的负相关趋势更突出，且与FVC呈负相关关系（P＜0.05）。结论 肥胖影响反映肺功能的多个参数，表现为肺通气功能和小气道功能多个指标水平降低，且肥胖男性更甚；在肥胖人群中，相较于BMI，WC与FVC的关系更密切。

      Objective To investigate the correlation between obesity and pulmonary function parameters．Methods Ninety patients undergoing pulmonary function testing were categorized into an obese group（BMI≥25 kg/m²，n=50）and a normal-weight group（18.5 kg/m²＜ BMI≤24.9 kg/m²，n=40）．Differences in pulmonary function parameters were compared between groups，including ventilatory parameters（forced vital capacity［FVC］，forced expiratory volume in 1 second［FEV₁］，FEV₁/FVC ratio，peak expiratory flow［PEF］） and parameters reflecting small airway function（maximum expiratory flow at 50% of forced expiratory volume［MEF₅₀］，and 25% maximum expiratory flow［MEF₂₅］）．Differences in these pulmonary function parameters between genders within the obese group and their correlations with waist circumference（WC）and BMI were also assessed．Results FVC，FEV₁，FEV₁/FVC，MEF₅₀，and MEF₂₅ were significantly lower in the obese group compared to the normal-weight group（P＜0.01）．Among obese subjects，male FVC and FEV₁ were significantly lower than female values（P＜0.01）．Correlation analysis revealed negative correlations of WC and BMI with multiple pulmonary function parameters in the obese group，with WC exhibiting a more pronounced negative correlation and a significant negative relationship with FVC（P＜0.05）．Conclusions Obesity impacts multiple parameters reflecting lung function，manifesting as reduced levels of several indicators of pulmonary ventilation and small airway function，with male obese individuals exhibiting greater impairment．Within the obese population，WC correlates more closely with FVC than BMI．

       目的   探讨经颅多普勒超声（TCD）参数联合屏气指数在颈内动脉（ICA）狭窄或闭塞所致急性脑梗死的评估价值。方法   选择2022年1月—2024年12月，在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数，包括搏动指数（PI）、阻力指数（ RI）、大脑中动脉平均血流速度（Vm）及屏气指数等。依据患者数字减影血管造影（DSA）结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数，采用单因素分析、多因素Logistic回归分析及ROC曲线。结果   共纳入ICA狭窄或闭塞所致急性脑梗死共136例，其中侧支循环良好组46例，侧支循环不良组90例。单因素分析提示：侧支循环良好组与侧支循环不良组在PI［0.95（0.80，1.03）vs 1.01（0.88，1.13）］、RI［0.58（0.51，0.62）vs 0.60（0.54，0.65）］、Vm［57（44，65）vs 50.5（41，63）］及屏气指数［0.78（0.75，0.85）vs 0.72（0.59，0.79）］方面，差异具有统计学意义（P＜0.05）。多因素Logistic回归分析提示Vm（OR=1.029，95%CI：1.006~1.053，P=0.014）、屏气指数（OR=723.401，95%CI：14.524~3 6031.859，P＜0.001）是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积（AUC）分别为0.713（95%CI：0.627~0.799）和0.605（0.505~0.705），两者的AUC值比较差异无统计学意义（P＞0.05）。结论   屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环，屏气指数和Vm的评估效能相当。

       Objective  To explore the evaluation value of transcranial Doppler ultrasound（TCD）in acute cerebral infarction caused by internal carotid artery（ICA）stenosis or occlusion．Methods  From January 2022 to December 2024，patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital．Patient’s demographic data，clinical data，and TCD related parameters，including pulsatility index（PI），resistance index（RI），average blood flow velocity（Vm）of the middle cerebral artery，and breath holding index（BHI）were recorded．According to the results of digital silhouette angiography（DSA），patients were divided into good collateral group and poor collateral group．Demographic，clinical data，and TCD related parameters were compared between two groups using univariate analysis，multivariate Logistic regression analysis and ROC curve．Results  A total of 136 cases of acute cerebral infarction caused by  ICA stenosis or occlusion were included，including 46 cases in the collateral good group and 90 cases in the collateral poor group．Univariate analysis showed that the good collateral group and the poor collateral group were different in PI（0.95［0.80，1.03］vs 1.01［0.88，1.13］），RI（0.58［0.51，0.62］vs 0.60［0.54，0.65］），Vm（57［44，65］vs 50.5［41，63］），BHI（0.78［0.75，0.85］ vs 0.72［0.59，0.79］）（P＜0.05）．Multivariate Logistic regression analysis showed that Vm（OR=1.029，95%CI：1.006-1.053，P=0.014）and BHI（OR=723.401，95%CI：14.524-36 031.859，P＜0.001）were independent risk factors for collateral circulation disorders．The area under the ROC curve（AUC）for predicting collateral circulation using BHI and Vm were 0.713（95%CI：0.627~0.799）and 0.605（0.505~0.705），respectively．There was no statistically significant difference in AUC values between the BHI and Vm．Conclusions  The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion，and their predictive power is comparable．

      目的   探讨多参数MRI在鉴别乳腺影像报告和数据系统（BI-RADS）4类乳腺病变良恶性中的应用。方法   回顾性分析2022年1月—2024年12月于同济大学附属东方医院庐江分院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的病例268例，其中良性组166例（包括乳腺纤维腺瘤93例，导管内乳头状瘤39例，乳腺囊性增生24例，乳腺分叶状肿瘤2例，浆细胞性乳腺炎8例），恶性组102例（包括浸润性导管癌89例，浸润性小叶癌6例，黏液癌2例，炎性乳腺癌5例）。对比分析单一序列和多序列联合诊断BI-RADS 4类乳腺病变良、恶性的效能；绘制基于多参数MRI受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）、特异度和灵敏度，量化多序列对于BI-RADS 4类乳腺病变良恶性的诊断效能。结果   基于多参数MRI联合诊断效能最高（AUC：0.912，95%CI：0.871~0.953），特异度为0.922，灵敏度为0.902；基于ADC值评估BI-RADS 4类乳腺病变最佳截断值为0.84×10-3 mm² /s，且均具有统计学意义（P＜0.05）。结论   基于多参数MRI能够有效诊断BI-RADS 4类乳腺病变的良、恶性，为乳腺外科疾病进一步诊疗提供影像学诊断依据。

       Objective  To explore the application of multiparametric MRI in differentiating benign and malignant lesions classified as BI-RADS category 4 in breast imaging．Methods  A total of 268 cases of breast MRI classified as BI-RADS category 4 with confirmed tumor pathology were retrospectively analyzed from January 2022 to December 2024 at the Tongji University Oriental Hospital Lujiang Branch. Among them，166 cases were categorized as benign lesions（including 93 cases of breast fibroadenoma，39 cases of intraductal papilloma，24 cases of cystic hyperplasia，2 cases of lobular tumor，and 8 cases of plasma cell mastitis），while 102 cases were categorized as malignant lesions（including 89 cases of invasive ductal carcinoma，6 cases of invasive lobular carcinoma，2 cases of mucinous carcinoma，and 5 cases of inflammatory breast cancer）．The efficacy of single-sequence versus combined multiple-sequence imaging in diagnosing benign and malignant BI-RADS category 4 breast lesions was compared and analyzed．The diagnostic efficacy of the multiparametric MRI sequences was quantified by plotting a receiver operating characteristic curve and calculating the area under the curve（AUC），as well as the specificity and sensitivity．Results  The combined diagnostic efficacy of multiparametric MRI yielded the highest performance，with an AUC of 0.912（95%CI：0.871-0.953），demonstrating a specificity of 0.922 and a sensitivity of 0.902．The optimal cutoff value for differentiating BI-RADS category 4 breast lesions based on apparent diffusion coefficient values was determined to be 0.84×10-3  mm² /s，with all results being statistically significant（P＜0.05）．Conclusions  Multiparametric MRI can effectively diagnose benign and malignant lesions classified as BI-RADS category 4，providing a reliable imaging basis for further diagnosis and treatment in breast surgery．

目的 探讨脊柱微调手法治疗产后腰椎-骨盆复合体疼痛的临床疗效及对腰椎前凸曲度（LL）和骨盆入射角度（PI）的调整作用,为产后腰椎-骨盆复合体疼痛的治疗提供理论依据。方法 选取2022年7月—2023年7月在上海市杨浦区中医医院推拿科和上海中医药大学附属岳阳中西医结合医院推拿科门诊治疗的产后腰椎-骨盆复合体疼痛患者共82例,随机分为对照组和治疗组,每组41例。对照组采用传统理筋推拿手法,治疗组采用脊柱微调手法治疗,两组疗程均为8周,观察临床疗效,比较两组患者的疼痛数字评分法（NRS）、Oswestry功能障碍指数（ODI）、LL和PI在治疗前后组间与组内的变化。结果 治疗组总有效率为95.12%,对照组总有效率为75.60%,治疗组优于对照组（P<0.05）。治疗后,两组NRS评分、ODI评分较治疗前均有下降,且治疗组优于对照组（P<0.05）。治疗后,两组LL和PI测量较治疗前均无明显变化,治疗组与对照组比较差异无统计学意义（P>0.05）。结论 脊柱微调手法能有效减轻患者疼痛、提升日常活动功能,但对腰椎曲度、骨盆入射角未产生移位影响,安全性高。

Objective To explore the clinical efficacy of spinal fine adjustment manipulation in the treatment of postpartum lumbopelvic pain（PLPP） and its role in adjusting lumbar lordosis and pelvic incidence,and to provide theoretical basis for the treatment of PLPP. Methods A total of 82 patients with PLPP who were treated in the outpatient clinics of the Tuina Department of Yangpu District Hospital of Traditional Chinese Medicine and the Tuina Department of Yueyang Hospital of Integrative Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2023 were selected and randomly divided into the control group and the treatment group,with 41 cases in each group．The control group was treated with the traditional tendon manipulation and the treatment group was treated with spinal fine adjustment manipulation,and the course of treatment for both groups was 8 weeks．Clinical efficacy was observed,and the changes of pain Numerical Rating Scale（NRS）,Oswestry disability index（ODI）,lumbar lordosis（LL）,and pelvic incidence（PI）of the two groups were compared between the two groups and within the two groups before and after the treatment. Results The total effective rate was 95.12% in the treatment group and 75.60% in the control group,and the treatment group was superior to the control group（P<0.05）．After treatment,the NRS and ODI of both groups were lower than before treatment,and the treatment group was better than the control group（P<0.05）． After treatment,there was no significant change in LL and PI in both groups compared to pre-treatment．There was no significant difference between the treatment group and the control group（P>0.05）. Conclusions Spinal fine adjustment manipulation can effectively reduce the pain of patients and improve the function of daily activities,but it has no displacement effect on LL and PI,which is safe and suitable for clinical promotion and application．

目的 通过分析奥氮平的群体药代动力学研究,探讨影响奥氮平药动学参数的因素,为临床制定个体化给药方案提供依据。方法 在中国知网、万方、维普、迈特思创、PubMed和Embase等中英文数据库,以“奥氮平”“群体药代动力学”“模型”“非线性混合效应模型”及“olanzapine pamoate”“olanzapine”“population pharmacokinetic”“pharmacokinetic model”“nonlinear mixed effect”“NONMEM”为检索策略,检索建库至2023年5月所有关于奥氮平群体药代动力学的研究。结果 共纳入14篇奥氮平的群体药代动力学研究,大多数研究将奥氮平的药代动力学描述为一个单室模型。成人群体药代动力学模型群体典型值吸收速率常数：（0.3~2.85）/h;表观分布清除率：（10.4~25.4）L/h;表观分布容积：（223~2 390）L。儿童青少年模型群体典型值吸收速率常数：（0.142~0.758）/h;表观分布清除率：（13.6~16.8）L/h;表观分布容积：（322~899）L。年龄、体质量、性别、种族、吸烟状况、合并用药是影响奥氮平药动学参数的显著协变量。结论 奥氮平药动学参数估计值存在差异且有不同程度的个体间变异,未来应侧重于对特殊人群的研究。有必要对先前发表的模型进行外部验证,以便更准地的描述模型的适用性。

Objective By analyzing the population pharmacokinetics of olanzapine,the factors affecting the pharmacokinetic parameters of olanzapine were discussed,so as to provide a basis for the clinical formulation of individualized dosing regimens．Methods In Chinese and English databases such as CNKI,Wanfang,Wipro database,FMRS,PubMed and Embase,all studies on population pharmacokinetics of olanzapine from the establishment of the database to May 2023 were searched with “olanzapine pamoate”“olanzapine”,“population pharmacokinetics”,“pharmacokinetic model”,“nonlinear mixed-effect” and “NONMEM” as key words．Results A total of 14 population pharmacokinetic studies of olanzapine were included．Most studies described the pharmacokinetics of olanzapine as a single-chamber model．Adult pharmacokinetic model population typical values absorption rate constant was（0.3-2.85）/h;apparent distribution clearance was（10.4-25.4）L/h;apparent volume of distribution was（223-2390）L．absorption rate constants of the population of children and adolescents was（0.142-0.758）/h,apparent distribution clearance was（13.6-16.8）L/h,apparent volume of distribution was（322-899）L．Age,weight,gender,ethnicity,smoking status and concomitant medication were significant covariates affecting the pharmacokinetic parameters of olanzapine．Conclusions Estimates of pharmacokinetic parameters of olanzapine vary and have varying degrees of inter-individual variation．In the future,research should focus on special populations．Externally validation of previously published models should also be performed to more accurately describe the applicability of the models．

目的 分析血流感染（BSI）患者血小板参数的动态变化及其在患者预后中的价值。方法 回顾性分析南通市中西医结合医院检验科明确BSI的66例患者,分为生存组（55例）和死亡组（11例）。比较不同组间病原菌分布及1周内血小板参数动态变化情况,并通过Logistic回归分析评估血小板参数动态变化的在治疗预后评估中的价值。结果 （1）BSI患者病原菌分为革兰氏阳性菌（G+）25株、革兰氏阴性菌（G-）39株、真菌2株;G+病原菌中前三位为金黄色葡萄球菌（10.61%）、表皮葡萄球菌（7.58%）、头状葡萄球菌（4.55%）;G-病原菌中前三位为大肠埃希菌（24.24%）、肺炎克雷伯菌肺炎亚种（15.15%）、肠炎沙门菌血清型（3.03%）;真菌为新生隐球酵母（1.52%）、光滑假丝酵母（1.52%）。（2）生存组序贯性器官功能衰竭评分（SOFA）评分为（3.24±0.53）分,低于死亡组的（6.02±1.17）分（t=12.535,P<0.001）;生存组BSI病程为（20.50±2.17）d,低于死亡组的（25.71±4.81）d（t=3.352,P<0.001）;生存组肺部原发感染灶30.91%,高于死亡组的63.64%（χ²=4.243,P=0.039）;生存组最大平均血小板体积（MPV）为（10.96±1.58）fL,低于死亡组的（11.99±1.42）fL（t=2.004,P=0.049）;生存组入院血小板计数（PLT）为（144.33±23.18）10⁹/L,低于死亡组的（166.91±20.29）10⁹/L（t=3.005,P=0.004）;生存组最低PLT为（113.48±30.76）10⁹/L,高于死亡组的（80.16±38.24）10⁹/L（t=3.148,P=0.002）。（3）两组入院及BSI时、BSI后4 d内的指标比较差异均无统计学意义（P>0.05）,在BSI后的5~7 d,生存组PLT为（210.83±102.37）10⁹/L,高于死亡组的（112.75±116.84）10⁹/L（t=2.835,P=0.006）;生存组MPV为（10.12±1.58）fL,低于死亡组的（11.27±1.85）fL（t=2.142,P=0.036）;生存组MPV/PLT 比值（MPR）为（5.69±2.89）,低于死亡组的（11.64±8.23）（t=4.290,P<0.001）。（4）多因素Logistic回归分析发现,入院SOFA（OR=5.461,95%CI：1.544~19.319,P=0.008）、BSI病程（OR=0.773,95%CI：0.622~0.960,P=0.020）、5~7 d MPR（OR=18.976,95%CI：1.776~202.709,P=0.015）是BSI的预测因素。结论 BSI患者血小板参数动态变化较为明显,而入院SOFA、BSI病程、5~7 d MPR对于预测患者死亡风险有重要意义。

目的 探讨动态对比增强磁共振成像（DCE-MRI）多参数定量特征对乳腺癌腋窝淋巴结转移（ALNM）风险的预测价值。方法 回顾性收集2020年3月—2022年11月在佛山市高明区人民医院经手术病理确诊的155例乳腺癌患者临床资料,根据患者是否发生ALNM分为ALNM 组（n=39）和无ALNM 组（n=116）。采用单因素分析和多因素Logistic回归分析乳腺癌发生ALNM的影响因素。结果 ALNM组和无ALNM 组患者的肿块质地、肿块直径、肿块部位、肿块形状、肿块内部强化特征等指标比较差异无统计学意义（t/χ²=2.249、0.977、1.369、0.524、2.158,P>0.05）。两组患者肿块表观扩散系数（ADC）值、腋窝淋巴结（ALN）短径、肿块边缘、动态增强时间-信号强度曲线（TIC）曲线等指标比较,差异有统计学意义（t/χ²=6.573、9.873、29.441、2.031,P<0.05）。二元Logistic回归模型结果显示,肿块ADC值、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素（OR=0.251、0.106、0.002,P<0.05）。结论 DCE-MRI多参数定量特征中,乳腺癌患者的肿块ADC值低、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素。

Objective To investigate the predictive value of multi-parameter quantitative features of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）in the risk of axillary lymph node metastasis（ALNM）in breast cancer．Methods Clinical data of 155 patients with breast cancer diagnosed by surgery and pathology in Foshan Gaoming District People's hospital from March 2020 to November 2022 were retrospectively collected．According to whether the patients had ALNM,they were divided into ALNM group（n=39）and non-ALNM group（n=116）．Univariate analysis and multiple Logistic regression models were used to explore the influencing factors of ALNM in breast cancer．Results There was no significant difference in mass texture,mass diameter,mass location,mass shape and internal enhancement between the ALNM group and the non-ALNM group（t/χ²=2.249,0.977,1.369,0.524,2.158,P>0.05）．There were significant differences in ADC value,ALN short diameter,tumor margin and TIC curve between the two groups（t/χ²=6.573,9.873,29.441,2.031,P<0.05）．Binary Logistic regression model showed that ADC value,ALN short diameter（≥5 mm）and tumor margin（blur）were risk factors for the occurrence of breast cancer ALNM（OR=0.251,0.106,0.002,P<0.05）．Conclusions Among the multi-parameter quantitative features of DCE-MRI,the ADC value of breast cancer,the short diameter of ALN（≥5 mm）,and the edge of the tumor（blur）are the risk factors for the occurrence of ALNM in breast cancer．

目的 分析宫颈弹性成像(UE)参数在宫颈机能不全(CIC)孕妇妊娠结局中的预测价值。方法 选取我院收治的119例(2019年10月—2021年8月)CIC孕妇,根据妊娠结局分为早产组(孕周＜37周)56例、正常组(孕周≥37周)63例,均于孕20～24周接受阴道超声、宫颈UE检查,获取宫颈长度(CL)、宫颈UE参数[超声弹性对比指数(ECI)、宫颈外口弹性应变率(EOS)、宫颈内口弹性应变率(IOS)]并进行比较,以了解宫颈UE参数在CIC孕妇妊娠结局中的应用价值。结果 早产组CL水平较正常组低,ECI、IOS、EOS水平较正常组高(P＜0.05);单因素分析发现,CL、ECI、IOS、EOS均可对CIC孕妇妊娠结局产生影响(P＜0.05);受试者工作特征(ROC)曲线结果显示,CL、ECI、EOS、IOS预测CIC孕妇早产的AUC分别为0.616、0.765、0.728、0.814,敏感度分别为64.29%、75.00%、73.21%、82.14%,特异度分别为42.86%、52.38%、57.14%、42.86%。结论 宫颈UE参数能有效反映宫颈组织情况,对CIC孕妇妊娠结局具有一定的预测价值。

目的 探讨多参数磁共振成像对T₁高信号间隔与非T₁高信号间隔的原发性鼻腔鼻窦黑色素瘤（PSM）的鉴别价值。方法 回顾性分析经病理证实的 PSM 44例,术前均接受常规,DWI 和DCE-MRI检查。通过单因素和多因素Logistic分析评估T₁高信号间隔与非T₁高信号间隔PSM各MRI参数的差异。结果 44例PSMs 中,T₁高信号间隔PSMs 25例,非T₁高信号间隔PSMs 19例。两者在多参数MRI中,仅T₂低信号间隔,ADC值、达峰时间（Tp）及最大相对增强率（MRER）在单变量分析中差异存在统计学意义（均P<0.05）,在多因素Logistic分析中差异均无统计学意义（P均>0.05）。结论 多参数MRI对区分T₁高信号间隔与非T₁高信号间隔的PSM具有一定的指导价值,但并不能作为区分两者的独立预测指标。

Objective To evaluate the diagnostic value of multi-parameter MRI in differential diagnosis of primary sinonasal melanoma（PSM）with high- and non-high-T₁ signal septa．Methods Forty-four patients pathologically confirmed with PSMs underwent conventional,DWI and DCE-MRI examinations before operation．Univariate and multivariate Logistic analyses were used to evaluate the differences of MRI parameters between high- and non-high-T₁ signal septa in PSMs．Results Among 44 PSMs,25 cases had high T₁ signal septa and 19 cases had non-T₁ high signal septa．In multi-parameter MRI,only T₂ low signal septa,the value of ADC,peak time（TP）and maximum relative enhancement rate（MRER）were significantly different in univariate analysis（P<0.05）,but not in multivariate Logistic analysis（P>0.05）．Conclusions Multi-parameter MRI has some value in differentiating PSM with high-T₁ and non-high-T₁ signal septa,but it can not be used as an independent predictor to distinguish them．

目的 探讨超低频经颅磁刺激(ILF-TMS)联合艾司唑仑对失眠症患者睡眠脑电图参数及血清神经营养因子表达的影响。方法 选取2018年8月—2020年4月我院失眠症患者114例,随机数字表法分为研究组(n=57)、对照组(n=57)。对照组予以艾司唑仑联合ILF-TMS假性刺激,研究组予以艾司唑仑联合ILF-TMS真性刺激,均治疗1个月。对比2组疗效与治疗前、治疗1个月后睡眠进程参数(总睡眠时间、入睡时间、睡眠效率、觉醒时间)、睡眠结构(非快速眼动睡眠期、快速动眼睡眠期)、匹兹堡睡眠质量量表(PSQI)评分、失眠严重程度指数量表(ISI)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、血清神经营养因子[胶质细胞源性神经营养因子(GDNF)、脑源性神经营养因子(BDNF)]水平。结果 (1)疗效:研究组治疗1个月后总有效率高于对照组(P＜0.05);(2)睡眠进程参数:治疗1个月后研究组总睡眠时间、睡眠效率高于对照组,入睡时间、觉醒时间短于对照组(P＜0.05);(3)睡眠结构:治疗1个月后研究组Ⅲ期、Ⅱ期、非快速眼动睡眠期高于对照组,Ⅰ期睡眠期低于对照组(P＜0.05);(4)PSQI、ISI评分:治疗1个月后研究组PSQI、ISI评分低于对照组(P＜0.05);(5)SAS、SDS评分:治疗1个月后研究组SAS、SDS评分低于对照组(P＜0.05);(6)血清神经营养因子:治疗1个月后研究组血清GDNF、BDNF水平高于对照组(P＜0.05)。结论 ILF-TMS联合艾司唑仑治疗失眠症效果确切,可上调血清神经营养因子表达,改善睡眠脑电图参数,提高睡眠质量,控制焦虑、抑郁症状。

Objective To investigate the effects of infra-low frequency transcranial magnetic stimulation (ILF-TMS) combined with estazolam on sleep EEG parameters and serum neurotrophic factors expression in patients with insomnia. Methods One hundred and fourteen patients with insomnia in our hospital from August 2018 to April 2020 were divided into study group (n=57) and control group (n=57) by random number table method. The control group was treated with estazolam combined with pseudo ILF-TMS stimulation, and the study group was treated with estazolam combined with real ILF-TMS stimulation, all of which were treated for 1 month. Comparing curative effect of two groups before and 1 month after treatment, and sleep process parameters (total sleep time, falling asleep time, sleep efficiency, waking time), the structure of the sleep stages (stage Ⅲ, Ⅱ, Ⅰ, rapid eye movement sleep), Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, serum neurotrophic factors (GDNF, BDNF) levels. Results (1) Efficacy: the total effective rate of the study group was higher than that of the control group after 1 month of treatment (P＜0.05). (2) Sleep process parameters: after 1 month of treatment, the total sleep time and sleep efficiency in the study group were higher than those in the control group, and the falling asleep time and waking time were shorter than those in the control group (P＜0.05). (3) Sleep structure: after 1 month of treatment, compared to the control group, the study group had more in stageⅢ, Ⅱ, rapid eye movement sleep, and less in stage Ⅰsleep(P＜0.05). (4) PSQI and ISI scores: after 1 month of treatment, PSQI and ISI scores of the study group were lower than those of the control group (P＜0.05). (5) SAS and SDS scores: after 1 month of treatment, SAS and SDS scores in the study group were lower than those in the control group (P＜0.05). (6) Serum neurotrophic factors: after 1 month of treatment, serum GDNF and BDNF levels in the study group were higher than those in the control group (P＜0.05). Conclusions ILF-TMS combined with estazolam is an effective treatment of insomnia. It can up-regulate the expression of serum neurotrophic factors, improve the parameters of sleep EEG, improve sleep quality, and control the symptoms of anxiety and depression.