重复经颅磁刺激治疗卒中后失眠的基础及临床研究进展
Basic and Clinical Research Progress of Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-Stroke Insomnia
DOI: 10.12677/acm.2025.15102760, PDF,   
作者: 陈 彬*, 陈瑞鸥, 贲雨薇, 仝单梦：黑龙江中医药大学研究生院，黑龙江 哈尔滨；李宏玉, 唐 强#：黑龙江中医药大学附属第二医院康复科，黑龙江 哈尔滨
关键词: 卒中后失眠；重复经颅磁刺激；机制；临床研究；Post-Stroke Insomnia； Repetitive Transcranial Magnetic Stimulation； Mechanism of Action； Clinical Research
摘要: 脑卒中后失眠(post-stroke insomnia, PSI)作为脑卒中后常见并发症，显著延缓神经功能恢复进程而且可能出现抑郁、焦虑等不良情绪，降低患者生存质量。通过系统梳理重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)在PSI治疗领域的国内外机制研究与临床实践进展，结果显示，rTMS通过干预相关神经递质及细胞因子，改善睡眠结构；此外rTMS可调节生物钟、脑部血流量，从而实现PSI的治疗与改善；在一定程度上缓解患者临床症状并提升生活质量。本文总结现有rTMS及常见联合治疗方案，提出可优化建议，以期为临床rTMS治疗PSI提供理论依据与实践思路，促进rTMS在临床上的应用与发展。
Abstract: Post-stroke insomnia (PSI), a common complication following stroke, significantly delays the process of neurological function recovery, may lead to adverse emotions such as depression and anxiety, and reduces patients’ quality of life. By reviewing the progress of domestic and international mechanistic studies and clinical practices regarding repetitive transcranial magnetic stimulation (rTMS) in the treatment of PSI, the results show that rTMS improves sleep structure by interfering with relevant neurotransmitters and cytokines; in addition, rTMS can regulate the biological clock and cerebral blood flow, thereby achieving the treatment and improvement of PSI, alleviating patients’ clinical symptoms to a certain extent and enhancing their quality of life. This article summarizes the existing rTMS-based treatment regimens and common combined treatment protocols, puts forward optimization suggestions, aiming to provide a theoretical basis and practical ideas for the clinical application of rTMS in PSI treatment, and promote the clinical application and development of rTMS.
文章引用：陈彬, 李宏玉, 陈瑞鸥, 贲雨薇, 仝单梦, 唐强. 重复经颅磁刺激治疗卒中后失眠的基础及临床研究进展[J]. 临床医学进展, 2025, 15(10): 320-327. https://doi.org/10.12677/acm.2025.15102760

参考文献

[1] 许文杰, 王枫, 周一心, 等. 脑卒中后失眠中西医病因机制初探[J]. 陕西中医, 2020, 41(1): 134-136.
[2] Jiang, B. (2025) Current Snapshots on Stroke Prevention and Control and More Proactive National Strategies against It in China. Journal of Central Nervous System Disease, 17. [Google Scholar] [CrossRef] [PubMed]
[3] Baylan, S., Griffiths, S., Grant, N., Broomfield, N.M., Evans, J.J. and Gardani, M. (2020) Incidence and Prevalence of Post-Stroke Insomnia: A Systematic Review and Meta-Analysis. Sleep Medicine Reviews, 49, Article ID: 101222. [Google Scholar] [CrossRef] [PubMed]
[4] 杨行妹, 韩美荣, 蒋雪龙, 等. 卒中后失眠的研究进展[J]. 中国卒中杂志, 2023, 18(5): 527-533.
[5] De Crescenzo, F., D’Alò, G.L., Ostinelli, E.G., Ciabattini, M., Di Franco, V., Watanabe, N., et al. (2022) Comparative Effects of Pharmacological Interventions for the Acute and Long-Term Management of Insomnia Disorder in Adults: A Systematic Review and Network Meta-Analysis. The Lancet, 400, 170-184. [Google Scholar] [CrossRef] [PubMed]
[6] Lefaucheur, J.P. (2019) Transcranial Magnetic Stimulation. In: Handbook of Clinical Neurology, Vol. 160, Elsevier, 559-580.
[7] Ngan, S.T.J. and Cheng, P.W.C. (2025) A Review of Transcranial Pulse Stimulation: Innovations in Neuromodulation. Expert Review of Medical Devices, 22, 979-988. [Google Scholar] [CrossRef] [PubMed]
[8] Sharbafshaaer, M., Cirillo, G., Esposito, F., Tedeschi, G. and Trojsi, F. (2024) Harnessing Brain Plasticity: The Therapeutic Power of Repetitive Transcranial Magnetic Stimulation (rTMS) and Theta Burst Stimulation (TBS) in Neurotransmitter Modulation, Receptor Dynamics, and Neuroimaging for Neurological Innovations. Biomedicines, 12, Article No. 2506. [Google Scholar] [CrossRef] [PubMed]
[9] d’Errico, P., Früholz, I., Meyer-Luehmann, M. and Vlachos, A. (2025) Neuroprotective and Plasticity Promoting Effects of Repetitive Transcranial Magnetic Stimulation (rTMS): A Role for Microglia. Brain Stimulation, 18, 810-821. [Google Scholar] [CrossRef] [PubMed]
[10] Ikeda, T., Kobayashi, S. and Morimoto, C. (2019) Effects of Repetitive Transcranial Magnetic Stimulation on ER Stress-Related Genes and Glutamate, Γ-Aminobutyric Acid and Glycine Transporter Genes in Mouse Brain. Biochemistry and Biophysics Reports, 17, 10-16. [Google Scholar] [CrossRef] [PubMed]
[11] Sasso, V., Bisicchia, E., Latini, L., Ghiglieri, V., Cacace, F., Carola, V., et al. (2016) Repetitive Transcranial Magnetic Stimulation Reduces Remote Apoptotic Cell Death and Inflammation after Focal Brain Injury. Journal of Neuroinflammation, 13, Article No. 150. [Google Scholar] [CrossRef] [PubMed]
[12] 中国中医药信息学会抗衰老分会. 物理技术辅助脑卒中康复的临床指南[J]. 国际生物医学工程杂志, 2019, 42(2): 100-108.
[13] 肖利君, 谭红, 陈娟, 等. 经颅磁刺激治疗失眠的研究进展[J]. 中外医学研究, 2023, 21(31): 178-180.
[14] Kovalzon, V.M. (2021) Serotonin, Sleep and Depression: A Hypothesis. In: Serotonin and the CNS—New Developments in Pharmacology and Therapeutics, IntechOpen.
[15] 张可灿, 班玮康, 陈品秋, 等. 卒中后睡眠障碍及其信号分子变化的研究进展[J]. 中国脑血管病杂志, 2024, 21(12): 841-849, 864.
[16] 柳亭, 吕东升, 唐瑛. 重复经颅磁刺激治疗失眠障碍机制的研究进展[J]. 国际精神病学杂志, 2023, 50(2): 207-209, 214.
[17] 刘靖文, 尚万余, 张立红, 等. 脑卒中后睡眠结构及睡眠-觉醒周期的改变[J]. 中风与神经疾病杂志, 2022, 39(3): 239-241.
[18] Herrero Babiloni, A., Bellemare, A., Beetz, G., Vinet, S., Martel, M.O., Lavigne, G.J., et al. (2021) The Effects of Non-Invasive Brain Stimulation on Sleep Disturbances among Different Neurological and Neuropsychiatric Conditions: A Systematic Review. Sleep Medicine Reviews, 55, Article ID: 101381. [Google Scholar] [CrossRef] [PubMed]
[19] 高微, 薛蓉, 周凯丽. 脑卒中并发睡眠障碍研究进展[J]. 国际神经病学神经外科学杂志, 2018, 45(5): 539-543.
[20] 张瑾, 李春华, 尹豆, 等. 大鼠海马CA1区GABA能神经元在睡眠调节中的作用[J]. 动物学杂志, 2010, 45(3): 148-153.
[21] 严子昂, 田其, 李明昌. 星形胶质细胞在睡眠剥夺引发认知功能障碍中的作用机制研究进展[J]. 神经损伤与功能重建, 2025, 20(8): 470-473+496.
[22] 雷瑞宁, 杨倩, 杨思宇, 等. 经颅磁刺激在脑卒中功能损伤中应用的研究进展[J]. 中风与神经疾病杂志, 2025, 42(3): 273-278.
[23] Zhang, H., Huang, X., Wang, C. and Liang, K. (2022) Alteration of Gamma-Aminobutyric Acid in the Left Dorsolateral Prefrontal Cortex of Individuals with Chronic Insomnia: A Combined Transcranial Magnetic Stimulation-Magnetic Resonance Spectroscopy Study. Sleep Medicine, 92, 34-40. [Google Scholar] [CrossRef] [PubMed]
[24] Dubin, M.J., Mao, X., Banerjee, S., Goodman, Z., Lapidus, K.A.B., Kang, G., et al. (2016) Elevated Prefrontal Cortex GABA in Patients with Major Depressive Disorder after TMS Treatment Measured with Proton Magnetic Resonance Spectroscopy. Journal of Psychiatry and Neuroscience, 41, E37-E45. [Google Scholar] [CrossRef] [PubMed]
[25] Mojtabavi, H., Shaka, Z., Momtazmanesh, S., Ajdari, A. and Rezaei, N. (2022) Circulating Brain-Derived Neurotrophic Factor as a Potential Biomarker in Stroke: A Systematic Review and Meta-Analysis. Journal of Translational Medicine, 20, Article No. 126. [Google Scholar] [CrossRef] [PubMed]
[26] Ballester Roig, M., Leduc, T., Areal, C. and Mongrain, V. (2021) Cellular Effects of Rhynchophylline and Relevance to Sleep Regulation. Clocks & Sleep, 3, 312-341. [Google Scholar] [CrossRef] [PubMed]
[27] Ditmer, M., Gabryelska, A., Turkiewicz, S. and Sochal, M. (2023) Investigating the Role of BDNF in Insomnia: Current Insights. Nature and Science of Sleep, 15, 1045-1060. [Google Scholar] [CrossRef] [PubMed]
[28] Muheim, C.M., Singletary, K.G. and Frank, M.G. (2021) A Chemical-Genetic Investigation of BDNF-NtrkB Signaling in Mammalian Sleep. Sleep, 45, zsab237. [Google Scholar] [CrossRef] [PubMed]
[29] Monteiro, B.C., Monteiro, S., Candida, M., Adler, N., Paes, F., Rocha, N., et al. (2017) Relationship between Brain-Derived Neurotrofic Factor (BDNF) and Sleep on Depression: A Critical Review. Clinical Practice & Epidemiology in Mental Health: CP & EMH, 13, 213-219. [Google Scholar] [CrossRef] [PubMed]
[30] Tang, A., Thickbroom, G. and Rodger, J. (2016) Repetitive Transcranial Magnetic Stimulation of the Brain: Mechanisms from Animal and Experimental Models. The Neuroscientist, 23, 82-94. [Google Scholar] [CrossRef] [PubMed]
[31] 赵秀秀, 韩肖华, 郭风, 等. 高频重复经颅磁刺激对脑缺血后海马BDNF、VEGF和Nestin表达的影响[J]. 神经损伤与功能重建, 2013, 8(6): 431-434.
[32] Zhou, J., Fangma, Y., Chen, Z. and Zheng, Y. (2023) Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention. Aging and disease, 14, 2127-2152. [Google Scholar] [CrossRef] [PubMed]
[33] Lu, W. and Wen, J. (2025) Neuroinflammation and Post-Stroke Depression: Focus on the Microglia and Astrocytes. Aging and Disease, 16, 394-407. [Google Scholar] [CrossRef] [PubMed]
[34] Amalia, L., Garyani, M. and Lailiyya, N. (2023) Increasing of Cortisol Level and Neutrophil-Lymphocyte-Ratio Are Associated with Severity Level and Sleep Disturbances in Acute Ischemic Stroke. International Journal of General Medicine, 16, 5439-5448. [Google Scholar] [CrossRef] [PubMed]
[35] 刘玉景, 彭敏, 黄显军, 孙文, 刘新峰. 失眠与脑卒中双向关联的研究进展[J]. 中华神经科杂志, 2020, 53(6): 475-480.
[36] Nardone, R., Sebastianelli, L., Versace, V., Brigo, F., Golaszewski, S., Pucks-Faes, E., et al. (2020) Effects of Repetitive Transcranial Magnetic Stimulation in Subjects with Sleep Disorders. Sleep Medicine, 71, 113-121. [Google Scholar] [CrossRef] [PubMed]
[37] 李冬, 强静, 刘惠苗, 仇福成, 顾平. 经颅磁刺激治疗失眠的研究进展[J]. 中华物理医学与康复杂志, 2015, 37(2): 155-157.
[38] 狄凌云, 田振军. 生物钟Bmal1基因与慢性代谢性疾病及其运动干预研究进展[J]. 生物化学与生物物理进展, 2022, 49(3): 468-480.
[39] Stewart, D. and Albrecht, U. (2025) Beyond Vision: Effects of Light on the Circadian Clock and Mood-Related Behaviours. NPJ Biological Timing and Sleep, 2, Article No. 12. [Google Scholar] [CrossRef] [PubMed]
[40] Peng, J., Ren, B.Y., Zhang, H., et al. (2023) Research Progress in Control Strategies of Biological Clock Disorder. Acta Physiologica Sinica, 75, 279-290.
[41] Piña-Leyva, C., Lara-Lozano, M., Rodríguez-Sánchez, M., Vidal-Cantú, G.C., Barrientos Zavalza, E., Jiménez-Estrada, I., et al. (2022) Hypothalamic A11 Nuclei Regulate the Circadian Rhythm of Spinal Mechanonociception through Dopamine Receptors and Clock Gene Expression. Life, 12, Article No. 1411. [Google Scholar] [CrossRef] [PubMed]
[42] 王舒恒, 白帅东, 白雪, 等. 光遗传学技术在昼夜节律及相关疾病中的应用研究进展[J]. 生命科学, 2024, 36(7): 929-942.
[43] Dadon-Freiberg, M., Chapnik, N. and Froy, O. (2021) REV-ERBα Alters Circadian Rhythms by Modulating mTOR Signaling. Molecular and Cellular Endocrinology, 521, Article ID: 111108. [Google Scholar] [CrossRef] [PubMed]
[44] 向祥清, 廖家权, 郑国尧. 浅针治疗卒中后失眠的疗效观察及脑血流动力学的影响[J]. 上海针灸杂志, 2025, 44(3): 317-321.
[45] Turner, K.L., Gheres, K.W., Proctor, E.A. and Drew, P.J. (2020) Neurovascular Coupling and Bilateral Connectivity during NREM and REM Sleep. eLife, 9, e62071. [Google Scholar] [CrossRef] [PubMed]
[46] 李莎, 李欣怡, 白一凡, 赵丽, 王春燕, 万春晓. 基于功能性近红外光谱成像技术观察重复经颅磁刺激对缺血性脑卒中患者脑皮质血流动力学的影响[J]. 中华物理医学与康复杂志, 2024, 46(12): 1085-1090.
[47] 陈伟英, 何丽平, 蔡惠霞, 等. 早期低频重复经颅磁刺激对急性脑梗死患者失眠及生活质量的影响分析[J]. 中国实用医药, 2022, 17(27): 27-31.
[48] 黄丹霞. 观察重复经颅磁刺激对缺血性脑卒中失眠患者的临床疗效[J]. 世界睡眠医学杂志, 2022, 9(2): 209-211.
[49] 陈丽萍, 傅思媚, 古智文, 等. 高频重复经颅磁刺激治疗卒中后抑郁伴失眠的临床研究[J]. 广州医药, 2020, 51(6): 28-32.
[50] 覃彬, 高文, 覃惠洵, 等. 重复经颅磁刺激治疗脑卒中后失眠疗效的meta分析[J]. 中国医药科学, 2022, 12(11): 43-48, 126.
[51] Nardone, R., Sebastianelli, L., Versace, V., Brigo, F., Golaszewski, S., Pucks-Faes, E., et al. (2020) Effects of Repetitive Transcranial Magnetic Stimulation in Subjects with Sleep Disorders. Sleep Medicine, 71, 113-121. [Google Scholar] [CrossRef] [PubMed]
[52] 李京谕, 赵琦. 针灸治疗中风后失眠的研究进展[J]. 新疆中医药, 2025, 43(3): 128-132.
[53] 单薪颖, 梁慧敏, 康瑞, 等. 宁心安眠针法结合rTMS治疗卒中后失眠的临床观察[J]. 湖北中医杂志, 2024, 46(3): 52-55.
[54] 刘吉权, 邓丽霞. “眠三针”配合重复经颅磁刺激改善脑卒中后失眠的临床研究[J]. 中医药导报, 2021, 27(1): 99-102.
[55] 王卓慧, 刘婧, 郭保君, 等. 针刺补泻跷脉对失眠大鼠5-HT、NE及IL-1β含量的影响[J]. 中华中医药杂志, 2017, 32(3): 1321-1323.
[56] 史菡萏, 徐欣欣, 许彤, 等. 吴茱萸穴位贴敷治疗脑卒中后睡眠障碍临床观察[J]. 浙江中医杂志, 2025, 60(6): 497.
[57] 胡依依, 张仙飞. 重复经颅磁刺激仪联合吴茱萸穴位敷贴对脑卒中后失眠患者血清单胺类神经递质的影响[J]. 医疗装备, 2023, 36(23): 80-82.
[58] 梁廷营, 张鋆. 调和阴阳法针灸配合腹式深呼吸训练治疗顽固性失眠[J]. 中医学报, 2023, 38(8): 1778-1782.
[59] 王芳. 重复经颅磁刺激联合腹式深呼吸治疗缺血性脑卒中后失眠的临床研究[J]. 世界睡眠医学杂志, 2025, 12(1): 28-31.
[60] Fleming, M.K., Smejka, T., Macey, E., Luengo‐Fernandez, R., Henry, A.L., Robinson, B., et al. (2023) Improving Sleep after Stroke: A Randomised Controlled Trial of Digital Cognitive Behavioural Therapy for Insomnia. Journal of Sleep Research, 33, e13971. [Google Scholar] [CrossRef] [PubMed]
[61] 杜丽. 经颅磁刺激与失眠认知行为对脑梗死患者睡眠障碍疗效的研究[J]. 世界睡眠医学杂志, 2024, 11(2): 257-259.

为你推荐