【摘要】 目的 探讨重复经颅磁刺激（rTMS）对孤独症谱系障碍（ASD）儿童睡眠问题的治疗效果。方法 于2018年10月至2021年6月通过天津市安定医院儿童门诊及网络平台发布招募广告,选取符合美国精神障碍诊断统计手册第五版（DSM-5）ASD的诊断标准的58例ASD儿童,年龄（5.51±1.28）岁,将其随机分为试验组和对照组。试验组采用左侧高频（10 Hz）+右侧低频（1 Hz）_rTMS刺激ASD患儿双侧背外侧前额叶,而对照组采取伪刺激,刺激时间和部位同试验组。两组均干预4周,分别于治疗前及干预2、4周采用孤独症评定量表（CARS）、儿童睡眠习惯问卷（CSHQ）对被试进行评估。采用重复测量资料的方差分析对资料进行统计。结果 两组治疗前的年龄、性别构成、CARS评分及CSHQ评分比较,差异均无统计学意义（P>0.05）。重复测量方差分析结果显示,CARS评分方面,组别主效应差异无统计学意义(F_（1,55）=0.108,P=0.743),疗程主效应差异无统计学意义(F_（2,54）=0.667,P=0.515);组别与疗程的交互作用明显(F_（2,54）=28.757,P<0.001)。CSHQ方面,组别主效应(F_（1,55）=4.489,P=0.039)、疗程主效应(F_（2,54）=7.735,P=0.001)和两者交互作用(F_（2,54）=138.478,P<0.001)差异均有统计学意义。通过简单效应分析,进一步分析组别与疗程的交互作用发现,试验组CARS总分（干预前比干预2周:t=8.328;干预前比干预4周:t=8.375;干预2周比干预4周:t=4.783;均P<0.001）与CSHQ总分在不同时间点两两比较,差异均有统计学意义（干预前比干预2周:t=13.257;干预前比干预4周:t=25.902;干预2周比干预4周:t=12.840;均P<0.001）;对照组在不同时间点两两比较,差异均无统计学意义。试验组在CSHQ各个维度上得分随着干预周期的延长均具有不同程度的改善。结论 rTMS左侧高频+右侧低频刺激ASD儿童双侧背外侧前额叶能够有效改善ASD儿童的临床症状和睡眠状况,且2周（10次）可取得明显疗效。更多还原

【Abstract】 Objective To explore the clinical efficacy of repetitive transcranial magnetic stimulation（rTMS） on the children with autism spectrum disorder（ASD） comorbid with sleep disorder.Methods A total of 58 children with ASD who met the diagnostic criteria of American Diagnostic and Statistical Manual of Mental Disorder,Fifth Edition（DSM-5） were selected through recruitment advertisements published in the Children Outpatient Department and online platform of Tianjin Anding Hospital from October 2018 to June2021.All selected children were（5.51±1.28） years old,and were divided into the trail group and the control group randomly.The bilateral dorsolateral prefrontal cortex（DLPFC） of the participants in the trail group were stimulated with high frequency（10 Hz） on the left+low frequency（1 Hz） on the right,while the participants in the control group received the sham condition with the same stimulating sites & duration.All the participants were intervened for 4 weeks.The childhood autism rating scale（CARS） & Children’s Sleep Habits Questionnaire（CSHQ） were used to assess the symptoms of ASD before intervention,2 weeks and 4 weeks after intervention.The data were analyzed by ANOVA of repeated measurement data.Results There was no statistical difference between the two groups on age,gender composition,CARS score and CSHQ score（P> 0.05）.The results of repeated measurement ANOVA showed that in terms of CARS score,there was no significant difference in the main effect of the group（F（1,55）=0.108,P=0.743） and the main effect of the course of treatment(F_（2,54）=0.667,P=0.515),however,there was statistical significance for the interaction between group and course(F_（2,54）=28.757,P <0.001).In terms of CSHQ,the differences on the main effect of group(F_（1,55）=4.489,P=0.039),the main effect of the course of treatment(F_（2,54）=7.735,P=0.001),and the interaction between group and course(F_（2,54）=138.478,P <0.001) were all statistically significant.Through simple effect analysis and further analysis of the interaction between the group and the course of treatment,it was found that the total scores of CARS（pre-intervention vs post-two-week intervention:t=8.328;pre-intervention vs post-fourweek intervention:t=8.375;post-two-week intervention vs post-four-week intervention:t=4.783;P <0.001）and CSHQ（pre-intervention vs.post-two-week intervention:t=13.257;pre-intervention vs post-four-week intervention:t=25.902;post-two-week intervention vs post-four-week intervention:t=12.840;P <0.001） in the trail group were compared at different time points,and the differences were statistically significant,while those in the control group were compared at different time points,and the differences were not statistically significant.The scores of the subscales of CSHQ in the trail group improved to varying degrees with the extension of the intervention.Conclusions The protocols of rTMS stimulation（left-side high-frequency+right-side lowfrequency） on bilateral DLPFC of children with ASD could improve the core symptoms and sleep disorder of ASD simultaneously,and it began to take effect as short as two weeks（10 times）.更多还原