蒙医温针治疗老年失眠症的临床疗效及其脑肠肽机制

Clinical effect of the warm acupuncture of Mongolian medicine on insomnia in the elderly and its brain-gut peptide mechanism: a randomized controlled trial

目的:观察蒙医温针治疗老年失眠症的临床疗效及安全性,并探究其脑肠肽机制。方法:将60例老年失眠症患者随机分为温针组和西药组,各30例。温针组采用蒙医温针治疗,穴取顶会穴(头顶正中,前正中线与两耳尖上缘连线交叉处)、赫依穴(第7颈椎棘突下凹陷正中)、心穴(第6胸椎棘突下凹陷正中),每次只取1个穴位,3个穴位循环交替使用,每次行蒙医温针20 min,每隔1~2 d治疗1次,每周3次,共治疗3周。西药组给予艾司唑仑片,每日1次,睡前口服1 mg,连续服用3周。于治疗前后及治疗结束后1个月随访时观察两组患者匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)评分,比较两组患者治疗前后血清脑肠肽相关指标[P物质(SP)、神经肽(NPY)及5-羟色胺1A(5-HT1A)、5-羟色胺2A(5-HT2A)]水平,并评定两组临床疗效及安全性。结果:治疗后及随访时,两组患者PSQI睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分及总分与ISI评分均降低(P<0.05,P<0.01),且温针组均低于西药组(P<0.05,P<0.01)。治疗后,两组患者血清SP、5-HT2A含量较治疗前降低(P<0.01),血清NPY、5-HT1A含量较治疗前升高(P<0.01);温针组患者血清SP、5-HT2A含量低于西药组(P<0.05),血清NPY、5-HT1A含量高于西药组(P<0.05)。治疗后,温针组患者总有效率为93.3%(28/30),高于西药组的83.3%(25/30,P<0.05),两组均未出现严重不良反应。结论:蒙医温针能够有效改善老年失眠症患者的睡眠质量,其机制可能与调节血清SP、NPY、5-HT1A、5-HT2A水平有关。

Objective To observe the clinical effect and safety of the warm acupuncture of Mongolian medicine in treatment of insomnia in the elderly,and to explore its underlying brain-gut peptide mechanism.Methods Sixty elderly patients with insomnia were randomly divided into a warm acupuncture group and a western medication group,30 cases in each group.In the warm acupuncture group,the warm acupuncture of Mongolian medicine was operated at Dinghuixue(at the center of the vertex,the crossing site of the anterior midline and the line connected the upper edges of two ear apexes),Heyixue(at the depression of the spinous process of the 7th cervical vertebra)or Xinxue(at the depression of the spinous process of the 6th thoracic vertebra)in each treatment.Only one of the above points was selected and stimulated for 20 min one treatment and the three points were used alternatively.The treatment was given once every day or every other day,3 times a week,and for a total of 3 weeks.In the western medication group,estazolam tablets were administered orally,once a day,1 mg before bedtime,consecutively for 3 weeks.Before and after treatment,as well as in 1-month follow-up visit after the treatment completion,the scores of the Pittsburgh sleep quality index(PSQI)and the insomnia severity index(ISI)were observed in the two groups.The serum brain-related peptide markers(substance P[SP],neuropeptide Y[NPY],5-hydroxytryptamine 1A[5-HT1A]and 5-hydroxytryptamine 2A[5-HT2A])were measured before and after treatment,and the clinical efficacy and safety was evaluated in the two groups.Results After treatment and in follow-up,the scores of sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance and daytime dysfunction,as well as the total scores of PSQI,and ISI scores were all reduced in the two groups(P<0.05,P<0.01);and the scores in the warm acupuncture group were lower than those of the western medication group(P<0.05,P<0.01).After treatment,the levels of serum SP and 5-HT2A were decreased(P<0.01)and the levels of serum NPY and 5-HT1A were increased(P<0.01)when compared with those before treatment in the two groups.The levels of serum SP and 5-HT2A in the warm acupuncture group were lower than those of the western medication group(P<0.05),and the levels of serum NPY and 5-HT1A were higher than those of the western medication group(P<0.05).After treatment,the total effective rate was 93.3%(28/30)in the warm acupuncture group,which was higher than 83.3%(25/30)of the western medication group(P<0.05).No serious adverse reactions were found in the two groups.Conclusion Warm acupuncture of Mongolian medicine can effectively improve the sleep quality of the elderly patients with insomnia,and its mechanism may be related to the regulation of the levels of serum SP,NPY,5-HT1A and 5-HT2A.