代谢综合征伴睡眠障碍患者中医证型分布与下丘脑-垂体-肾上腺轴功能变化的关系分析

Analysis of Relationship between Distribution of Traditional Chiense Medicine Syndromes and the Functional Changes of Hypothalamic-pituitary-adrenal Axis Function for Patients with Metabolic Syndrome Complicated with Sleep Disorders

目的:分析代谢综合征伴睡眠障碍患者中医证型分布与下丘脑-垂体-肾上腺(HPA)轴功能变化的关系。方法:选择2018年1月~2020年1月医院收治的代谢综合征患者126例,根据匹兹堡睡眠质量指数量表(PSQI)评分分为无睡眠障碍组(n=35)、轻度睡眠障碍组(n=37)、中度睡眠障碍组(n=31)和重度睡眠障碍组(n=23),分析患者中医证型分布情况,比较不同中医证型代谢综合征患者PSQI评分,并分析代谢综合征患者中医证型分布与HPA轴功能变化的关系。结果126例代谢综合征患者中,脾肾气虚证占14.29%(18/126),肝郁脾虚证占28.57%(36/126),气阴两虚证占20.63%(26/126),气滞湿阻证占26.19%(33/126),痰瘀互结证占10.32%(13/126);不同程度睡眠障碍患者中医证型分布比较,差异有统计学意义(P<0.05),其中无睡眠障碍、轻度睡眠障碍以气滞湿阻证占比最高,中重度睡眠障碍以肝郁脾虚证占比最高;脾肾气虚证、肝郁脾虚证、气阴两虚证、痰瘀互结证患者PSQI评分均显著高于气滞湿阻证患者(P<0.05),且肝郁脾虚证患者PSQI评分显著高于脾肾气虚证、气阴两虚证、痰瘀互结证患者(P<0.05);肝郁脾虚证患者ACTH水平显著低于其他各证型患者(P<0.05),COR水平显著高于气滞湿阻证患者(P<0.05),脾肾气虚证、痰瘀互结证患者COR水平显著高于气滞湿阻证患者(P<0.05);不同中医证型代谢综合征患者PSQI评分与ACTH呈负相关(P<0.05),与COR呈正相关(P<0.05)。结论:肝郁脾虚证患者睡眠障碍程度最严重,气滞湿阻证患者睡眠障碍程度最轻,代谢综合征伴睡眠障碍患者发病机制可能与HPA轴功能变化有关。

Objective:To analyze the relationship between distribution of TCM syndromes and changes of hypothalamus-pituitary-adrenal(HPA)axis function for patients with metabolic syndrome complicated with sleep disorders.Methods:126 patients with metabolic syndrome treated in the hospital were selected between January 2018 and January 2020.According to the Pittsburgh Sleep Quality Index(PSQI)score,the patients were divided into a anon-sleep disorder group(n=35),a mild sleep disorder group(n=37),a moderate sleep disorder group(n=31)and a severe sleep disorder group(n=23).The distribution status of TCM syndromes of patients were analyzed,and the PSQI score of patients with metabolic syndrome of different TCM syndromes was compared,and the relationship between distribution of TCM syndromes and changes of HPA axis function was analyzed among patients with metabolic syndrome.Results:Among 126 patients with metabolic syndrome,there were 14.29%(18/126)of spleen-kidney Qi deficiency syndrome,28.57%(36/126)of syndrome of liver depression and spleen deficiency,20.63%(26/126)of Qi-Yin deficiency syndrome,26.19%(33/126)of syndrome of Qi and damp stagnation and 10.32%(13/126)of syndrome of turbid phlegm and blood stasis.There was a statistically significant difference in the distribution of TCM syndromes in patients with different degrees of sleep disorder(P<0.05).Syndrome of Qi and damp stagnation accounted for the highest proportion in non-sleep disorder and mild sleep disorder,and syndrome of liver depression and spleen deficiency accounted for the highest proportion in moderate-to-severe sleep disorder.The PSQI score of patients with spleen-kidney Qi deficiency syndrome,syndrome of liver depression and spleen deficiency,syndrome of Qi-Yin deficiency and syndrome of turbid phlegm and blood stasis was significantly higher than that of patients with syndrome of Qi and damp stagnation(P<0.05),and the PSQI score of patients with syndrome of liver depression and spleen deficiency was significantly higher than that of patients with spleen-kidney Qi deficiency syndrome,Qi-Qin deficiency syndrome and syndrome of turbid phlegm and blood stasis(P<0.05).The ACTH level of patients with syndrome of liver depression and spleen deficiency was significantly lower than that of patients with other syndromes(P<0.05),and the level of COR was significantly higher than that of patients with syndrome of Qi and damp stagnation(P<0.05),and the level of COR in patients with spleen-kidney Qi deficiency syndrome and syndrome of turbid phlegm and blood stasis was significantly higher than that of patients with syndrome of Qi and damp stagnation(P<0.05).PSQI score in patients with metabolic syndrome of different TCM syndromes was negatively correlated with ACTH(P<0.05),and was positively correlated with COR(P<0.05).Conclusion:The degree of sleep disorder is the most serious in patients with syndrome of liver depression and spleen deficiency,and the mildest in patients with syndrome of Qi and damp stagnation.The pathogenesis of metabolic syndrome with sleep disorders in patients may be related to the changes of HPA axis function.