不同证候寻常型银屑病患者睡眠参数及心率变化特征分析

Characteristics of sleep parameters and nocturnal heart rate dynamics in patients with psoriasis vulgaris

目的观察并提取不同证候的寻常型银屑病患者的睡眠期生理特征。方法将纳入研究的36例寻常型银屑病患者按辨证分为血热证组(n=21)和血燥证组(n=15),以15例正常人作为对照组,均采用床垫式睡眠检测系统进行睡眠检测,比较银屑病患者与对照组、血热证组与血燥证组间的睡眠参数和睡眠期心率的变化特征。结果与对照组比较,两组银屑病患者均存在睡眠表浅、睡眠节律紊乱、微觉醒增多等睡眠质量下降表现;血热证组较血燥证组微觉醒增多更明显,血燥证组睡眠潜伏期延长较明显;银屑病患者入睡后心率下降不明显,第一个睡眠周期心率相对偏高,睡眠期心率变异系数增大;与血燥证组比较,血热证组心率变异增大更明显(P<0.05)。结论银屑病患者的睡眠质量下降现象以及心率变化特点可能与血热、阴虚证候因素导致阴不涵阳、热扰心神有关,并且不同证候患者的表现存在差异。患者存在副交感活动度下降而交感神经活动相对活跃的表现,且不同证候的患者表现有所不同。

Objective To investigate the physiological features of patients with psoriasis vulgaris during sleep.Methods Thirty-six psoriasis patients were classified into the group with ＂blood-heat＂ syndrome（n=21） and the group with ＂blood-dry＂ syndrome（n=15）.Fifteen healthy volunteers served as control.All the subjects underwent a nocturnal sleep examination using the micro-movement sensitive mattress sleep monitoring system（MSMSMS）.The sleep indices and nocturnal heart rate dynamics of the patients were compared with that of the control,and also between the two groups with different syndrome.Results In comparison with the control group,both psoriasis patient groups showed the phenomena of poor sleep quality,such as the shallow sleep phase,disorder of sleep rhythm and increased slight-arousals.The slight-arousal occurred more often in blood-heat syndrome group than in blood-dry syndrome group,while the sleep latency was elongated more evidently in blood-dry syndrome group.Compared with the control group,the two patient groups presented a little decrease in heart rate（HR） after sleeping.However,the HR increased in the first phase of sleep,and the variation coefficient of HR increased in the whole sleep period.An increase in HR variation coefficient was more obvious in blood-heat syndrome group than in blood-dry syndrome group（P〈0.05）.Conclusions The phenomena of decreased sleep quality and the variation of nocturnal HR in psoriasis patients may be due to the failure of Yin to control Yang,and disturbance of heat to the mind induced by blood-heat and Yin deficiency.The degrees of the phenomena are different between the two psoriasis groups.There is also a decrease in parasympathetic activity and relative increase in sympathetic activity in both psoriasis groups,with manifestation of different features in patients with different syndromes.