针药结合治疗绝经过渡期失眠50例临床研究

Clinical Study on Acupuncture Combined with Medication for 60 Cases of Perimenopausal Insomnia

目的评价针药结合治疗绝经过渡期失眠(心肾不交型)的临床疗效及其对相关神经递质的影响。方法将绝经过渡期失眠(心肾不交型)患者140例随机分为中药组45例、针刺组45例、针药结合组50例,中药组口服益肾清心汤,每日1剂;针刺组选穴安眠、四神聪、神门、三阴交、申脉、照海进行电针治疗,隔日1次;针药结合组同时进行针刺结合中药治疗,各组均4周为1个疗程,4个疗程后评价疗效,并分别记录各组患者治疗前后Kupperman量表评分和匹兹堡睡眠质量指数(PSQI)评分,检测血清性激素、单胺类神经递质包括多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)、5-羟吲哚乙酸(5-HIAA)、γ-氨基丁酸(GABA)。结果针药结合组总有效率(74.0%)与中药组(66.7%)、针刺组(62.2%)比较差异有统计学意义(P<0.05);而中药组与针刺组比较差异无统计学意义(P>0.05)。治疗后各组Kupperman量表各因子评分及总积分、PSQI各因子评分及总积分均较本组治疗前显著下降(P<0.01),且针药结合组的改善程度优于中药组和针刺组(P<0.05)。治疗后各组患者血清性激素比较及与本组治疗前比较差异均无统计学意义(P>0.05)。治疗后各组血清单胺类神经递质水平与本组治疗前比较差异均有统计学意义(P<0.05);治疗后针刺组DA、NE与针药结合组比较差异有统计学意义(P<0.05),中药组DA、NE、5-HT与针药结合组比较差异有统计学意义(P<0.05)。结论针药结合比单纯中药或针刺改善绝经过渡期心肾不交型失眠疗效更佳,其机理与升高5-HT、5-HIAA、GABA含量、降低NE、DA合成相关。

Objective To observe the therapeutic effect of acupuncture combined with medication for perimenopausal insomnia and its effect on the related neurotransmitters. Methods Totally 140 perimenopausal insomnia patients of non-interaction of the heart and kidney syndrome were randomized into the acupuncture group of 45 cases, Chinese medication group of 45 ca- ses and acupuncture combined with medication group of 50 cases. The Chinese medication group was given Yishen Qingxin Decoction （decoction to boost the kidney and clear the heart） one dosage daily. The acupuncture group was given electro-acupunc- ture on Anmian （EX-HN） points, Sishencong （EX-HN1）, Shenmen （HT7）, Sanyinjiao （SP6）, Shenmai （BL62） and Zhaohai （KI6） every other day. The acupuncture combined with medication group was given the combo therapy. The treatment course lasted for 4 weeks. Four courses later, the therapeutic effect was analyzed according to Kupperman Scale and the Pittsburgh Sleep Quality Index （PSQI）. Meanwhile, serum sex hormones, dopamine （DA）, norepinephrine （NE）, 5-hydroxytryptamine （5-HT）, 5-hydroxyindoleacetic acid （5-HIAA） and ）＇-aminobutyric acid （GABA） were detected. Results The total effective rate of the acupuncture combined with medication group was 74.0%, which was superior to 66.7% of the Chinese medication group and 62.2% of the acupuncture group （P〈0.05）. There was no significant difference between the Chinese medication group and the acupuncture group in the total effective rate （P〈0.05）. After treatment, the factor and total scores in Kupper- man Scale and PSQI in all groups were significantly decreased （P%0.01）, especially in the acupuncture combined with medica- tion group （P%0.05）. The difference of serum sex hormones between pretreatment and after treatment was not statistically significant in all groups （P〈0.05）. The differences of monoamine neurotransmitters between pretreatment and after treatment were statistically significant in all groups （P〈0.05）. After treatment, the differences in DA and NE was statistically signifi- cant between the acupuncture group and the acupuncture combined with medication group （P%0.05）. The differences in DA, NE and 5-HT was statistically significant between the Chinese medication group and the acupuncture combined with medication group （P%0.05）. Conclusion Comparing with single acupuncture or medication, the combo therapy is more effective for perimenopausal insomnia of non-interaction of the heart and kidney syndrome. Its effect is relevant to the increase of 5-HT, 5- HIAA and GABA and reduce of NE and DA.