加味酸枣仁汤治疗肝血亏虚证失眠患者60例临床观察

A Clinical Observation on Supplemented Suanzaoren Decoction for 60 Insomnia Patients with Liver-Blood Deficiency Pattern

目的观察加味酸枣仁汤治疗肝血亏虚证失眠的临床疗效及其对单胺类神经递质的影响。方法将120例失眠患者随机分为中医治疗组和西医对照组各60例,同时征集60例睡眠正常人群为正常对照组。中医治疗组给予加味酸枣仁汤中药配方颗粒剂,每日1剂;西医对照组给予艾司唑仑片,每次1mg,睡前30min口服,两组均治疗2周。正常对照组不作特殊处理。两组分别于治疗前后填写匹兹堡睡眠指数量表(PSQI)、睡眠状态自评量表(SRSS)。两治疗组患者分别于治疗前后,健康对照组于入组时检测5-羟色胺(5-HT)、5-羟吲哚乙酸(5-HIAA)和β-内啡肽(β-EP)水平。观察两治疗组的临床疗效。结果两组患者治疗后SRSS、PSQI量表评分均较治疗前降低(P<0.01);治疗后中医治疗组SRSS、PSQI量表评分低于西医对照组(P<0.05)。治疗前与正常对照组比较,两组患者5-HT、β-EP水平明显降低,5-HIAA水平明显升高(P<0.01);治疗后两组患者5-HT、β-EP水平较本组治疗前明显升高,5-HIAA水平明显降低(P<0.05或P<0.01);中医治疗组治疗后与西医对照组比较,5-HT、β-EP水平明显升高,5-HIAA水平明显降低(P<0.05或P<0.01)。中医治疗组临床综合疗效总有效率(86.67%)明显高于西医对照组(75.00%)(P<0.05)。结论肝血亏虚证失眠患者单胺类递质紊乱,加味酸枣仁汤可以改善失眠患者及调节神经递质。

Objective To observe the therapeutic effect of Supplemented Suanzaoren Decoction （Supplemented Spiny Jujube Decoction） for insomnia with liver-blood deficiency pattern and its effect on monoamine neurotransmitters. Methods Totally 120 insomnia patients with liver-blood deficiency pattern were randomized into the TCM treatment group and western medicine （WM） control group, with 60 in each. Sixty normal sleepers were chosen as the normal control group. The TCM treatment group was given Supplemented Suanzaoren Decoction granules one dosage daily and once with a half dose in the morning and evening respectively. The WM control group was given 1 mg Estazolam Tablets 30 rain before bedtime orally. The treatment lasted for 2 weeks. The normal control group was not given any special treatment. The insomnia patients were asked to fill the Pittsburgh Sleep Quality Index （PSQI） and self-rating scale of sleep （SRSS） on the admission day and after 2-week treatment. The levels of 5-hydroxytryptamine （5-HT）, 5-hydroxy indole acetic acid （5-HIAA） and β-endorphin （β-EP） were detected be- fore and after treatment in the TCM treatment group and WM control group and when enrolled in the normal control group. The therapeutic effect was observed as well. Results The SRSS and PSQI scores were significantly improved in the TCM treatment group and WM control group after treatment （P〈0.01）, especially in the TCM treatment group （P〈0.05）. Com- paring with the normal control group, the levels of 5-HT andβ-EP were significantly lower （P〈0.01） but the 5-HIAA levels were significantly higher （P〈O. 01） in the insomnia patients with liver-blood deficiency pattern before treatment. After treat- ment, the levels of 5-HT and β-EP were significantly increased in the TCM treatment group （P〈0, 01） and WM control group （P〈0.05 or P〈0.01）, but the 5-HIAA levels were significantly decreased in the TCM treatment group （P〈0.01） and WM control group （P（0.05）, especially in the TCM treatment group （P-C0.05 or P〈0.01）. Comparing with the normal control group, the difference in 5-HT level was not statistically significant （P〉0.05）, but the β-EP level was significantly decreased （P〉O. 05） and 5-HIAA level was significantly increased （P〈O. 05） in the TCM treatment group after treatment. Comparing with the normal control group, the levels of 5-HT and 13-EP were significantly decreased （P〈0.01） and 5-HIAA level was sig- nificantly increased （P,〈0.01） in the WM control group after treatment. The total effective rate in the TCM treatment group was 86.67%, which was superior to 75.00% in the WM control group （P〈0.05）. Conclusion The monoamine neurotrans-mitters in insomnia patients with liver-blood deficiency pattern are disorder. Supplemented Suanzaoren Decoction can improve insomnia and balance neurotransmitters.