364例围绝经期失眠症患者肾虚肝郁证临床特征

Clinical Characteristics of 364 Cases of Menopausal Insomnia with Kidney Deficiency and Liver Depression Syndrome

目的观察围绝经期失眠症肾虚肝郁证的临床特征。方法采用临床流行病学调查方法对602例围绝经期失眠症患者的社会人口学特征、睡眠及月经情况进行调查,运用神经心理学量表进行评估,同时检测血清雌二醇（E2）、卵泡刺激素（FSH）和促黄体激素（LH）水平。采用单因素及多因素非条件Logistic回归方法分析围绝经期失眠症肾虚肝郁证的临床特征。结果 602例患者中,肾虚肝郁证364例,非肾虚肝郁证238例。在排除了年龄、A型性格、体育锻炼、优质蛋白及胆固醇的摄入量、宗教信仰、兴趣爱好、社会支持与联系等社会人口学特征的影响后,肾虚肝郁证患者与非肾虚肝郁证患者匹兹堡睡眠质量指数、抑郁自评量表评分、焦虑自评量表评分、睡眠潜伏期、睡眠时间、月经规律、血清E2及FSH水平比较差异仍有统计学意义（P〈0.05或P〈0.01）,其关联强度OR值（95%CI可信区间）分别为1.64（1.08~2.49）、1.77（1.06~2.95）、1.65（1.00~2.70）、1.41（1.08~1.85）、1.68（1.06~2.68）、1.71（1.07~2.73）、2.56（1.74~3.78）、2.69（1.82~3.98）。结论围绝经期失眠症肾虚肝郁证患者多为绝经妇女,存在明显的抑郁和焦虑状态,睡眠质量差,表现为明显的入睡困难和睡眠时间缩短,血清性激素水平紊乱,以E2水平低下、FSH升高为主。

Objective To observe the clinical characteristics of menopausal insomnia（ MI） with kidney deficiency and liver depression syndrome. Methods Social demographic characteristics as well as sleep and menstrual status of 602 MI patients were studied by adopting clinical epidemiological investigation methods and neuropsychological evaluation scale. Serum levels of estradiol（ E2）,follicle stimulating hormone（ FSH） and luteinizing hormone（ LH）were detected. Clinical characteristics of MI with kidney deficiency and liver depression syndrome were analyzed by applying single and multi-factor non-conditional logistic regression method. Results There were 364 cases with kidney deficiency and liver depression syndrome in 602 MI patients,and 238 cases without kidney deficiency and liver depression syndrome. After excluding the influence of social demographic characteristics factors,such as age,type A personality,exercises,quality protein and cholesterol intake,religion,hobbies and interests,social support and connection,etc.,there were still significant differences in Pittsburgh Sleep Quality Index,scores of Self-rating Depression Scale and Self-Rating Anxiety Scale,sleep latency,total sleep time,menstrual status,and serum levels of E2 and FSH between patients with and without kidney deficiency and liver depression syndrome（ P 0. 05 or P 0. 01）; the correlation strength OR（ 95% confidence interval） were 1. 64（ 1. 08- 2. 49）,1. 77（ 1. 06- 2. 95）,1. 65（ 1. 00- 2. 70）,1. 41（ 1. 08- 1. 85）,1. 68（ 1. 06- 2. 68）,1. 71（ 1. 07- 2. 73）,2. 56（ 1. 74- 3. 78）,and 2. 69（ 1. 82- 3. 98） respectively. Conclusion Most MI patients with kidney deficiency and liver depression syndrome were postmenopausal women,with significant depression and anxiety status,low sleep quality including obvious difficulty falling asleep and short sleep time,and disorder of serum levels of sex hormone（ mainly low E2 and high FSH level）.