针刺对原发性失眠症患者觉醒状态调节作用及其相关神经电生理学效应研究

Regulation action and nerve electrophysiology mechanism of acupuncture on arousal state in patients of primary insomnia

目的:比较针刺与艾司唑仑调节原发性失眠症患者觉醒状态的差异,并探讨其相关神经电生理学效应。方法:将64例原发性失眠症患者随机分为针刺组(32例)和药物组(32例),共剔除3例,最终针刺组31例,药物组30例。针刺组主穴取四神聪、安眠、神门、三阴交、照海、申脉,结合配穴针刺治疗,每天1次,每周5次,连续治疗4周;药物组口服艾司唑仑片,每天1次,连续服用4周。观察两组治疗前后匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分及多次睡眠潜伏时间试验(multiple sleep latency test,MSLT)的平均睡眠潜伏时间(mean sleep latency,MSL),并采用多导睡眠监测仪(polysomnography,PSG)监测睡眠结构相关指标。结果:两组治疗后PSQI评分较治疗前均明显降低(均P<0.01),针刺组治疗后PSQI评分较药物组降低幅度更大(P<0.05)。与治疗前比较,两组治疗后睡眠潜伏期(sleep onset latency,SOL)缩短、觉醒次数(number of awakenings,NWAK)、入睡后清醒时间(wake after sleep onset,WASO)减少,总睡眠时间(total sleep time,TST)增多、睡眠效率(sleep efficiency,SE)明显增高(均P<0.01)。药物组治疗后非快速眼动1/2/3期(non-rapid eye movement period 1/2/3,N1、N2、N3)、快速眼动睡眠期(rapid eye movement period,REM)占TST比例与治疗前比较差异无统计学意义(均P>0.05)。针刺组治疗后较治疗前N1、N2比例减少,N3、REM比例增多(均P<0.01);针刺组治疗后较药物组N1、N2比例减少,N3、REM比例增多(均P<0.01)。两组治疗后SOL、NWAK、WASO、TST、SE比较差异均无统计学意义(均P>0.05)。两组治疗后MSLT的MSL较治疗前均明显缩短(均P<0.01),针刺组治疗后MSLT的MSL较药物组缩短更显著(P<0.05)。结论:针刺较艾司唑仑能更有效地改善原发性失眠症患者的睡眠质量,并更有利于调节其过度觉醒状态。

Objective To compare the difference between acupuncture and estazolam on arousal state in patients of primary insomnia,and to explore its nerve electrophysiology mechanism.Methods Sixty-four patients of primary insomnia were randomized into an acupuncture group（32 cases）and a medication group（32 cases）.After 3 patients were excluded,31 cases in the acupuncture group and 30 cases in the medication group were included.Patients in the acupuncture group were treated with acupuncture at Sishencong（EX-HN 1）,Anmian（Extra）,Shenmen（HT 7）,Sanyinjiao（SP 6）,Zhaohai（KI 6）,Shenmai（BL 62）as main acupoints,combined with supporting acupoints,once a day,five times per week,continuously for 4weeks.Patients in the medication group were treated with oral administration of estazolam,once a day,continuously for 4 weeks.The Pittsburgh sleep quality index（PSQI）and mean sleep latency（MSL）of multiple sleep latency test（MSLT）were compared before and after treatment in the two groups;the polysomnography（PSG）was applied to monitor the indices regarding sleeps tructure.Results Compared before treatment,PSQI score was reduced after treatment in the two groups（both P〈0.01）,which was more significant in the acupuncture group（P〈0.05）.Compared before treatment,sleep onset latency（SOL）,number of awakenings（NWAK）and wake after sleep onset（WASO）were reduced,while total sleep time（TST）and sleep efficiency（SE）were significantly increased in the two groups after treatment（all P〈0.01）.Compared before treatment,the percentage of non-rapid eye movement period 1/2/3（N1,N2,N3）and the percentage of rapid eye movement period（REM）to TST were not significantly changed after treatment in the medication group（all P〉0.05）.Compared before treatment,the percentage of N1,N2 to TST was reduced,while the percentage of N3 and REM to TST was increased after treatment in the acupuncture group（P〈0.01）.The SOL,NWAK,WASO,TST,SE were not statistically changed after treatment in each group（all P〉0.05）.Compared with the medication group,the percentage of N1 and N2was reduced while that of N3 and REM was increased after treatment in the acupuncture group（all P〈0.01）.After treatment,MSL of MSLT were obviously decreased in the two groups（both P〈0.01）,which were more significant in the acupuncture group（P〈0.05）.Conclusion Acupuncture can more effectively improve sleep quality of primary insomnia than estazolam,and is more beneficial for regulation of hyperarousal state.