活血化痰降浊方合针刺治疗顽固性失眠疗效及对炎症因子、单胺类神经递质水平的影响

Therapeutic effect of the decoction for activating blood circulation, removing phlegm and turbidity with acupuncture on refractory insomnia and its effect on inflammatory factors and monoamine neurotransmitters

目的观察活血化痰降浊方合针刺治疗顽固性失眠疗效及对炎症因子、单胺类神经递质水平的影响。方法将94例顽固性失眠患者随机分为2组,对照组47例给予西医综合干预,观察组47例则在此基础上加用活血化痰降浊方合针刺治疗,2组均以1周为1个疗程,治疗4个疗程。比较2组患者治疗前后匹兹堡睡眠质量指数量表(PSQI)评分、抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、多导睡眠图监测指标、中医证候评分及白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、5-羟色胺(5-HT)、5-羟吲哚乙酸(5-HIAA)水平,统计2组临床疗效。结果治疗后观察组PSQI评分、SDS评分、SAS评分、睡眠潜伏期、觉醒次数、中医证候评分均显著低于治疗前及对照组(P均<0.05),总睡眠时间、睡眠期、IL-1β、TNF-α、5-HT及5-HIAA水平均显著高于治疗前及对照组(P均<0.05)。观察组治疗总有效率显著高于对照组(P<0.05)。结论活血化痰降浊方合针刺治疗能够显著延长顽固性失眠患者睡眠时间,促进入睡,降低觉醒频率,并有助于缓解负面情绪状态,可能与其能有效调节IL-1β、TNF-α、5-HT、5-HIAA水平有关。

Objective It is to observe the effect of the decoction for activating blood circulation, removing phlegm and turbidity with acupuncture on refractory insomnia and its effect on inflammatory factors and monoamine neurotransmitters. Methods 94 patients with refractory insomnia were randomly divided into 2 groups. 47 patients in the control group were given comprehensive intervention with western medicine. 47 patients in the observation group were treated with the decoction for activating blood circulation, removing phlegm and turbidity with acupuncture on the basis of treatment in the control group. 1 week as a course of treatment, both groups were treated for 4 courses. The scores of the Pittsburgh Sleep Quality Index(PSQI), the Self-rating Depression Scale(SDS), the Self-rating Anxiety Scale(SAS), the polysomnography monitor indexes, the TCM syndrome scores, and the levels of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), serotonin(5-HT), 5-hydroxyindoleacetic acid(5-HIAA) before and after treatment were compared, and the clinical efficacy were assessed in the two groups. Results After treatment, the PSQI scores, SDS scores, SAS scores, sleep latency, arousal number, TCM syndrome scores were significantly lower or shorter in the observation group than those before treatment and in the control group(P<0.05), while total sleep time, the levels of IL-1β, TNF-α, 5-HT and 5-HIAA were significantly higher or longer than those before treatment and in the control group(P<0.05). The total effective rate of the observation group was significantly higher than that of the control group(P<0.05). Conclusion The decoction for activating blood circulation, removing phlegm and turbidity with acupuncture can significantly prolong the sleep time, promote sleep, reduce the frequency of arousal, and help to alleviate the negative emotional state in patients with intractable insomnia, the mechanism may be related with its effective regulation of the levels of IL-1β, IL-6, TNF-α, 5-HT, 5-HIAA.