针刺联合疏肝汤治疗肝郁化火型不寐对患者睡眠及神经递质表达的影响

Effects of Acupuncture Combined with Shugan Decoction on Sleep and Neurotransmitter Expression in Patients with Liver Depression Transforming Fire Syndrome Insomnia

目的:探讨针刺联合疏肝汤治疗肝郁化火型不寐对患者睡眠及神经递质表达的影响。方法:选取2015年12月至2018年1月济南市第五人民医院收治的肝郁化火型不寐患者184例作为研究对象,按照随机数字表法分为对照组和观察组,每组92例。2组均给予常规治疗,观察组在此基础上应用针刺联合疏肝汤进行治疗,4周为1个疗程,2组均连续治疗2个疗程。比较2组治疗前后睡眠状况及相关中医症状积分;检测并比较治疗前后2组神经递质表达水平。结果:与治疗前比较,治疗后2组入寐困难、醒后不寐、烦躁易怒、胸闷肋痛、头痛面红等主要中医症状积分及PSQI评分均显著下降(P<0.01),且观察组显著低于对照组(P<0.05或P<0.01)。与治疗前比较,治疗后2组血清中5-HT水平及外周血中PKC mRNA、BDNF mRNA表达量显著升高,血清NE、DA水平显著下降(P<0.01);且2组间各指标差异有统计学意义(P<0.05或P<0.01)。结论:针刺联合疏肝汤治疗肝郁化火型不寐可显著改善患者睡眠质量,其作用机制可能与其对5-HT、NE、DA、PKC mRNA、BDNF mRNA等神经递质水平的调节有关,临床效果突出。

Objective:To investigate the effect of acupuncture combined with Shugan Decoction on sleep and neurotransmitter expression in patients with liver depression transforming fire syndrome insomnia.Methods:A total of 184 liver depression transforming fire symdrome insomnia patients in Jinan Fifth People′s Hospital from December 2015 to January 2018 were selected as the study objects,and they were randomly divided into an observation group and a control group,with 92 cases in each group.The 2 groups were given routine treatment,and the observation group was treated with acupuncture combined with Shugan Decoction on that basis.4 weeks was a course of treatment.The two groups were treated continuously for 2 courses.The sleep status and traditional Chinese medicine(TCM)symptom scores before and after treatment between the 2 groups were compared.The neurotransmitter expression in the 2 groups before and after treatment were detected and compared.Results:Compared with before treatment,the main TCM symptoms such as insomnia,restlessness,irritability,chest pain,headache and PSQI scores of the 2 groups significantly decreased after treatment(P<0.01),and the observation group was significantly lower than the control group(P<0.05 or P<0.01).Compared with before treatment,the serum levels of 5-HT increased significantly,while the serum levels of NE and DA decreased significantly(P<0.01);The peripheral blood levels of PKC mRNA and BDNF mRNA expression amount in the 2 groups increased significantly after treatment(P<0.01).There was significant difference between the 2 groups in above indexes(P<0.05 or P<0.01).Conclusion:Acupuncture combined with Shugan Decoction can significantly improve the sleep quality of patients with liver depression transforming fire syndrome insomnia.Its mechanism may be related to its regulation on the levels of neurotransmitters such as 5-HT,NE,DA,PKCmRNA and BDNFmRNA.The clinical effect is prominent.