加味酸枣仁汤对焦虑性失眠患者躯体过度觉醒水平的影响

目的 观察加味酸枣仁汤对焦虑性失眠患者的临床疗效及躯体过度觉醒指标的影响.方法 将符合纳入标准的120例患者采用随机数字表法分为治疗组和对照组,每组各60例.并与健康睡眠者30例作对照.治疗组给予加味酸枣仁汤150ml(0.25g/ml),早晚2次温服;对照组给予劳拉西泮1mg,早晚2次口服,疗程为4周.评定两组患者治疗前、治疗2周和4周后的失眠严重指数(ISI);采用ELISA法测定两组治疗前后躯体过度觉醒相关指标[血清促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(CORT)、α-促黑激素(α-MSH)]水平.结果 ISI评分:治疗组治疗2周、4周后均较前明显下降(P<0.01),其中治疗4周后明显低于对照组(P<0.01);ISI减分率:两组治疗2周后无明显差异(P>0.05),治疗4周后治疗组明显高于对照组(P<0.05).CRH、ACTH、CORT水平:两组治疗前无明显差异(P>0.05),均较健康睡眠者明显升高(P<0.01),治疗4周后明显下降,并且治疗组明显优于对照组(P<0.05或P<0.01),其中,治疗组ACTH、CORT水平与正常组无明显差异(P>0.05).α-MSH水平:两组治疗前无明显差异(P>0.05),均较健康睡眠者明显下降(P<0.01),治疗4周后明显升高,并且治疗组明显优于对照组(P<0.05).结论 加味酸枣仁汤可减轻患者失眠严重程度;有效调节神经内分泌紊乱,降低躯体过度觉醒水平,可能是加味酸枣仁汤远期疗效更优的机制之一.

Objective To observe the effects of modified Suan Zao Ren Tang(m-SZRT)on the somatic hyperarousal in insomniacs with anxiety.Methods Subjects accorded with the inclusion criteria were randomized into treatment group(n=60)and control group(n=60),and 30 cases of good sleep as a normal control.Subjects in the former group received packages of m-SZRT and were instructed to drink one bag(150ml,0.25g/ml)twice per day.Subjects in the latter group were instructed to take one lorazepam orally twice a day.The primary outcome parameter of this study was ISI score,which was evaluated at baseline and after 2 and 4 weeks of treatment intervention.The secondary outcome parameters were the indicators related to somatic hyperarousal,including the level of CRH/ACTH/CORT and α-MSH,which were tested at baseline and 4 weeks of treatment intervention.Results Subjects in two groups exhibited a significant reduction in ISI score at weeks 2 and 4 of treatment period(P<0.01).Additionally,the m-SZRT reduced ISI score more effectively than lorazepam tablets after 4 weeks of treatment(P<0.05).The ISI score-reducing rate(P<0.05)was higher in treatment group than that in control group in week 4.Subjects in two groups showed no difierences in CRH/ACTH/CORT and α-MSH at baseline,and CRH/ACTH/CORT levels were lower,α-MSH level was higher,than good sleepers(P<0.01).Also subjects in two groups displayed a significant difference in CRH/ACTH/CORT and α-MSH between before and after treatment period(P<0.01).Furthermore,after 4 weeks of treatment,m-SZRT reduced CRH/ACTH(P<0.001)and CORT(P<0.05)levels more effectively than lorazepam,while increased the level of α-MSH more significantly than lorazepam(P<0.05).Compared with good sleepers,subjects in Chinese medicine group had similar ACTH and CORT level after 4-week treatment(P>0.05).Conclusion Treatment with m-SZRT appears to be an effective option when aging to improve sleep quality and anxiety in insomniacs with anxiety.lt may be one of the mechanisms that can eflectively regulate the neuroendocrine disorder and reduce the somatic hyperarousal level.