调神针法对慢性失眠症患者血浆褪黑素及皮质醇的影响

Effect of Tiaoshen needling on plasma melatonin and cortisol in patients with chronic insomnia

目的:观察调神针法治疗慢性失眠症(CI)的临床疗效,并结合患者血浆褪黑素(MT)及皮质醇(CORT)含量变化探讨其可能的作用机制。方法:将60例CI患者随机分为治疗组和对照组,每组30例。治疗组选取百会、神庭、印堂、神门(双)、三阴交(双);对照组选取手三里(双)、伏兔(双)、飞扬(双),两组均给予手针和电针治疗,均隔日治疗1次,每周3次,共治疗4周。两组在治疗前均给予睡眠卫生宣教。治疗前后采用匹兹堡睡眠质量指数(PSQI)量表及疲劳严重程度(FSS)量表评定睡眠质量及日间疲劳程度;采用ELISA法测定患者血浆MT及CORT含量。结果:与治疗前比较,治疗组治疗后PSQI各因子评分及总分、FSS量表总分明显下降(P<0.01,P<0.05),血浆MT含量升高、CORT含量下降(P<0.01);对照组治疗后PSQI量表中入睡时间、睡眠障碍评分及总分明显下降(P<0.05)。与对照组比较,治疗组PSQI量表中的睡眠障碍评分及总分、FSS量表总分显著降低(P<0.01,P<0.05),血浆MT含量升高、CORT含量降低(P<0.05)。结论:调神针法可明显改善CI患者睡眠质量,缓解日间疲劳,可能与提高失眠患者血浆MT含量从而抑制下丘脑-垂体-肾上腺轴过度活化有关。

Objective To observe the clinical efficacy of Tiaoshen needling(dredging Governor Vessel and regulating mind)in the treatment of chronic insomnia(CI) and its effect on plasma melatonin(MT) and cortisol(CORT) levels, so as to explore its underlying mechanism. Methods Sixty patients with CI were randomly divided into the treatment group and the control group, with 30 cases in each group. Both groups were given sleep hygiene education before treatment. Patients in the treatment group received acupuncture or electroacupuncture at Baihui(GV20), Shenting(GV24), Yintang(GV29), bilateral Shenmen(HT7) and Sanyinjiao(SP6). Patients in the control group received acupuncture or electroacupuncture at bilateral Shousanli(LI10), Futu(ST32) and Feiyang(BL58). Both groups were treated every other day, 3 times a week, for a total of 4 weeks. Before and after treatment, Pittsburgh sleep quality index(PSQI) and fatigue severity scale(FSS) were used to evaluate sleep qua-lity and daytime fatigue, the plasma MT and CORT levels were measured by enzyme-linked immunosorbent assay. Results Compared with before treatment, the PSQI scores and total FSS score of the treatment group decreased significantly(P<0.01,P<0.05), and the plasma MT content increased and CORT decreased significantly in the treatment group(P<0.01),while the sleep-onset time score, sleep disturbance score and the PSQI total score of the control group decreased significantly(P<0.05). Compared with the control group, the PSQI sleep disorder score and total score, and the total FSS score as well as plasma CORT level were significantly down-regulated(P<0.01,P<0.05), while the plasma MT content was up-regulated(P<0.05) in the treatment group. Conclusion Tiaoshen acupuncture can significantly improve the sleep quality of patients with CI and relieve daytime fatigue, which may be related to the increase of plasma MT content in patients with CI, thereby inhibiting the excessive activation of the hypothalamic-pituitary-adrenal axis.