疏肝养血安神汤联合穴位贴敷治疗失眠肝郁血虚证疗效观察及对中医证候评分、睡眠质量和单胺类神经递质的影响

Observation of Shugan Yangxue Anshen Decoction combined with acupoint application for insomnia of liver depression and blood deficiency and its influence on syndrome score and sleep quality and monoamine neurotransmitters

目的观察疏肝养血安神汤联合穴位贴敷治疗失眠肝郁血虚证的临床疗效及对中医证候评分、睡眠质量和单胺类神经递质的影响。方法将68例失眠肝郁血虚证患者按照随机数字表法分为2组。对照组34例予艾司唑仑片治疗,治疗组34例在对照组治疗基础上采用疏肝养血安神汤联合穴位贴敷治疗。2组均治疗4周。比较2组治疗前后中医证候评分、睡眠质量、单胺类神经递质[血清神经肽Y(NPY)、P物质(SP)、神经递质谷氨酸(GA)、γ-氨基丁酸(GABA)水平]水平,并统计临床疗效。结果治疗组总有效率97.06%(33/34),对照组总有效率79.41%(27/34),治疗组疗效优于对照组(P<0.05)。治疗后2组中医证候各项评分均较本组治疗前降低(P<0.05),且治疗后治疗组均低于对照组(P<0.05)。治疗后2组睡眠效率、总睡眠时间、快速眼动睡眠期潜伏期时间均较本组治疗前延长(P<0.05),觉醒时间、睡眠潜伏期时间均缩短(P<0.05),且治疗后治疗组睡眠效率、总睡眠时间、快速眼动睡眠期潜伏期时间均长于对照组(P<0.05),觉醒时间、睡眠潜伏期时间均短于对照组(P<0.05)。治疗后2组N1、N2、N3期睡眠时间、N3期睡眠比例、快速眼动睡眠期睡眠时间及快速眼动睡眠比例均较本组治疗前增加(P<0.05),N1、N2期睡眠比例均下降(P<0.05),且治疗后治疗组N1、N2、N3期睡眠时间、N3期睡眠比例、快速眼动睡眠期睡眠时间及快速眼动睡眠比例均高于对照组(P<0.05),N1、N2期睡眠比例均低于对照组(P<0.05)。治疗后2组NPY、GA、GABA水平均较本组治疗前升高(P<0.05),SP水平均降低(P<0.05),且治疗后治疗组NPY、GA、GABA水平均高于对照组(P<0.05),SP水平低于对照组(P<0.05)。结论疏肝养血安神汤联合穴位贴敷能够有效改善失眠肝郁血虚证患者睡眠质量,效果显著,可在临床推广使用。

Objective To observe the curative effect of Shugan Yangxue Anshen Decoction combined with acupoint application for insomnia of liver depression and blood deficiency and its influence on traditional Chinese medicine(TCM) syndrome score,sleep quality and monoamine neurotransmitters(MN).Methods Totally 68 patients with insomnia of liver depression and blood deficiency were randomly divided into two groups,34 cases in control group were treated with estazolam tablets,and 34 cases in treatment group were treated with Shugan Yangxue Anshen Decoction combined with acupoint application on the basis of control group.Treated 4 weeks,aiming to compare TCM syndrome score,sleep quality,and MN [neuropeptide y(NPY),substance p(SP),glutamic acid(GA),and gamma-aminobutyric acid(GABA) ],and the clinical efficacy was counted.Results The total effective rates were better in treatment group than in control group [97.06%(33/34) vs 79.41%(27/34),(P < 0.05),respectively].Compared with before treatment,TCM syndrome score in groups was lower after treatment(P <0.05),which in treatment group was significantly decreased(P < 0.05);sleep efficiency,sleep duration,and rapid eye movement(REM) sleep in groups was significantly increased after treatment(P < 0.05),which were longer in treatment group than in control group(P < 0.05);while awakening-time and sleep latency in groups were significantly decreased after treatment,which were shorter in treatment group than in control group(P < 0.05);sleep time of non rapid eye movement(NREM) sleep,sleep proportion of period N3,REM sleep time and proportion in groups were higher after treatment(P < 0.05),which in treatment group were significantly increased(P < 0.05);while sleep proportion of periods N1 and N2 in groups was lower after treatment(P < 0.05),which in treatment group was significantly decreased(P < 0.05);levels of NPY,GA and GABA in groups were higher after treatment(P < 0.05),which in treatment group were significantly increased(P < 0.05);while SP level in groups were lower(P < 0.05),which in treatment group was significantly decreased(P < 0.05).Conclusion For patients with insomnia of liver depression and blood deficiency,Shugan Yangxue Anshen Decoction combined with acupoint application can effectively improve the sleep quality,and the effect is significant.It can be used in clinical treatment.