神门、三阴交改善失眠症日间疲乏嗜睡的穴位配伍效应及调控机制研究

Acupoint compatibility effect and mechanism of Shenmen(HT7)and Sanyinjiao(SP6)in improving daytime fatigue and sleepiness of insomnia

目的:观察神门、三阴交改善失眠症日间疲乏嗜睡的穴位配伍效应并探讨其下丘脑-垂体-肾上腺(HPA)轴、视交叉上核-松果体-褪黑素(SCN-PG-MT)系统调控机制。方法:90例失眠症患者随机分为神门组、三阴交组、神门-三阴交组,每组30例。分别电针神门、三阴交、神门-三阴交,每次30min,1次/d,5d为1个疗程,疗程间休息2d,治疗2个疗程。治疗前后评价患者匹兹堡睡眠质量指数(PSQI)评分和Epworth嗜睡指数(ESS)评分,酶联免疫吸附测定法检测血清促肾上腺皮质激素(ACTH)、皮质醇(CS)、褪黑素(MT)含量。结果:各组患者治疗后PSQI总分均低于治疗前(P<0.05);神门-三阴交组、三阴交组治疗后PSQI总分低于神门组(P<0.05);神门组治疗后睡眠质量、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分低于治疗前(P<0.05);三阴交组、神门-三阴交组治疗后睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分低于治疗前(P<0.05);神门-三阴交组治疗后睡眠质量、入睡时间、睡眠效率评分低于神门组(P<0.05),日间功能障碍评分低于神门组、三阴交组(P<0.05);三阴交组治疗后睡眠质量、睡眠效率评分低于神门组(P<0.05)。三阴交组、神门-三阴交组治疗后ESS总分低于治疗前(P<0.05);治疗后神门-三阴交组ESS总分低于神门组(P<0.05)。各组治疗后血清ACTH、CS含量均低于治疗前(P<0.05);三阴交组、神门-三阴交组治疗后血清MT含量高于治疗前(P<0.05);神门-三阴交组治疗后血清ACTH、CS含量低于神门组(P<0.05),MT含量高于神门组(P<0.05);三阴交组治疗后血清MT含量高于神门组(P<0.05)。结论:神门-三阴交配伍在改善失眠症患者夜间睡眠质量和日间疲乏嗜睡状态方面具有协同增效作用,三阴交作用优于神门,在穴位配伍中发挥主要作用。神门-三阴交可下调失眠症患者血清ACTH、CS水平抑制亢进的HPA轴,升高血清MT含量改善SCN-PG-MT系统功能,发挥改善夜间睡眠、缓解日间疲乏嗜睡的穴位配伍效应。

Objective To observe the acupoint compatibility effect of Shenmen(HT7)and Sanyinjiao(SP6)in improving daytime fatigue and sleepiness of insomnia,and its mechanism in regulating hypothalamic-pituitary-adrenal(HPA)axis and suprachiasmatic nucleus-pineal gland-melatonin(SCN-PG-MT)system.Methods Ninety patients with insomnia were randomly divided into HT7,SP6and HT7-SP6(HT7plus SP6)groups,with 30cases in each group.Electroacupuncture(EA,5Hz/25Hz)was applied to HT7,SP6or HT7-SP6in each group for 30min.The EA treatment was conducted once daily,5days a week for 2 weeks.Before and after treatment,the Pittsburgh Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS)were observed,separately.The contents of serum adrenocorticotrophic hormone(ACTH),cortisol(CS)and melatonin(MT)were detected by ELISA.Results Compared with before treatment,the sleep quality,sleep time,sleep efficiency,sleep disturbance,daytime dysfunction scores and total score of PSQI in the three groups after treatment were decreased(P<0.05),the time to fall asleep score of PSQI and total score of ESS were decreased in the SP6and HT7-SP6groups(P<0.05).After treatment,the sleep quality,time to fall asleep,sleep efficiency,daytime dysfunction scores,total score of PSQI and total score of ESS in the HT7-SP6group were lower than those in the HT7group(P<0.05),the sleep quality,sleep efficiency and total score of PSQI in the SP6group were lower than those in the HT7group(P<0.05).Compared with before treatment,the serum ACTH and CS levels in the three groups were decreased(P<0.05),and the serum MT levels in the SP6and HT7-SP6groups were increased(P<0.05).After treatment,the ACTH and CS levels in the HT7-SP6group were lower than those in the HT7group(P<0.05),and the serum MT levels in the SP6and HT7-SP6groups were higher than that in the HT7group(P<0.05).Conclusion The compatibility of HT7and SP6has a synergism effect on the improvement of night sleep quality and daytime fatigue and sleepiness of insomnia patients,the mechanism may be related with its function in down-regulating the serum ACTH and CS levels and increasing the serum MT content.SP6has a better effect than HT7,and plays a major role in acupoint compatibility.