酸枣仁汤治疗失眠及作用机制研究进展

Research Progress on Suanzaoren Decoction(酸枣仁汤) in Treatment of Insomnia and Its Mechanism

目的 分析总结酸枣仁汤治疗失眠症的疗效及作用机制的研究进展,为优选临床失眠症治疗方案、深入研究其作用机制提供依据。方法 全面检索各大中英文数据库建库至2021年3月的酸枣仁汤治疗失眠的中英文文献,构建“酸枣仁汤治疗失眠临床研究数据库”(clinical research database of suanzaoren decoction in treating insomnia, CRDSDTI)。根据排除/纳入标准的筛选文献并提取相关数据,对文献数据进行归类分析和疗效评价;并以网络药理学方法为例,获取酸枣仁汤化学成分、化合物靶点、疾病靶点、共有靶点等相关信息,运用生物信息学技术分析“靶点-通路”之间的联系,对关键通路进行解释,介绍酸枣仁汤治疗失眠症的主要作用机制。结果 共纳入64篇文献,含患者:观察组3290例,对照组2971例。数据整理结果显示,在临床有效率、睡眠评分改善、调节睡眠质量和调控血样方面,观察组的治疗效果均优于对照组,具有统计学意义(P<0.05);通过在线数据库检索,共得到135个化学成分和413个潜在靶点,其中77个化学成分、36个潜在靶点和47条通路与治疗失眠密切相关,主要涉及多巴胺能突触(dopaminergic synapse)、神经活性配体-受体相互作用(neuroactive ligand-receptor interaction)、5-羟色胺能突触(serotonergic synapse)、肿瘤坏死因子信号转导通路(TNF signaling pathway)、细胞因子-细胞因子受体互作(cytokine-cytokine receptor interaction)等途径。结论 在常规西药治疗失眠的基础上联合使用酸枣仁汤可通过调节血样指标、改善睡眠质量、减少不良反应,显著提高治疗效果;此外,酸枣仁汤主要通过干预神经递质调节、炎性反应、下丘脑-垂体-肾上腺轴(HPA轴)功能等途径治疗失眠症。研究汇集近年较全面酸枣仁汤治疗的临床研究数据,从治疗效果评价到微观作用机制分析,对酸枣仁汤治疗失眠的研究进展进行综述,为后续相关研究的深入及其他药物的临床评价、机制研究等提供参考与借鉴。

Objective To analyze and summarize the research progress of Suanzaoren Decoction(酸枣仁汤)in the treatment of insomnia and its mechanism,and provide a basis for optimizing clinical insomnia treatment plans and in-depth study of the mechanism of Suanzaoren Decoction.Methods A comprehensive search of Chinese and English literature on the treatment of insomnia by Suanzaoren Decoction from the establishment of the database to March 2021 was carried out,and a literature database—Clinical Research Database of Suanzaoren Decoction in Treating Insomnia(CRDSDTI)was constructed.The literatures based on the exclusion/inclusion criteria were screened and the relevant data was extracted,and the statistical classification and efficacy evaluation were performed.And the network pharmacology method was as an example to obtain the relevant information such as the chemical components,compound targets,disease targets and common targets of Suanzaoren Decoction.The bioinformatics technology was used to analyze the relationship between"target-pathway"and explain the key path.The main mechanism of action of Suanzaoren Decoction in the treatment of insomnia was also introduced.Results A total of 64 articles were included,including 3290 cases in the observation group and 2971 cases in the control group.The results of data showed that the treatment effect of the observation group was better than that of the control group in terms of clinical effectiveness,sleep score improvement,sleep quality regulation and blood sample regulation,and there was statistically significant difference(P<0.05).Through online database search,a total of 135 chemical components and 413 potential targets were obtained,of which 77 chemical components,36 potential targets and 47 pathways were closely related to the treatment of insomnia.The mainly involved pathways were Dopaminergic synapse,Neuroactive ligand-receptor interaction,Serotonergic synapse,TNF signaling pathway,Cytokine-cytokine receptor interaction,etc.Conclusion The combined use of Suanzaoren Decoction on the basis of conventional western medicine for insomnia can significantly improve the therapeutic effect by adjusting blood samples,improving sleep quality and reducing adverse reactions.In addition,Suanzaoren Decoction mainly treats insomnia by intervening in neurotransmitter regulation,inflammation,and the function of the hypothalamus-pituitary-adrenal axis(HPA axis).This study collected the clinical research data of the treatment of Suanzaoren Decoction in recent years.From the evaluation of the therapeutic effect to the analysis on the microscopic mechanism of action,the research progress of Suanzaoren Decoction in the treatment of insomnia was reviewed so as to provide reference for the in-depth study of follow-up and the clinical evaluation and mechanism research of other drugs.