浅针联合艾司唑仑治疗肝郁化火型失眠患者的随机对照试验

Clinical efficacy of shallow-needle therapy combined with estazolam on insomnia of liver stagnation transforming into fire pattern:a randomized controlled trial

目的:观察浅针联合艾司唑仑治疗肝郁化火型失眠的临床疗效及其对血浆促肾上腺皮质激素(ACTH)、皮质醇(CORT)的影响,探讨其效应机制。方法:将119例肝郁化火型失眠患者随机分为浅针组(40例)、药物组(39例)和浅针联合药物组(40例)。浅针组于镇静穴、太冲穴进行点按和浅针手法操作,药物组采用口服艾司唑仑1 mg治疗,浅针联合药物组采用浅针联合药物治疗。以上治疗均1次/d,10 d为1个疗程,共治疗2个疗程,疗程间休息2 d。治疗前后以匹兹堡睡眠质量指数量表(PSQI)、焦虑自评量表(SAS)评分进行睡眠和焦虑情况评定;磁微粒化学发光法检测各组患者血浆ACTH、CORT含量;评价各组临床疗效。结果:与本组治疗前比较,3组患者治疗后的PSQI评分、SAS评分及血浆ACTH、CORT含量均降低(P<0.05)。治疗后,浅针联合药物组PSQI总分、入睡时间、睡眠时间、日间功能障碍评分及SAS评分均低于浅针组(P<0.05),且其PSQI总分、睡眠时间、睡眠效率评分及SAS评分均较药物组降低(P<0.05)。浅针组总有效率为87.50%(35/40),药物组总有效率为82.05%(32/39),浅针联合药物组总有效率为95.00%(38/40),浅针联合药物组高于浅针组及药物组(P<0.05)。结论:浅针联合艾司唑仑治疗肝郁化火型失眠有效,其作用机制可能与降低血浆ACTH和CORT含量有关。

Objective To observe the clinical efficacy of shallow-needle therapy combined with estazolam on insomnia differentiated as liver stagnation transforming into fire and its effect on adrenocorticotropic hormone(ACTH)and cortisol(CORT),so as to explore the mechanism of this combined treatment.Methods A total of 119 patients with insomnia of liver stagnation transforming into fire pattern were randomly divided into shallow-needle therapy group(n=40),medication group(n=39),and shallow-needle therapy combined with medication group(combined therapy group,n=40).In the shallow-needle therapy group,the patients were treated with finger pressure and operation with shallow stimulating at Zhenjing(Dong’s extra point,sedative point)and Taichong(LR3).In the medication group,the patients were administered with estazolam(1 mg)orally.In the combined therapy group,both shallow-needle therapy and medication were administered.The treatment was given once daily in each group,10 days as one session of treatment and 2 sessions were required.Before and after the treatment,Pittsburgh sleep quality index scale(PSQI)and Self-rating anxiety scale(SAS)were used to assess sleep and anxiety status.ELISA was used to detect the contents of ACTH and CORT in plasma.The clinical efficacy was evaluated in each group.Results In within-group comparison,PSQI scores,SAS scores and the concentrations of ACTH and CORT in plasma were all decreased(P<0.05)after treatment for the patients of three groups.After treatment,the total PSQI score,the score for sleep latency,sleep duration and daytime dysfunction,as well as SAS score in the combined therapy group were all lower than those of the shallow-needle therapy group(P<0.05);the total PSQI score,the score for sleep duration and sleep efficiency,as well as SAS score were lower when compared with the medication group(P<0.05).The total effective rates were 87.50%(35/40),82.05%(32/39)and 95.00%(38/40)in the shallow-needle therapy group,the medication group and the combined therapy group,respectively.The total effective rate in the combined therapy group was higher than those of the shallow-needle therapy group and the medication group separately(P<0.05).Conclusion Shallow-needle therapy combined with estazolam is effective on insomnia of liver stagnation transforming into fire pattern,and its underlying effect mechanism is related to the reduction of plasma ACTH and CORT levels.