养血柔肝针法治疗肝风内动型脑卒中后失眠临床研究及作用机制探讨

Clinical Study and Mechanism of Blood-nourishing and Liver-softening Acupuncture in the Treatment of Insomnia after Stroke with Internal Movement of Liver Wind

目的 观察养血柔肝针法治疗卒中后失眠的临床疗效,并对其作用机制进行初步的探讨。方法 以天津市中医药研究院附属医院针灸科2017年10月—2019年3月门诊及住院部肝风内动型卒中后失眠患者为研究对象,随机分为观察组和对照组,两组患者均进行中风后康复的常规基础治疗+常规针刺治疗,观察组采用养血柔肝针法+安慰剂(艾司唑仑片模拟剂型)治疗;对照组采用艾司唑仑片治疗,疗程均为2周。以匹兹堡睡眠质量指数(PSQI)评分、美国国立卫生院卒中量表(NIHSS)评分、神经炎性因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及神经递质[γ-氨基丁酸(GABA)、5-羟色胺(5-HT)]水平为疗效指标。结果 观察组总有效率为91.3%,对照组总有效率为74.5%,观察组疗效优于对照组(P<0.05)。两组治疗后PSQI评分、NIHSS评分均优于本组治疗前(P<0.05);治疗后观察组PSQI评分优于对照组(P<0.05);治疗后两组NIHSS评分比较差异无统计学意义(P>0.05)。两组治疗前5-HT、IL-6、TNF-α、GABA水平比较差异均无统计学意义(P>0.05);治疗后观察组血清IL-6、TNF-α水平较前下降,5-HT、GABA水平较前升高(P<0.05),而治疗后对照组除血清GABA水平与观察组相当,其余各项指标较治疗前比较差异无统计学意义(P>0.05)。结论 养血柔肝针法可明显改善脑卒中后失眠肝风内动型患者的睡眠质量及神经功能缺损情况,改善神经炎性因子(IL-6、TNF-α)及神经递质(GABA、5-HT)水平,且作用时间持久,不良反应小,其疗效优于艾司唑仑片治疗,是一种安全而有效的治疗方法,临床值得推广应用。

Objective To observe the clinical efficacy of blood-nourishing and liver-softening acupuncture in the treatment of insomnia after stroke,and to explore its mechanism. Methods From October 2017 to March 2019,patients with post-stroke insomnia in the outpatient and inpatient departments of the affiliated hospital of Tianjin academy of traditional Chinese Medicine were randomly divided into observation group and control group. the patients in the two groups were treated with routine basic treatment of poststroke rehabilitation plus routine acupuncture,and the observation group was treated with blood-nourishing and liver-softening acupuncture+placebo(simulated dosage form of estazolam). The control group was treated with estazolam tablets for 2 weeks. Pittsburg Sleep quality Index(PSQI),National Institutes of Health Stroke scale(NIHSS),neuroinflammatory factors IL-6,TNF-α and neurotransmitters GABA and 5-HT were used as therapeutic scorees. Results The total effective rate of the observation group was 91.3%,while that of the control group was 74.5%,which was better than that of the control group(P<0.05).The comparison of PSQI score and NIHSS score within the two groups showed that the two groups after treatment were better than those before treatment(P<0.05),and the comparison of PSQI score between the observation group and the control group after treatment showed that the curative effect of the observation group was better than that of the control group(P<0.05). The comparison of NIHSS score between the two groups showed that the curative effect of the two groups was similar(P>0.05). The comparison of neuroinflammatory factors and neurotransmitters showed that there was no significant difference in 5-HT,IL-6,TNF-α and GABA between the two groups before treatment(P>0.05). After treatment,the levels of serum IL-6 and TNF-α decreased and 5-HT and GABA increased in the observation group(P<0.05),but there was no significant change in the control group except that the concentration of serum GABA after treatment was the same as that in the observation group(P>0.05). Conclusion Blood-nourishing and liversoftening acupuncture can obviously improve the sleep quality and neurological function defect of patients with insomnia and internal movement of liver wind after stroke,and improve the levels of neuroinflammatory factors IL-6,TNF-α and neurotransmitters GABA and 5-HT,with long-lasting action and little side effects. Its curative effect is better than that of estazolam tablets. It is a safe and effective treatment method,which is worth popularizing and applying in clinic.