慢性失眠障碍与促肾上腺皮质激素释放激素和皮质醇的相关性研究

Correlation Study of Adult Chronic Insomnia Disorder with CRH and CORT

目的:探讨成年人慢性失眠障碍(CID)与促肾上腺皮质激素释放激素(CRH)和皮质醇(CORT)的相关性及其临床意义。方法:选取2021年8月至2022年2月云南省精神病医院收治的慢性失眠障碍患者50例作为观察组,同时期健康人群50例作为对照组,测定并比较2组间CRH、CORT、汉密尔顿抑郁量表-17(HAMD-17)、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)的差异,同时对50例观察组进行多导睡眠监测(PSG),比较观察组治疗前后PSG的变化,从而分析慢性失眠障碍与CRH、CORT的相关性。结果:观察组治疗前与对照组CRH、CORT水平及量表评分比较差异有统计学意义(P<0.05);观察组治疗前与治疗8周末CRH、CORT比较差异有统计学意义(P<0.05);观察组治疗前与治疗8周末PSG睡眠参数比较,总睡眠时间、睡眠效率、睡眠潜伏期、快速眼动(REM)时间、N1时间、N3时间及觉醒时间比较差异有统计学意义(P<0.05);观察组治疗前CRH、CORT与PSG睡眠参数中的部分指标有相关性。结论:CID患者CRH、CORT水平高于健康人群,失眠症状改善后,CRH及CORT接近正常水平。CID失眠症状的严重程度与CRH和CORT的增高有明显相关性。因此,下丘脑-垂体-肾上腺(HPA)轴的外周血CRH和CORT水平或许可以作为反映失眠症状严重程度的生物学指标。

Objective:To investigate the relationship between chronic insomnia disorder(CID)and Corticotropin releasing hormone(CRH)and cortisol(Cort)in adults and its clinical significance.Methods:A total of 50 chronic insomnia disorder patients admitted to Yunnan Provincial Psychiatric Hospital from August 2021 to February 2022 were selected as observation group,and 50 from healthy population in the same period were selected as the control group to determine and compare the differences between CRH,CORT,Hamilton Depression Scale-17(HAMD-17),Hamilton Anxiety Scale(HAMA)and Pittsburgh Sleep Quality Index(PSQI).At the same time,polysomnography(PSG)was performed on 50 observation groups to compare the changes in PSG before and after treatment,in order to analyze the correlation between chronic insomnia disorder and CRH and CORT.Results:There was a statistically significant difference in CRH,CORT levels,and scale scores between the observation group and the control group before treatment(P<0.05).There was a statistically significant difference in CRH and CORT between the observation group before treatment and after 8 weeks of treatment(P<0.05).There were statistically significant differences in total sleep time,sleep efficiency,sleep latency,rapid eye movement(REM)time,N1 time,N3 time,and awakening time between the observation group and the treatment group at the end of the 8th week(P<0.05).There was a correlation between some indicators of CRH,CORT,and PSG sleep parameters in the observation group before treatment.Conclusion:The levels of CRH and CORT in patients with CID were higher than those in healthy people,and CRH and CORT were close to normal levels after the improvement of insomnia symptoms.The severity of CID was correlated with the increase of CRH and CORT.Therefore,the levels of CRH and CORT in peripheral blood of HPA axis may be used as biological indicators to reflect the severity of insomnia symptoms.