疏肝调神整合针灸对失眠症觉醒状态的作用及神经机制研究

Study on the effect and neural mechanism of dispersing stagnated liver qi for mindregulation integrated acupuncture and moxibustion on insomnia awakening state

目的探究疏肝调神整合针灸疗法对原发性失眠症觉醒状态的干预作用及其神经机制。方法选择92例原发性失眠症患者,采用随机数表法分为观察组与对照组,各46例。对照组予艾司唑仑口服,观察组实施究疏肝调神整合针灸疗法,4周后观察临床疗效。比较2组治疗前后匹兹堡睡眠质量指数(PSQI)评分、过度觉醒量表(HAS)、平均睡眠潜伏时间(MSL)、夜间多导睡眠监测(PSG)指标睡眠潜伏期(SOL)、觉醒次数(NWAK)、入睡后清醒时间(WASO)、总睡眠时间(TST)、快速眼动期(REM)占TST百分比、非快速眼动期1/2/3期(N1/N2/N3)占TST百分比及血清单胺类神经递质5-羟色胺(5-HT)、γ-氨基丁酸(GABA)水平变化。结果治疗4周后,2组PSQI量表中睡眠潜伏期、睡眠紊乱、习惯性睡眠效率、睡眠持续性、白天功能紊乱、主观睡眠质量各维度评分均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);2组HAS评分均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);2组MSL均较治疗前缩短(P<0.05),且观察组短于对照组(P<0.05);2组SOL、NWAK、WASO均较治疗前减小(P<0.05),TST均较治疗前增加(P<0.05),但2组组间差异均无统计学意义(P>0.05),2组REM、N3占TST百分比均较治疗前提高(P<0.05),且观察组高于对照组(P<0.05),N1、N2占TST百分比均较治疗前下降(P<0.05),且观察组低于对照组(P<0.05);2组血清5-HT、GABA水平均较治疗前提高,且观察组5-HT、GABA水平均高于对照组(P<0.05)。结论疏肝调神整合针灸疗法与口服艾司唑仑比较,可更有效改善原发性失眠症患者的睡眠质量和过度觉醒状态,可能与其调节神经递质作用有关。

Objective To explore the intervention effect and neural mechanism of dispersing stagnated liver qi for mind-regulation integrated acupuncture and moxibustion therapy on awakening state of primary insomnia.Methods 92 patients with primary insomnia were selectd and divided into the observation group and the control group according to random number table method,46 cases in each group.The control group was treated with Estazolam orally,and the observation group was treated with dispersing stagnated liver qi for mind-regulation integrated acupuncture and moxibustion,and the curative effect was observed 4 weeks later.Pittsburgh Sleep Quality Index(PSQI)score,Hyperarousal Scale(HAS),mean sleep latency(MSL),nocturnal polysomnography(PSG)index,sleep onset latency(SOL),number of awakenings(NWAK),wake-time after sleep onset(WASO),total sleep time(TST),the percentage of rapid eye movement(REM)in TST,the percentage of non-REM 1/2/3(N1/N2/N3)in TST,and levels of serum monoamine neurotransmitter serotonin(5-HT)and gamma-aminobutyric acid(GABA)were compared between the two groups before and after treatment.Results After 4 weeks of treatment,the scores of sleep latency,sleep disorder,habitual sleep efficiency,sleep persistence,daytime dysfunction and subjective sleep quality in PSQI scale in both groups were lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05);HAS scores in both groups were lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05);MSL in both groups was shorter than that before treatment(P<0.05),and the observation group was shorter than the control group(P<0.05);SOL,NWAK and WASO of the two groups were decreased compared with before treatment(P<0.05),while TST of the two groups was increased compared with before treatment(P<0.05),but there was no statistically significant difference between the two groups(P>0.05);The percentage of REM and N3 in TST in the two groups increased compared with before treatment(P<0.05),and the observation group was higher than the control group(P<0.05);The percentage of N1 and N2 in TST in the two groups decreased compared with before treatment(P<0.05),and the observation group was lower than the control group(P<0.05);The levels of serum 5-HT and GABA in both groups increased compared with before treatment,and the levels of serum 5-HT and GABA in the observation group were higher than those in the control group(P<0.05).Conclusion Compared with oral administration of Esazolam,dispersing stagnated liver qi for mind-regulation integrated acupuncture and moxibustion therapy can improve sleep quality and hyperarousal state more effectively in patients with primary insomnia.The mechanism may be related to the effect of regulating neurotransmitters.