柴胡疏肝散联合常规疗法治疗老年精神分裂症合并失眠临床研究

Clinical Study on Chaihu Shugan San Decoction Combined with Routine Therapy for Senile Patients with Schizophrenia Complicated with Insomnia

目的:观察柴胡疏肝散加减联合常规疗法治疗老年精神分裂症合并失眠患者的临床效果。方法:纳入96例肝气郁结型精神分裂症合并失眠患者,按随机数字表法分成2组各48例。2组均予对症支持治疗,口服艾司唑仑片和氨磺必利片,试验组加予柴胡疏肝散加减治疗。2组疗程均为8周。治疗前后评定阳性与阴性症状量表(PANSS)评分、匹兹堡睡眠质量指数(PSQI)评分,检测血清白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)水平及血浆γ-氨基丁酸(GABA)、谷氨酸(Glu)含量。比较2组的临床疗效。观察患者的不良反应发生情况。结果:治疗8周后,试验组精神分裂症疗效总有效率及失眠疗效总有效率均高于对照组(P<0.05)。2组PANSS阴性症状、阳性症状、精神病理症状及其他症状评分均较治疗前降低(P<0.05);试验组4项评分均低于对照组(P<0.05)。2组PSQI睡眠质量、日间功能、入睡时间、催眠药物、睡眠障碍、睡眠时间、睡眠效率评分及总分均较治疗前降低(P<0.05);试验组各项评分及总分均低于对照组(P<0.05)。2组血清IL-6、TNF-α水平及血浆GABA含量均较治疗前下降(P<0.05),血浆Glu含量均较治疗前升高(P<0.05);试验组血清IL-6、TNF-α水平及血浆GABA含量均低于对照组(P<0.05),血浆Glu含量高于对照组(P<0.05)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:柴胡疏肝散加减联合常规疗法治疗肝气郁滞型老年精神分裂症合并失眠疗效显著,可减轻患者的精神分裂症症状,改善睡眠质量。

Objective:To observe the clinical effect of modified Chaihu Shugan San Decoction combined with routine therapy for senile patients with schizophrenia complicated with insomnia.Methods:A total of 96 cases of patients with schizophrenia complicated with insomnia of liver qi stagnation type were included and divided into two groups according to the random number table method,with 48 cases in each group.Both groups were given symptomatic supportive treatment and the oral administration of Estazolam Tablets and Amisulpride Tablets,and the trial group was additionally treated with modified Chaihu Shugan San Decoction.Both groups were treated for 8 weeks.Before and after treatment,the scores of Positive and Negative Syndrome Scale(PANSS)and Pittsburgh Sleep Quality Index(PSQI)were evaluated;the levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in serum andγ-aminobutyric acid(GABA)and glutamic acid(Glu)in plasma were measured.The clinical effects were compared between the two groups.The occurrence of adverse reactions was observed.Results:After 8 weeks of treatment,the total curative effective rates of schizophrenia and insomnia in the trial group were higher than those in the control group(P<0.05).The scores of negative symptoms,positive symptoms,psychopathological symptoms and other symptoms in PANSS in the two groups were lower than those before treatment(P<0.05),and the above four scores in the trial group were lower than those in the control group(P<0.05).The PSQI scores of subjective sleep quality,daytime function,sleep latency,use of sleep medication,sleep disturbances,sleep duration,and habitual sleep efficiency as well as the total scores in the two groups were decreased when compared with those before treatment(P<0.05),and the above scores in the trial group were lower than those in the control group(P<0.05).The levels of IL-6 and TNF-αin serum and GABA in plasma in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of Glu in plasma were increased when compared with those before treatment(P<0.05).The levels of IL-6 and TNF-αin serum and GABA in plasma in the trial group were lower than those in the control group(P<0.05),and the level of Glu in plasma was higher than that in the control group(P<0.05).There was no significant difference being found in the comparison of the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Modified Chaihu Shugan San Decoction combined with routine therapy has a significant curative effect in treating senile patients with schizophrenia complicated with insomnia of liver qi stagnation type,which can reduce the symptoms of schizophrenia and improve the sleep quality.