“补肾安神”针刺疗法治疗围绝经期失眠的临床观察

Clinical observation of kidney-tonifying and mind-calming acupuncture therapy in the treatment of perimenopausal insomnia

目的:观察“补肾安神”针刺疗法对围绝经期失眠(PMI)患者睡眠、情绪、性激素水平及中医症状的影响。方法:将90例PMI患者随机分为治疗组和对照组,每组45例。治疗组予以针刺肾俞、太溪、百会和安眠治疗;对照组给予假针刺治疗。两组均每周治疗3次,共4周。治疗前、治疗后及治疗结束1月后采用匹兹堡睡眠质量指数(PSQI)量表和失眠严重指数(ISI)量表评价受试者睡眠情况;采用BECK抑郁量表(BDI)、BECK焦虑量表(BAI)评价受试者的抑郁和焦虑情绪;采用中医证候量表评价受试者的中医症状。治疗前后检测受试者血清雌二醇(E2)、卵泡刺激素(FSH)和促黄体生成激素(LH)水平。结果:研究过程中治疗组脱落2例,对照组无脱落。与治疗前相比,治疗组治疗后及随访1个月时的PSQI评分显著降低(P<0.05),与对照组相比差异有统计学意义(P<0.05)。对照组治疗后PSQI评分较治疗前显著降低(P<0.05),随访1个月与治疗前差异无统计学意义(P>0.05)。与治疗前相比,治疗组治疗后及随访1个月时的ISI、BDI、BAI评分和中医证候量表评分均降低(P<0.05),与同时间点对照组差异有统计学意义(P<0.05)。对照组治疗前、治疗后及随访1个月的ISI、BDI、BAI评分和中医证候量表评分差异均无统计学意义(P>0.05)。治疗后,治疗组血清E2较治疗前显著升高(P<0.05),与对照组差异有统计学意义(P<0.05)。对照组治疗前后血清E2水平差异无统计学意义(P>0.05)。两组受试者治疗前后血清FSH和LH水平差异均无统计学意义(P>0.05)。结论:“补肾安神”针刺疗法治疗PMI患者能改善睡眠质量,缓解焦虑及抑郁情绪,延缓血清E2水平的降低,改善相关中医症状。

Objective:To observe the effects of kidney-tonifying and mind-calming acupuncture therapy on sleep,mood,sex hormone levels,and traditional Chinese medicine(TCM)symptoms in patients with perimenopausal insomnia(PMI).Methods:A total of 90 patients with PMI were randomly divided into a treatment group and a control group,with 45 cases in each group.Patients in the treatment group were treated with acupuncture at Shenshu(BL23),Taixi(KI3),Baihui(GV20),and Anmian(Extra).The control group was treated with sham acupuncture.Both groups were treated 3 times a week for 4 weeks.Pittsburgh sleep quality index(PSQI)and insomnia severity index(ISI)were used to evaluate the sleep quality of the subjects before treatment,after treatment,and 1 month after treatment(follow-up).Beck depression inventory(BDI)and Beck anxiety inventory(BAI)were used to evaluate the depression and anxiety of the subjects before treatment,after treatment,and at 1-month follow-up.The TCM symptom scale was used to evaluate the TCM symptoms of the subjects before treatment,after treatment,and 1 month after treatment.Serum levels of estradiol(E2),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)were measured before and after treatment.Results:During the study,2 cases dropped out of the treatment group,and no cases dropped out of the control group.The PSQI scores of the treatment group were significantly lower after treatment and at 1-month follow-up compared with those before treatment(P<0.05),and the difference was statistically significant compared with that of the control group(P<0.05).In the control group,the PSQI score was significantly lower after treatment compared with before treatment(P<0.05),and the difference was not statistically significant at 1-month follow-up compared with before treatment(P>0.05).Compared with the pre-treatment,the ISI,BDI,BAI,and TCM symptom scale scores of the treatment group were lower after treatment and at 1-month follow-up(P<0.05),and the differences with the control group at the same time point were statistically significant(P<0.05).The differences in ISI,BDI,BAI,and TCM symptom scale scores of the control group before treatment,after treatment,and at 1-month follow-up were not statistically significant(P>0.05).After treatment,the serum E2 level in the treatment group was significantly higher than that before treatment(P<0.05),and the difference with the control group was statistically significant(P<0.05).The difference in the serum E2 level before and after treatment in the control group was not statistically significant(P>0.05).The differences in the serum FSH and LH levels between before and after treatment were not statistically significant in either group of subjects(P>0.05).Conclusion:Kidney-tonifying and mind-calming acupuncture therapy can improve sleep quality,relieve anxiety and depression,delay the decrease of serum E2 level,and improve related TCM symptoms in patients with PMI.